The Rocket Incision in Neuromuscular Scoliosis: A Modified Posterior Approach for Enhanced Pelvic Correction and Wound Safety (Retrospective Cohort Study).

Abstract

Study designRetrospective cohort study.ObjectivesWound complications and suboptimal pelvic correction remain significant challenges in posterior spinal fusion to the pelvis for neuromuscular scoliosis. We describe and evaluate the <i>Rocket incision</i>, a novel modification of the posterior midline approach designed to redistribute closure tension and enhance access for soft tissue release.MethodsThis retrospective cohort study included 16 paediatric patients with neuromuscular scoliosis who underwent long posterior spinal fusion to the pelvis using the Rocket incision between 2020 and 2022. Radiographic parameters included Cobb angle and pelvic obliquity, measured pre- and postoperatively. Wound complications and readmissions were documented. Surgical exposure, instrumentation, and closure were standardised. Statistical analysis was performed using paired <i>t</i>-tests (significance set at <i>P</i> < .05).ResultsThe mean Cobb angle improved from 81.5° (95% CI: 72.5-90.5) to 21.0° (95% CI: 15.0-27.1), representing a 74% mean correction (<i>P</i> < .001). Pelvic obliquity, a primary outcome, improved from 19.8° to 3.2° (mean correction: 16.6°, <i>P</i> < .0001), with 81.3% of patients achieving <5° tilt. There were no early wound infections, wound breakdowns, or readmissions within 90 days. One patient (6.25%) developed a late superficial infection treated non-operatively. No patients experienced radiographic decompensation or loss of correction.ConclusionThe Rocket incision appears to be a safe and effective modification to the posterior spinal approach in neuromuscular scoliosis, with promising early results in deformity correction and wound morbidity. These preliminary findings, derived from a small retrospective cohort, should be interpreted as hypothesis-generating and require further validation in comparative or prospective studies.