The impact of comprehensive correction and trunk stability of posterior thoracic to pelvic fixation in nonambulant neuromuscular scoliosis as assessed by CPCHILD analysis.

Abstract

We evaluated the imaging and clinical outcomes of posterior thoracic-pelvic corrective fixation (TP-PCF) for nonambulant neuromuscular scoliosis (NA-NMS), including the Caregiver Priorities and Child Health Index of Life with the Japanese version of the Disabilities Questionnaire (J-CPCHILD), and analyzed the J-CPCHILD and preoperative and postoperative radiographic parameters to determine whether sagittal and coronal alignment correlate with preoperative and postoperative quality of life (QoL) in NMS, respectively. Twenty-five patients (nine males and 16 females) with a mean age of 14.3 ± 2.0 years, who had TP-PCF and were followed up for >2 years postoperatively, were included. Sitting radiographs and the J-CPCHILD were evaluated preoperatively, at 1 year postoperatively, and at the final visit. Preoperative major curve and pelvic obliquity (PO) were 102.4 ± 22.2 ° and 21.5 ± 9.9 °, which significantly improved to 51.4 ± 18.8 ° and 10.9 ± 7.6 °, respectively, at the final visit. At the final visit, lumbar lordosis and sacral slope showed a significant increase of 46.6 ± 18.5 ° and 30.2 ± 17.5 ° compared with preoperative values of 25.8 ± 33.2 ° and 24.4 ± 31.0 °, respectively. Sagittal vertical axis showed a significant decrease of 2.2 ± 35.3 mm at the final visit compared with 37.1 ± 36.5 mm preoperatively. However, iliac screw (IS)-related implant failure was observed in four (16%) patients. Significant improvement from 37.1 ± 20.8 to 51.2 ± 25.2 points and from 49.6 ± 12.6 to 59.1 ± 14.9 points was observed in the positioning domain (P = 0.047) and total score (P = 0.032) of the J-CPCHILD, respectively, at 1 year postoperatively compared with preoperatively. However, no correlations were identified between the respective domains of the J-CPCHILD and the magnitude of the major curves, PO, or sagittal plane vertical axis, either preoperatively or postoperatively. According to caregivers, improvement in comprehensive trunk stability with better global balance, similar to that of the ambulant patient, contributed to overall QoL after TP-PCF for NA-NMS. However, IS-related implant failure occurred in approximately 16% of the patients.