Journal
CHILDS NERVOUS SYSTEM
Volume 30, Issue 2, Pages 249-255Publisher
SPRINGER
DOI: 10.1007/s00381-013-2221-6
Keywords
Bone morphogenetic protein; Neuromuscular; Scoliosis; Pseudoarthrosis; Pediatric; Fusion
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Neuromuscular scoliosis is a challenging pathology to treat with high incidence of complications and failure of surgical fusion. Surgical correction can entail long fusion constructs extending to the pelvis. We report our experience in the use of bone morphogenetic protein (BMP) to augment L5-S1 arthrodesis in long segment fusions in pediatric patients with neuromuscular scoliosis. Retrospective review of 11 pediatric patients with neuromuscular spinal deformity (mean, age 13.7 years; range, 10-20 years) who underwent long (mean, 15 levels; range, 10-18 levels) spinal instrumentation and fusion to the pelvis at a single institution from 2007 to 2012 with an average follow-up of 34 months (range, 11-62 months). Of the 11 patients, one had pseudoarthrosis at L5-S1. The average coronal Cobb angle measured 59A degrees before surgery and 42A degrees immediately after surgery. The average preoperative thoracic kyphosis and lumbar sagittal lordosis measured 34 and 59A degrees, respectively. Immediately after surgery, the thoracic and lumbar angles measured 28 and 39A degrees, respectively. At last follow-up, the average coronal Cobb angle was maintained at 43A degrees and the thoracic and lumbar sagittal angles were 28 and 44A degrees, respectively. An average of 14.2 mg of recombinant human bone morphogenetic protein-2 (rh-BMP-2) was used for each case. L5-S1 arthrodesis may be effectively achieved in long fusions for pediatric neuromuscular spinal deformity with posterolateral fusion supplemented with rh-BMP-2. This surgical strategy may be associated with lower complication rates, decreased blood loss, and shorter operative times than circumferential fusion, which is particularly important in this complex fragile patient population.
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