Raramente el SPP amenaza la vida. La gravedad de la debilidad residual y la discapacidad posteriores a la poliomielitis aguda tiende a predecir el desarrollo del SPP. Los estudios han demostrado que esto no sucede. La causa es desconocida. March of Dimes,
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To evaluate retrospectively the results related to the use of pelvic fixation with alar-iliac S2 screw in individuals with myelomeningocele. Retrospective study of cases surgically treated with this technique, between January and March at the Pequeno Principe Children's Hospital. Radiographic images and clinical records were analyzed in search of complications. Twelve patients with mean age of The mean follow-up was The mean of the highest magnitude curve measured by the Cobb angle in the preoperative period was The mean pelvic obliquity was El promedio de seguimiento fue de 11,5 meses.
Myelomeningocele occurs due to a defect in the closure of the neural tube involving the spinal cord and meninges between the third and fourth weeks of the embryonic period. There is a strong association between myelomeningocele and spinal deformities that begin to appear in early infancy and become severe before 10 years of age.
Pelvic obliquity is often related to spinal deformities and is attributed to muscle contractions above and below the pelvis, as well as to intrinsic deformities of the pelvic bones due to growth disturbances.
The objectives of spinal arthrodesis surgery are the correction of the deformity and the restoration of the balance between the trunk and pelvis, thus influencing the improvement in the quality of life of these patients. Pelvic obliquity and lumbar kyphosis are indications for extending fixation to the pelvis. We conducted a retrospective study of the data obtained prospectively from cases treated surgically via this technique between January and March at the Hospital Infantil.
Twelve cases were reviewed by analyzing radiographic images and clinical records in search of complications. The radiographs were reviewed by a single examiner looking for signs of material failure, such as loosening and breakage of the screws or rods at the level of pelvic fixation.
The radiographic parameters were measured with the assistance of Surgimap Spine software, using the Cobb angle method to measure the degrees of the highest magnitude curve in pre- and postoperative panoramic anterior-posterior spinal radiographs and the Osebold method to measure pelvic obliquity. The surgical pelvic fixation technique using S2 alar-iliac screws was described by Sponseller et al.
The case reports were reviewed in search of clinical reports of pain or ulceration at the level of S2 alar-iliac fixation, as well as the duration of follow-up. All patients participating in the study signed the Informed Consent Form. The mean age of the patients was Mean follow-up was The clinical data are shown in Table 1. The mean highest magnitude preoperative curve measured by the Cobb angle was The mean highest magnitude curve measured at the last postoperative follow-up was Mean pelvic obliquity was The data obtained are shown in Table 2.
In one case, the head of the left polyaxial S2 alar-iliac screw had loosened at the 7-month follow-up and, in the other case, the month control radiograph revealed loosening of the head of the right polyaxial S2 alar-iliac screw and breakage of the rod below the left S1 screw.
We also observed that both these patients remained asymptomatic in the clinical follow-up, with no need for revision of the fixation. There was one case of rod breakage at level L3-L4 in a patient who fell from the own height, defining a traumatic event as the cause of the complication, without compromising the S2 alar-iliac fixation.
Another complication reported, but not associated with the alar-iliac fixation, was of a patient who had a broken rod at level TT12 due to pseudoarthrosis, but without compromising the level S2 alar-iliac fixation, which required reintervention.
There were no clinical reports of wound complications or pain directly related to the material at the level of the S2 alar-iliac fixation.
Patients with myelomeningocele have a good chance of progress with spinal deformities that require surgical correction. Due to the neuromuscular nature of the pathology in the spine, pelvic obliquity usually accompanies the deformities and makes it necessary to include the pelvis in the fixation.
Among the several techniques described, the Hospital Infantil group has used S2 alar-iliac fixation. Modi et al. The study used the iliac screw technique and none of the patients included were diagnosed with myelomenigocele.
Sharma et al. The revision rate, however, was around 7. Montero et al. Only 5 of these patients had a diagnosis of myelomeningocele. This study had a rate of complications related to the implant of 1. In their study using this technique in 38 patients with neuromuscular scoliosis with a minimum 5-year follow-up, Jain et al. This case series, however, included only 2 patients diagnosed with myelomeningocele.
Comparing the sacral alar-iliac technique with fixation with iliac screws in the treatment of neuromuscular scoliosis, Shabtai et al. Even with a minimum follow-up of two years, the study included only one out of the 46 patients evaluated for the sacral alar-iliac technique with a diagnosis of myelomenigocele. Comparing the technique of sacral alar-iliac fixation with other methods, Sponseller et al.
There was only one case of revision of the sacral alar-iliac screws. The satisfactory results observed in this study were not previously found in other studies that generally present case series that include patients with countless neuromuscular pathologies, most of them with cerebral palsy.
There is still a dearth of articles in the literature dealing with this technique specifically in patients with myelomeningocele. The limitations of this study include follow-up time and the number of patients included, even though it is higher than that found in the literature.
Surgical Treatment of Scoliosis Associated with Myelomeningocele. Eur J Pediatr Surg. Scoliosis in myelodysplasia. J Bone Joint Surg Am. Mayfield JK. Severe spine deformity in myelodysplasia and sacral agenesis: an agressive surgical approach. Spine Phila Pa Comparison of pelvic fxation techniques in neuromuscular spinal deformity correction: Galveston rod versus iliac and lumbosacral screws.
Evaluation of pelvic fixation in neuromuscular scoliosis: a retrospective study in 55 patients. Int Orthop.
Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years.
Eur Spine J. Outcomes and complications of S2 alar iliac fixation technique in patients with neuromuscular scoliosis: experience in a third level pediatric hospital. J Spine Surg. World Neurosurg. J Pediatr Orthop.
Pelvic fixation for neuromuscular scoliosis deformity correction. Curr Rev Musculoskeletal Med. Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Orthop Surg. Low profile pelvic fixation with the sacral alar iliac technique in the pediatric population improves results at two-year minimum follow-up. Bairro Flores. CEP: Email: coracybrasil hotmail.
CGBN and LMA conducted the bibliographical research, reviewed the manuscript, and contributed to the intellectual concept of the study. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Services on Demand Journal. Methods: Retrospective study of cases surgically treated with this technique, between January and March at the Pequeno Principe Children's Hospital. Results: Twelve patients with mean age of Received: April 22, ; Accepted: October 03, Lorena, cj.
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To evaluate retrospectively the results related to the use of pelvic fixation with alar-iliac S2 screw in individuals with myelomeningocele. Retrospective study of cases surgically treated with this technique, between January and March at the Pequeno Principe Children's Hospital. Radiographic images and clinical records were analyzed in search of complications. Twelve patients with mean age of The mean follow-up was The mean of the highest magnitude curve measured by the Cobb angle in the preoperative period was
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