Spinopelvic fixation in neurogenic scoliosis: validity of indications

Objective. Analysis of the results of surgical correction of neuromuscular scoliosis in order to optimize indications for performing spinal and pelvic fixation.

Material and Methods. A total of 45 patients aged 10 to 17 years were operated on for neurogenic scoliosis in the period of 2012–2024. Thirty patients without pelvic fixation were divided into two groups: Group I included 15 patients with pelvic tilt of less than 15°, and Group II – 15 patients with pelvic tilt of more than 15°. Group III consisted of 15 patients with pelvic tilt of more than 15° who underwent pelvic fixation. All patients underwent postural radiographs before and after surgery. The treatment results were assessed according to the following criteria: the frontal pelvic tilt angle according to Maloney, the tilt of the L5 vertebra, and the magnitude of scoliotic curve angle according to Cobb. A search for possible relationships between various radiographic parameters was also performed.

Results. The average value of pelvic tilt before surgery in Group I was 7.9° ± 5.1°, in Group II – 36.3° ± 14.7°, and in Group III – 37.9° ± 14.2°; after surgery in Group I – 5.9° ± 4.5°, in Group II – 13.6° ± 10.4°, and in Group III – 12.8° ± 4.0°. The average degree of correction in groups was 36.8 ± 32.0 %, 61.2 ± 26.8 % and 62.9 ± 8.9 %, respectively. No significant loss of correction was found during long-term follow-up in all groups. The preoperative Cobb angle of the primary curve was 73.3° ± 20.2° in Group I, 99.9° ± 31.0° in Group II, and 96.7° ± 17.5° in Group III. In the postoperative period, the average Cobb angle was 29.4° ± 9.7° in Group I, 40.2° ± 24.9° in Group II, and 41.6° ± 19.5° in Group III. In Group II, a direct relationship was found between the correction of the primary curve and the correction of pelvic tilt. When assessing the relationship between the L5 inclination and the correction of pelvic tilt in Group II, an inverse relationship was found. No reliable relationship was found between the initial angle of pelvic tilt and the correction of pelvic tilt in Group II.

Conclusion. Correction of pronounced pelvic tilt in patients with neuromuscular scoliosis is possible without pelvic fixation and without significant loss of correction, provided that the degree of correction of the primary curve is satisfactory (more than 50 %). A possible parameter determining the need for spinopelvic fixation may be the angle of L5 inclination. Narrowing the indications for inclusion of the pelvis in the fusion zone during surgical correction of neurogenic spinal deformities helps to reduce the frequency of implant-associated complications that are typical for spinopelvic fixation, which in general will lead to a significant increase in the effectiveness of surgical treatment of this category of patients.

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