Bipolar minimally invasive fusionless surgery can preserve spinal and thoracic growth without interfering with respiratory function in patients with spinal muscular atrophy (SMA), according to a study published in the Journal of Pediatric Orthopaedics.
The authors of the study wrote, “It provides a significant correction of spinal deformity and pelvic obliquity, having a reduced rate of complications.” They also reported that the correction of spinal deformity was maintained in the long term, and patients did not require definitive fusion at the end of their growth period.
Scoliosis is common in patients with SMA, often requiring surgery. There are several types of surgery that can be used to treat scoliosis in SMA, including spinal fusion and growing rods. Generally, these are performed when the patient is at least 10 years of age and has stopped growing. In recent years, new fusionless surgery techniques have been developed; these offer the advantage of correcting the deformity before the end of the growth spurt.
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Here, a team of researchers led by Lotfi Miladi, MD, evaluated the long-term outcomes of minimally invasive fusionless surgery techniques in patients with SMA. They retrospectively reviewed the clinical, genetic, respiratory, and radiographic data of all children who underwent the surgery at Necker Enfants Malades Hospital in Paris, France between 2011 and 2019. They also performed a patient satisfaction survey.
In the 59 children who underwent minimally invasive fusionless surgery, the mean major coronal curve improved from 79 to 41 degrees. Moreover, pelvic obliquity decreased from 24 to 5.9 degrees. The mean space available for the lungs went from 77% to 93%, but this had no significant impact on respiratory function.
Mechanical or infectious complications occurred in 9 patients (15.25%). The implant had to be removed in 1 patient, and 6 patients required unplanned surgeries. Thirteen children needed bracing after surgery, and 30 required rod lengthening procedures. None of the children needed arthrodesis at the last follow-up.
The results of the patient satisfaction survey found that almost all children (91.5%) were satisfied with the surgery.
The authors concluded that minimally invasive fusionless surgery is effective in the long term to treat scoliosis in patients with SMA.
Gaume M, Saudeau E, Gomez-Garcia de la Banda M, et al. Minimally invasive fusionless surgery for scoliosis in spinal muscular atrophy: long-term follow-up results in a series of 59 patients. J Pediatr Orthop. Published online August 19, 2021. doi:10.1097/BPO.0000000000001897