Patients with neuromuscular scoliosis after spinal fusion and instrumentation: clinical, radiometric and functional results

Objective: There are negative effects of neuromuscular scoliosis on motor function, respiratory capacity and pain. Effects on respiratory and motor function and complications after spinal surgery were analysed in a retrrospective study.

Patients: 45 patients (21m, 24 f) with neuromuscular scoliosis, 20 of them with a progressive form, underwent a spinal surgery in 2002–2008 in Tübingen.

Methods: Clinical data, including functional vital capacity (FVC), was taken from medical records. All patients were examined by one experienced physiotherapist with a standardised functional scoring. Subjective data of function in daily life and contentment after surgery was collected via structured telephon interview.

Results: 42% of patients reported preservation of function in daily life activities as a main aim of the surgery. Functional scoring showed that 24% had an improve of sitting, 22% of standing and walking function after surgery. 68% of patients or carers indicated a subjective improvement with respect to sitting. 5 patients got non invasive ventilation (NIV) at night before surgery, in 3 we initiated NIV before intervention. There were no respiratory complications after surgery, 66% were extubated the first postoperative day, no re-intubation was needed. 51% had frequent pain before surgery, only 9% after the intervention, even here intensity, duration and frequency were reduced. 97% reported complete satisfaction after surgery and 70% would make the decision again.

Conclusion: Although the patients studied underwent spinal surgery at an advanced stage of their neuromuscular scoliosis (median Cobb angle 82%, the progressive ones had a median FVC <40% before intervention) the high postoperative satisfaction, the functional course and the low complications seem encouraging