Spinal Stabilization in intermediated spinal atrophy patients SMA' A review of 46 living cases'

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Spinal Stabilization in intermediated spinal
atrophy patients (SMA). A review of 46 living
cases.

• Dr. N. Ventura, I. Vilalta, M. Pastor

nventura_at_hsjdbbcn.org
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S.M.A. type II . Genetically determined
neuromuscular disorder
. Normal intelligence. Severe early
onset scoliosis
. Posterior spine fusion at puberty and
fusionless techniques in very young children are
often required
Before pubirty
After pubirty
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Methods.

• This retrospective review included 46 living
  patients with SMA having undergone surgical
  correction of their spinal deformity between
  1990 and 2007 at our Institution.

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Two groups were distinguished with respect to the
technique of surgical intervention

• Group I. 31 patients underwent posterior fusion
  T.3 to the pelvis or to L.5, average follow up 8
  years ( 2-17)
• Group II. 15 patients treated with fusionless
  surgical techniques (10 growing rods, 5 VEPTER)
  average follow up 2.6 years ( 2-7).

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Results.

• Group I. M.A.11 years, O.T. 5 hours, 3.7 units of
  blood, 3 average ICU stay, 16 average hospital
  stay.
• Pre-operative radiograph
• . thoraco-lumbar 83º (65º-151º), 60 Correct.
• . lumbar 80º (50º-105º), 52 correct.
• . thoracic 52º (40º-93º), 47 correct.
• . Pelvic obliquity 25º (1º-44º) 71correct.
• . Twenty four patients had fixation to the pelvis
  (Galveston/ Iliac screw), 7 cases had fixation to
  L.5

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S.M.A. Type II. 10 Y. A. 2 months
Halo-traction. Posterior furion. P.S. T.2-L.5.
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Results

• Group II. M.A. 7 years , O.T. 2.5 hours, 0.7
  units of blood, 1 average ICU day stay, 9
  average hospital stay.
• Mean pre-operative radiographs
• thoraco-lumbar 90º (73º-108º), 60 correct.
  thoracic curves 76º (70º-100º),46 correct.
  pelvic obliquity 25º (6º-35º), 51 correct.

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7Y
S.M.A. type II. Halo/chair VEPTR
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Complications

• group I. there were 3 (10) atelectasis, 3
  postoperative infections (10) , 1 delay deep
  infection (3.3) requiring removal of implants 3
  years after the operation, 1 (3.3) patient
  require removal of one iliac screw.
• group II. 2 (15) cases treated with VEPTR
  required removal of implants. One of them 6
  months later underwent growing rods

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Conclusions

• Although the rate of complication is high,
  surgical treatment for patients with SMA can
  improved coronal, sagital and pelvic balance with
  an acceptable risk of complication. The fusion
  less technique in infantile scoliosis seems to
  control the progression of the curve and delay
  posterior fusion.