Use of a Hybrid Technique in the Surgical Correction of Severe Neuromuscular Scoliosis (Curves ≥85 Degrees): A Retrospective Study and Review of the Literature.

Background  Patients with neuromuscular scoliosis pose a challenge to surgeons due to rapid progression, diffuse vertebral involvement, osteopenia, and dysplasia. Surgical treatment of curves >50° results in high complication rates, and there remains no consensus on fixation techniques. Hybrid fixation utilizing pedicle screws and polyester sublaminar bands have been successful for surgical correction, but there is minimal data for major curves ≥85°. It's important to investigate surgical techniques in this understudied, complex patient population. This study aims to report the use and efficacy of this hybrid construct to correct curves ≥85°.  Methods This is a retrospective review of pediatric neuromuscular scoliosis cases performed by three surgeons at a single institution between 2009 and 2021. Patient inclusion criteria included Cobb angle ≥85°, no previous spine surgery, and a minimum of two years of follow-up. Demographics, including comorbidities, Gross Motor Function Classification System (GMFCS) and American Society of Anesthesiologists (ASA) physical status scores, were noted preoperatively. Preoperative and postoperative angles were measured and compared using paired t-tests. Maintenance of correction was evaluated at one year and the final follow-up visit. Complications were reported for comparison with other surgical techniques.  Results Twenty patients were included in the study with an average follow-up of 4.5 years. Preoperative major curves improved from an average of 100.3° to 34.1° immediately after the surgery (P<0.001). Curve correction was maintained from immediate post-op to the final follow-up in all cases. Pelvic obliquity improved from an average of 29.7° to 8.3° (P<0.001). The post-op major complication rate was 30%, requiring an additional surgery or prolonged ICU stay.  Conclusions For the most severe neuromuscular scoliosis patients, the hybrid construct technique improved and maintained Cobb angles and pelvic obliquity correction at a minimum follow-up of two years. The complication rates found in this complex patient population are comparable to or less than those reported after surgical correction of lesser curves. The hybrid construct proposed maintains correction in even the most severe major curves (≥85°), making it a viable option in this complex patient population.