Effect of vertebral or intraspinal abnormalities on the efficacy of posterior correction surgery for scoliosis with arthrogryposis multiplex congenita

English Keywords:Scoliosis  Arthrogryposis multiplex congenita  Poor segmentation  Tethered spinal cord  Orthopedic surgery

English Abstract:

  【Abstract】 Objectives: To analyze the effect of vertebral or intraspinal abnormalities on the efficacy of posterior corrective surgery for scoliosis patients with arthrogryposis multiplex congenita(AMC). Methods: A retrospective study was conducted on 30 scoliosis patients with AMC who underwent posterior corrective surgery in the Department of Spine Surgery of Drum Tower Hospital between August 2001 and November 2021. There were 18 males and 12 females with a mean age of 15.9±5.8(6-32) years. The patients were divided into abnormal group(15 cases) and control group(15 cases) according to with or without vertebral or intraspinal abnormalities. The types of vertebral or intraspinal abnormalities in the abnormal group were recorded, and the number of fusion segments, operative time and intraoperative blood loss were compared between groups. The complications during follow-up were also collected. The flexibility of major curve was assessed on Bending radiographs, and the main curve Cobb angle, the distance between C7 plumb line and center sacral vertical line(C7PL-CSVL), the sagittal vertical axis(SVA), the thoracic kyphosis(TK), and the lumbar lordosis(LL) were measured on the standing whole spine anteroposterior and lateral X-ray images at pre-operation, postoperative two weeks and two years, and the correction rate of major curve was calculated at 2 weeks after surgery and the final follow-up. Results: There were 10 cases of simple poor segmentation(66.6%), 2 cases of poor segmentation combined with tethered cord(13.3%), and 1 case of poor segmentation combined with arachnoid cyst, simple hemivertebra, and simple wedge-shaped vertebra(6.7%) each in the abnormal group. There were no significant differences between abnormal group and control group in the number of fusion segments, operative time and intraoperative blood loss(P>0.05). No complication was observed during operation in the abnormal group, and 3 complications were observed during follow-up, including 2 cases with screw misplacements and 1 case with thoracic effusion and the right brachial plexus paralysis; 5 cases of complications in the control group were observed, including 1 case with malignant hyperthermia and cardiac arrest during the surgery, 3 cases with screw misplacements and 1 with thoracic effusion and screw placement failure. The incidence of complications was not statistically different between the two groups(P=0.628). The flexibility of major curve before operation was not statistically different between the two groups(P>0.05); The major curve Cobb angle, C7PL-CSVL, SVA, TK and LL at pre-operation, post-operative two weeks and 2 months were not statistically different between groups(P>0.05); The correction rate of major curve at 2 weeks and 2 months after surgery were not significantly different as well(P>0.05). Conclusions: Vertebral or intraspinal abnormalities have no obvious effects on the efficacy of posterior corrective surgery for the treatment of scoliosis patients with AMC, and there is no significant increase in the incidence of intraoperative and postoperative complications.