Spinopelvic fixation with iliosacral screws in neuromuscular spinal deformities: results in a prospective cohort of 62 patients.

PURPOSE: The results of a prospective series of 62 patients treated for neuromuscular spinal deformities with spinopelvic fixation using iliosacral screws are presented and discussed. METHODS: Sixty-two consecutive patients diagnosed with neuromuscular disorders were prospectively included. Pelvic obliquity and other angular parameters were measured. RESULTS: Mean age was 15.2 years (11.9 to 19.2 years). Spinal deformity was a thoracolumbar curve in 36 cases, a lumbosacral curve in 14 cases, a lumbar curve in four cases, and a combined thoracic and lumbar curve in eight cases. Lumbo-pelvic correction was done using two different strategies. In 15 patients with a normal frontal spinopelvic balance, the two rods were extended directly down to the iliosacral screws. In 47 patients with pelvic obliquity, iliosacral screws were linked to two short rods. The correction was then corrected by distraction and contraction maneuvers applied between the long and short rods. Postoperative angular parameters showed a good correction of spinal deformity in both groups. Patients with preoperative pelvic obliquity had a satisfactory and stable correction at final follow-up. CONCLUSIONS: The technique of pelvic fixation using iliosacral screws and connectors reduce difficulties and operative time due to the complicated three-dimensional bending of the rods for proper placement within the ilium. In patients with preoperative pelvic imbalance, a powerful pelvic anchorage as the iliosacral fixation allowed to use intraoperative reduction maneuvers. Despite the high rate of infectious complications in our patients, we think that our technique provided effective and improved spinal correction for patients with neuromuscular scoliosis.

Traumatic transepiphyseal separation of the upper femoral epiphysis following seizures in a 5-month-old child: a case report.

INTRODUCTION: Traumatic transepiphyseal separation of the upper femoral epiphysis is a rare lesion of the hip in children. CASE REPORT: We report a case of conservative treatment of transepiphyseal separation of the upper femoral epiphysis following tonic/clonic seizures in a 5-month-old child. Magnetic resonance imaging confirmed the diagnosis The fracture was maintained with hip spica cast for 6 weeks. At the age of 2, complete healing of the lesion including femoral neck remodeling was noted on frontal and lateral radiographs. There was no radiological evidence of AVN or premature closure of the physis. He continues to be followed up. DISCUSSION: Because of the remodeling potential in young children, we assume not to perform additional reduction procedures in such traumatic lesions.