What Happens When You Wait? Larger Curves Require More Resources for Less Correction in Neuromuscular Scoliosis

Brandon Yoshida; Jacquelyn N Valenzuela-Moss; Tyler A Tetreault; Tishya A L Wren; Tiffany Phan; Gerard K Williams; Lindsay M Andras; Michael J Heffernan

doi:10.1097/BRS.0000000000005380

What Happens When You Wait? Larger Curves Require More Resources for Less Correction in Neuromuscular Scoliosis

Spine (Phila Pa 1976). 2025 May 5. doi: 10.1097/BRS.0000000000005380. Online ahead of print.

Authors

Brandon Yoshida¹, Jacquelyn N Valenzuela-Moss², Tyler A Tetreault^{1

2}, Tishya A L Wren^{1

2

3}, Tiffany Phan², Gerard K Williams^{1

2}, Lindsay M Andras^{1

2}, Michael J Heffernan^{1

2}

Affiliations

¹ Keck School of Medicine, University of Southern California, Los Angeles, CA.
² Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
³ Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA.

PMID: 40325500
DOI: 10.1097/BRS.0000000000005380

Abstract

Study design: Retrospective study.

Objective: Assess the impact of curve magnitude on the complexity of surgery, resources utilized, and outcomes during surgical management of neuromuscular scoliosis (NMS).

Summary of background data: Despite previous attempts to determine the impact of curve magnitude on outcomes after posterior spinal fusion (PSF) in NMS, equipoise remains regarding optimal surgical timing.

Methods: Patients aged 7-21 years with NMS and fusion to the pelvis at a single tertiary hospital were retrospectively reviewed. Patient demographics, surgical parameters, complications, and radiographic measurements were collected. Clinical and radiographic outcomes were compared between patients with pre-operative curves≥80° and <80°.

Results: 337 patients met inclusion criteria with a mean curve of 83.1°±26.5°. Patients with curves≥80° had greater blood loss (994±607 vs 764±535 mL, P=0.0003), transfusion requirement (795±647 vs 478±482 mL, P<0.0001), surgical time (418±117 vs 338±117 min, P<0.0001), anesthesia time (552±123 vs 472±122 min, P<0.0001), and ICU stay (3±2 vs 2±1 d, P=0.009) compared to patients with curves<80°. Continued intubation was 2.4 times more likely (OR 2.4; 95% CI [1.5, 3.9], P=0.0002) and the odds of utilizing adjunctive surgical techniques (i.e. intraoperative halo traction, temporary rods, and/or staged procedures) were 4 times more likely for patients with curves≥80° (OR 4.1; 95% CI [2.5, 6.6], P<0.0001). The use of spinal osteotomies was more likely among patients with larger curves (OR 4.6; 95% CI [2.8, 7.2], P<0.0001). Residual curve magnitude (44.7°±20.5° vs 22.6°±13.6°, P<0.0001) and pelvic obliquity (10.2°±12 .6° vs 4.8°±8.7°, P<0.0001) were higher in the≥80° group. Those with curves ≥80° were 3 times more likely to experience a change in neuromonitoring signals during surgery (OR 3.07; 95%CI:[1.40, 6.73], P=0.003).

Conclusion: Curve magnitude≥80° was associated with larger residual curves despite increased surgical complexity and greater resource utilization in the management of NMS.

Keywords: NMS; PSF; neuromuscular scoliosis; pediatric orthopedic surgery; posterior spinal fusion.