Pelvic or lumbar fixation for the surgical management of @entity1635 in XXXX .

@entity1 @entity190 @entity1635 @entity530 @entity1555 @entity281
STUDY DESIGN: This retrospective study evaluates two groups of @entity1 with @entity1635 and @entity1555 , treated with two different surgical stabilization methods. OBJECTIVE: To determine whether fixation to the sacropelvis is always necessary for adequate stabilization of @entity1635 in @entity1555 . SUMMARY OF BACKGROUND DATA: Pelvic fixation is generally recommended for @entity1635 in @entity1555 . Recent studies describe a more selective approach toward lumbar or pelvic fixation. Pelvic fixation is reserved for larger curves and established pelvic tilt. METHODS: Fifty cases of @entity1555 , operated in two different centers and followed up for a minimum of 3 years, were reviewed. In the first group (Oswestry), 31 @entity1 had fixation to the pelvis, using standard Luque instrumentation and pelvic fixation. The Galveston technique was used in 9 cases and L-rod configuration in 22 cases. In the second group (Nottingham), 19 cases had fixation to L5 using pedicle screws in the lumbar spine and sublaminar wires in the thoracic spine. These cases were operated on early, usually shortly after becoming wheelchair dependent. RESULTS: In the pelvic fixation group, the mean age at the time of surgery was 14 years, and forced vital capacity was 44%. The mean Cobb angle and @entity530 were 48 degrees and 19.8 degrees at the time of surgery, 16.7 degrees and 7.2 degrees immediately after surgery, and 22 degrees and 11.6 degrees at the final follow-up (mean 4.6 years), respectively. The mean @entity190 was 4.1 L, and the average hospital stay was 17 days. There were five major complications, including a deep wound @entity281 in one case, revision of instrumentation prominence at the proximal end in two cases, and loosening of pelvic fixation in two cases. In the lumbar fixation group, the mean age at the time of surgery was 11.7 years, and forced vital capacity was 58%. The mean Cobb angle and @entity530 were 19.8 degrees and 9 degrees at the time of surgery, 3.2 degrees and 2.2 degrees immediately after surgery, and 5.2 degrees and 2.9 degrees at the final follow-up (mean 3.5 years), respectively. The mean estimated @entity190 (3.3 L) and mean hospital stay (7.7 days) were much less compared with the pelvic fixation group. @entity530 was corrected and maintained below 10 degrees in all but two cases, who had an initial @entity530 exceeding 20 degrees. One @entity1 had instrumentation failure at the proximal end, and one had a deep wound @entity281 . CONCLUSION: Lumbar fixation to L5 is adequate if the surgery is performed early, soon after becoming wheelchair bound, and with smaller curves and minimal @entity530 . Use of pedicle screws in lumbar spine provides a solid foundation to maintain the correction over the period of relatively short life expectancy of these @entity1 . Pelvic fixation may be necessary in older @entity1 , who have larger curves and established @entity530 . In the presence of deteriorating lung function, this is associated with a greater morbidity and higher complication rate.
