Spine - 2026-04-15 - Journal Article
What Happens When You Wait? Larger Curves Require More Resources for Less Correction in Neuromuscular Scoliosis.
Yoshida B, Valenzuela-Moss JN, Tetreault TA, Wren TAL, Phan T, Williams GK, Andras LM, Heffernan MJ
Topics
Key Takeaway
In neuromuscular scoliosis, curves ≥80° require 4× more adjunctive surgical techniques and 80 minutes more OR time yet leave residual curves twice as large (44.7° vs 22.6°) compared to curves <80°.
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Summary
This single-center retrospective study compared surgical complexity, resource utilization, and radiographic outcomes in NMS patients aged 7–21 undergoing PSF to the pelvis, stratified by preoperative curve magnitude ≥80° vs <80°. Patients with curves ≥80° had significantly greater EBL (994 vs 764 mL), transfusion volume (795 vs 478 mL), OR time (418 vs 338 min), and ICU stay (3 vs 2 days), with 4.6× higher odds of requiring osteotomies. Despite this increased complexity, residual curve magnitude remained nearly double in the ≥80° group (44.7° vs 22.6°) and pelvic obliquity correction was inferior (10.2° vs 4.8° residual).
Key Limitation
The 80° threshold was chosen a priori without data-driven cutpoint analysis, and the absence of functional outcome measures (e.g., sitting balance, caregiver burden) limits assessment of whether the radiographic differences translate to clinically meaningful differences in patient quality of life.
Original 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).
BACKGROUND
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.
MATERIALS AND METHODS
Patients aged 7 to 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 preoperative curves ≥80° and <80°.
RESULTS
Three hundred thirty-seven patients met the 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 with 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.