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Title: Incidence of Complications in the Management of Non-Ambulatory Neuromuscular Early-Onset Scoliosis with a Rib-Based Growing System: High- Versus Low-Tone Patient

Authors: Ramirez N, Olivella G, Rodriguez O, Marrero P, Smith J, Garg S, Vitale MG, St. Hilaire T, Betz R.

Journal: European Journal Orthopedic Surgery and Trauma

Date: December 20, 2019

Excerpt: Surgical treatment of neuromuscular EOS is associated with high complication rates compared to idiopathic or congenital EOS patients. Despite the high use of surgical rib-based techniques in NEOS, few papers have described their outcomes and complications.

Keywords: Neuromuscular Scoliosis, EOS, Surgery, Complications


 What is the purpose of this study?

The purpose of this study is to determine rate, severity and type of complications after growth-friendly surgery in high-tone (unbalanced spine due to increased muscle activity) neuromuscular early onset scoliosis patients, when compared to low-tone (unbalanced spine due to decreased muscle activity) neuromuscular early onset scoliosis patients.


- Complications were measured as any change from the normal outcome after surgery.

- 41 out of 67 patients had complications after surgery.

- 77.3% of high-tone (unbalanced spine due to increased muscle activity) and 66.7% low tone (unbalanced spine due to decreased muscle activity) neuromuscular scoliosis patients required further surgeries to resolve their complications.

- High-tone patients experienced more severe complications and were two times as likely to experience a very severe complication (grade ¾).

Important Discussion Points

- Neuromuscular patients with increased muscle activity have a much greater chance of severe complications than those neuromuscular patients with decreased muscle activity.

- In these high-tone neuromuscular patients, surgeons were two times more likely to permanently abandon treatment due to complications.

- In all neuromuscular patients studied, infection and device migration were the most common complications.

- Hight-tone neuromuscular patients likely have more complication risk because of the normal further health risks in this population separate from going through surgery.