Pelvic Obliquity Correction in Distraction-Based Growth Friendly Implants

Effects of bracing on pelvic parameters in adolescent idiopathic scoliosis: A retrospective study

To evaluate the effects of Chêneau bracing on Cobb's angle (CA) and spinopelvic parameters in adolescent idiopathic scoliosis (AIS) patients. In this retrospective study, we evaluated 51 AIS patients who received Chêneau bracing treatment between January 2020 and August 2021. The prebracing and in-bracing radiographs were analyzed about the spinopelvic parameters. The CA, pelvic coronal obliquity angle, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical angle, and coronal vertical angle were measured. Paired t-test was used to compare prebracing and in-bracing spinopelvic parameters. The Pearson correlation analysis was used to identify the relationships between the variations in the spinopelvic parameters. The mean age at the initiation of bracing was 13.6 ± 1.5 years. The mean prebracing CA was 24.0° ± 6.3°. There were no statistically significant differences between prebracing and in-bracing measurements of sagittal and coronal vertical angles. However, there were statistically significant differences between the prebracing and in-bracing measurements of the CA, pelvic coronal obliquity angle, TLK, LL, PT, and SS. A significant correlation was observed between PT and thoracolumbar kyphosis variations in the sagittal plane. The pelvic coronal obliquity angle variation was correlated to the prebracing pelvic coronal obliquity angle in the coronal plane. Chêneau's bracing effects of AIS can be extended to the pelvis. Affected by the Chêneau brace, the pelvis should be retro-rotated correspondingly to TLK hyperkyphosis on the sagittal plane, whereas in the coronal plane, pelvic obliquity was improved independently. The effect of Chêneau braces on the pelvic parameters should be fully considered before bracing treatment.

Uncorrected Pelvic Obliquity Is Associated With Worse Health-related Quality of Life (HRQoL) in Children and Their Caregivers at the End of Surgical Treatment for Early Onset Scoliosis (EOS)

BACKGROUND

While largely of concern in nonambulatory patients, pelvic obliquity (PO) can be found in many patients with early onset scoliosis (EOS) and may remain following surgery. However, its association with health-related quality of life (HRQoL) in children and their caregivers at the end of treatment is not well understood. The purpose of this study was to investigate the association between residual PO and HRQoL in children and their caregivers at the end of surgical treatment in ambulatory patients with EOS.

METHODS

In this retrospective cohort study, a multicenter EOS registry was queried to identify ambulatory patients who underwent definitive posterior spinal fusion (PSF) from 2012 to 2019. Patients with fusions extending to the pelvis were excluded. PO was measured at least 1 year following PSF. HRQoL, Parental Burden, Financial Burden, and Satisfaction were assessed through the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) also at a minimum of 1 year following PSF.

RESULTS

A total of 155 patients (12.5±2.1 y, 73.5% female) were included. Etiology distribution was 30.3% congenital, 12.9% neuromuscular, 21.3% syndromic, and 35.5% idiopathic. In congenital patients, those with residual PO >8 degrees had worse Satisfaction by 23.2 points compared with those with PO ≤8 degrees. In neuromuscular patients, those with residual PO >7 degrees had worse HRQoL by 16.1 points and Parental Burden by 22.3 points compared with their counterparts. In syndromic patients, those with residual PO >8 degrees had worse HRQoL by 14.8 points, Parental Burden by 16.4 points, and Satisfaction by 21.2 points compared with their counterparts. In idiopathic patients, those with >9 degrees of residual PO had worse HRQoL by 15.0 points and Financial Burden by 26.8 points compared with their counterparts.

CONCLUSIONS

Remaining PO at the end of surgical treatment is associated with worse HRQoL in ambulatory children and their caregivers. These results suggest that correction of PO should remain a primary goal of treatment in patients with EOS undergoing surgery.

LEVEL OF EVIDENCE

Level II-multicenter retrospective cohort study investigating prognosis.

Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment

STUDY DESIGN

Literature Review.

OBJECTIVE

Review the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in cerebral palsy patients with neuromuscular scoliosis. Neuromuscular scoliosis (NMS) in cerebral palsy (CP) patients is rapidly progressive and often leads to an imbalance in musculoskeletal mechanics that extends to the pelvis. A horizontal misalignment of the pelvis in the frontal plane known as pelvic obliquity (PO) is a common finding in this population. When untreated, PO can exacerbate the back pain, postural strain, and walking difficulties experienced by these patients. Establishing the manifestation and treatment plan for PO in the setting of NMS can provide valuable insight for diagnosis and management.

METHODS

A comprehensive literature review was performed on the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in the setting of NMS in CP. The advantages and limitations of measurement and treatment options were evaluated.

RESULTS

PO is categorized into suprapelvic, infrapelvic, and intrapelvic causes, each presenting with a unique pattern of pathology. NMS in CP with hip contractures and structural deformities fall into these categories. The Maloney and O'Brien methods of pelvic measurement have demonstrated superior utility and are recommended for clinical diagnosis. The management of PO in NMS patients is focused on the cause of malalignment, with posterior fusion, contracture release, and osteotomy encompassing the mainstay of treatment.

CONCLUSION

PO is commonly found in patients with NMS in cerebral palsy. There is currently no standard method for determining the PO angle. Interventions designed to reduce scoliotic curves and release tissue contractures can level the pelvis and restore proper alignment of the spine and sacrum in the coronal plane in these patients. Further understanding of the causes of PO in NMS, as well as the establishment of a standardized measuring technique and diagnostic parameters will allow for more effective treatment options and improve outcomes in patients with CP.

LEVEL OF EVIDENCE

N/A.