What happens to the hip after scoliosis surgery in neuromuscular patients? Analyzing factors linked to pain, displacement, and need for surgery.

IF 1.6 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2025-05-05 DOI:10.1007/s43390-025-01097-w

Carmen Martínez-González, María Galán-Olleros, Laura Olías-Ortiz, Ana Ramírez-Barragán, Rosa M Egea-Gámez, Rafael González-Díaz, Ignacio Martínez-Caballero

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引用次数: 0

Abstract

Introduction: Patients with neuromuscular diseases frequently develop hip displacement (HD) and scoliosis, creating complex challenges in determining the optimal treatment strategy and sequence. This study aims to assess the frequency of new hip problems, including pain and HD progression, as well as the need for additional hip surgery following scoliosis correction in neuromuscular patients, and to identify predictive factors for these issues.

Methods: This retrospective study included 71 neuromuscular patients (142 hips) who underwent posterior spinal fusion (PSF) at a specialized center between 2015 and 2022. Clinical data such as age, sex, underlying pathology, ambulatory status, and prior hip surgeries were collected. Radiological parameters, including curve characteristics, coronal imbalance, Cobb angle, pelvic obliquity (PO), and migration percentage (MP), were measured pre- and post-operatively. Descriptive, comparative, and multivariate analyses, including logistic regression, were performed to identify significant predictors and determine optimal cutoff points.

Results: The mean age of patients was 15 ± 2 years, with 59% female and 84.5% nonambulatory. After scoliosis surgery, 15.5% of hips developed new hip problems: 20 hips experienced pain and 9 had HD progression, with 7 requiring additional surgery (3 reconstructive and 4 palliative). Factors including a preoperative up-hip and increased MP, with a cutoff > 25%, were strong predictors of hip pain. HD progression was linked to a postoperative up-hip and increased MP, with MP > 60% emerging as a critical predictor. The need for additional hip surgery was associated with cerebral palsy (CP) and with increased MP.

Conclusions: Approximately 1 in 7 hips developed new-onset problems following PSF in neuromuscular patients. Factors including a preoperative up-hip and increased MP were significant predictors of adverse outcomes, underscoring the importance of thorough preoperative assessment, personalized surgical planning, and proactive counseling regarding potential postoperative complications.

Level of evidence: Level IV, retrospective cohort study.

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神经肌肉患者脊柱侧凸手术后髋关节发生了什么变化？分析与疼痛、移位和手术需求相关的因素。

神经肌肉疾病患者经常发生髋关节移位（HD）和脊柱侧凸，这给确定最佳治疗策略和顺序带来了复杂的挑战。本研究旨在评估新髋关节问题的频率，包括疼痛和HD进展，以及神经肌肉患者脊柱侧凸矫正后额外髋关节手术的需要，并确定这些问题的预测因素。方法：本回顾性研究包括2015年至2022年间在专业中心接受后路脊柱融合术（PSF）的71例神经肌肉患者（142髋）。收集临床资料，如年龄、性别、基础病理、门诊状况和既往髋关节手术。术前和术后测量放射学参数，包括曲线特征、冠状不平衡、Cobb角、骨盆倾角（PO）和迁移率（MP）。描述性、比较性和多变量分析，包括逻辑回归，进行识别显著的预测因子和确定最佳截止点。结果：患者平均年龄为15±2岁，女性占59%，非活动患者占84.5%。脊柱侧凸手术后，15.5%的髋关节出现了新的髋关节问题：20个髋关节出现疼痛，9个髋关节出现HD进展，其中7个需要额外的手术（3个重建手术，4个缓和手术）。包括术前髋部抬高和MP增高（临界值为25%）在内的因素是髋部疼痛的有力预测因素。HD进展与术后上髋关节和MP增加有关，MP bbb60 %是一个关键的预测因子。需要额外的髋关节手术与脑瘫（CP）和MP增加有关。结论：大约七分之一的神经肌肉患者在PSF后出现新发问题。包括术前上臀和MP升高在内的因素是不良结果的重要预测因素，强调了全面的术前评估、个性化的手术计划和针对潜在术后并发症的积极咨询的重要性。证据等级：IV级，回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.