Don't you wish you had fused to the pelvis the first time: a comparison of reoperation rate and correction of pelvic obliquity.

STUDY DESIGN: Multicenter retrospective OBJECTIVE.: To compare pelvic obliquity correction and reoperation rate in neuromuscular scoliosis patients who had their pelvis included in a posterior spinal fusion (pelvic fusion, PF) at their index procedure vs revision procedures.

SUMMARY OF BACKGROUND DATA: There is limited information on outcomes specific to fusing to the pelvis for neuromuscular scoliosis in a revision operation versus index surgery.

METHODS: Charts and radiographs were reviewed of patients with PF for neuromuscular scoliosis from 01/2003 to 08/2015 at 4 high volume pediatric spine centers with > 2 year follow-up.

RESULTS: 285 patients met inclusion criteria; 271 had PF done at index surgery and 14 had PF done during revision surgery. Prior to index procedure, there were no significant differences in Cobb angle (p = 0.13). Prior to pelvic fusion there was no difference in pelvic obliquity (p = 0.26). At the time of fusion to the pelvis, estimated blood loss (p = 0.23) and operative time (p = 0.43) did not differ between index and revision groups. Percent correction in pelvic obliquity was similar for both groups (p = 0.72). Overall, 69 patients had complications requiring return to the OR. Excluding the revision surgery for inclusion of the pelvis for the revision group, there was still a lower reoperation rate with index PF (22.9%, n = 62/271) than revision PF (50.0%, n = 7/14) (p = 0.02). Implant failures were significantly higher in the revision group (index = 7.4%, 20/271; revision = 42.9%, 6/14; p < 0.001).

CONCLUSION: PF at the index spinal fusion led to similar correction of pelvic obliquity with approximately half the reoperation rate compared to PF at a revision surgery. Operative time and blood loss were similar between index and revision spinal fusion.

LEVEL OF EVIDENCE: 4.