Neuromuscular scoliosis (NMS), the three-dimensional deformity of the spine, has neurologic or muscular origin. Conservative treatment offers limited possibilities for severe deformities in NMS, hence surgical treatment is often ultimately necessary. Fusion surgery is a difficult procedure for the patient and carries substantial risks. In NMS, the surgical risks and complications are considerably higher than in patients with Adolescent idiopathic scoliosis (AIS). The aim of this dissertation was to investigate the characteristics associated with spinal fusion surgery in NMS patients in terms of perioperative bleeding, health-related quality of life (HRQoL) and bone mineral density.
Studies I and II examined perioperative bleeding and its risk factors. Perioperative bleeding was significantly higher in NMS patients compared to AIS. The risk factor profile differed between the study groups. Increasing operative time was a risk factor for intraoperative and total bleeding, whereas extent of fusion correlated to amount of drainage bleeding.
Study III investigated health-related quality of life changes associated with spinal fusion. NMS patients showed a significant improvement in quality of life at post-operative two-year follow-up, and the improvement of HRQoL was not inferior in comparison to AIS patients.
In study IV, the bone mineral density (BMD) of spinal muscular atrophy patients was investigated from spinal CT-imaging taken prior to spinal fusion. Patients pre-treated with growth-friendly spinal implants had poorer bone mineral density in a comparison to patients followed prior fusion without surgical interventions. Bone quality was poorer in both groups in comparison to healthy controls.
This study suggests that there are higher risks associated in spinal fusion for neuromuscular scoliosis patients compared to surgical treatment of idiopathic scoliosis. Perioperative bleeding is more extensive, and previous operative treatment further compromises the poorer bone quality of patients with neuromuscular scoliosis. Importantly, despite the risks, quality of life appears to improve significantly after spinal fusion surgery.