The Journal of Bone and Joint Surgery (American) 82:524 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
The Safety and Efficacy of Isola-Galveston Instrumentation and Arthrodesis in the Treatment of Neuromuscular Spinal Deformities*
Muharrem Yazici, M.D. ,
Marc A. Asher, M.D. and
James W. Hardacker, M.D.#
Investigation performed at the University of Kansas Medical
Center, Kansas City, Kansas
*One or more of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article. In addition,
benefits have been or will be directed to a research fund, foundation,
educational institution, or other nonprofit organization with which
one or more of the authors is associated. Funds were received in total
or partial support of the research or clinical study presented in
this article. The funding source was DePuy AcroMed Corporation,
Raynham, Massachusetts.
 Read at the Annual Meeting of the Scoliosis Research Society,
Asheville, North Carolina, September 15, 1995.
Hacettepe University, Faculty of Medicine, Orthopaedics, Sihhiye,
Ankara 06100, Turkey.
§Section of Orthopedics, University of Kansas Medical Center,
3901 Rainbow Boulevard, Kansas City, Kansas 66160-7387. E-mail address: masher{at}kumc.edu
#The Spine Institute, 5299 James Court, Carmel, Indiana 46033.
Background: Implant systems that realign
and stabilize a deformed spine continue to evolve. The purpose of the
study of this case series was to determine the safety and effectiveness
of a system designed to integrate hook, wire, screw, and post anchors
for the treatment of a wide spectrum of neuromuscular disorders
associated with pelvic deformity or the potential for deformity.
Methods: Forty-seven consecutive patients who
had a spinal deformity that was due to cerebral palsy or an upper
motor-neuron cerebral palsy-like disease (thirty-one patients),
myelomeningocele (nine), Duchenne muscular dystrophy (four), or
other disorders (three) were managed with Isola-Galveston instrumentation
and arthrodesis. The average age at the time of the operation was
fourteen years and three months (range, five years and four months
to twenty-three years and nine months). Eight patients (17 percent)
had an additional anterior discectomy and arthrodesis without instrumentation, and
three (6 percent) had an additional decancellation eggshell osteotomy.
The forty-seven patients were followed for an average of forty-seven months
(range, twenty-four to 100 months). The complications were tabulated
to assess the safety of the procedure, and the correction of each
deformity was calculated to determine the efficacy.
Results: There were no deaths, acute wound infections,
or serious neurological problems. Reoperation was necessary in five
patients (11 percent). One reoperation was performed because of
a delayed deep wound infection; one, because of delayed sterile drainage;
and one, for a pseudarthrosis repair. The remaining two reoperations
were done for removal of an implant because the cephalad portion
had become prominent. In addition to the pseudarthrosis that required
a reoperation, there were three possible pseudarthroses that did
not require a reoperation (overall prevalence of pseudarthrosis,
9 percent). Postoperative bracing was used for eleven patients (23
percent); it did not influence the rate of pseudarthrosis or possible
pseudarthrosis.
The average preoperative scoliosis of 70 degrees was corrected
to 24 degrees (a 66 percent correction) at the time of the latest
follow-up, and the average preoperative pelvic obliquity of 27 degrees was
corrected to 5 degrees (an 81 percent correction). A survey of the
patients, parents, and caregivers indicated that 96 percent of them
were satisfied or very satisfied with the result of the operation.
Conclusions: Isola-Galveston instrumentation
seems as safe and effective as other types of instrumentation that have
been studied in comparable series in the literature. Isola-Galveston
instrumentation is probably more effective for the correction of
pelvic obliquity and the maintenance of correction. Only a posterior
procedure is used, and the instrumentation appears to decrease the
need for an additional anterior approach. Spinal hook, wire, screw,
and post anchors have been successfully integrated into one posterior
spinal implant system.
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