Aim: The aim of this study is to prospectively evaluate the functional outcome of surgical correction in 20 patients with a significant neuromuscular scoliosis.

Method and Results: The principal objective of surgical correction of neuromuscular spinal deformity should be to maintain or improve function of the patient, but there is little evidence to support this. In wheelchair dependent patients the goal is also to maintain sitting ability, and in ambulant patients prevention of further deformity is important. Studies formally quantifying these outcome parameters have not been published with modern surgical techniques.

A consecutive series of 20 children with neuromuscu-lar scoliosis (age range 2–18 years) undergoing surgical correction were evaluated using 2 standard functional assessment tools, the Seated Postural Control Measure (SPCM) which assesses posture and function, and the Pediatric Evaluation of Disability Inventory (PEDI) which records functional ability in the domains of self-care, mobility and social function. The patients were evaluated pre-operatively and then at 2 weeks, 3 and 12 months post-operatively.

Complete data is presented for all patients at 3 months and 13 of 20 patients at 1 year follow up, the remaining data is to be collected.

The SPCM demonstrated an improvement in posture in 95% from pre-op to 2 weeks post-op, with 25% demonstrating some regression at 3 months. Most maintained or improved this at 1 year. The PEDI demonstrated a reduction in mobility at 3 months but at 1 year 60% returned to preop status.

Conclusion: Sitting position is improved by surgery, but mobility is impaired for a significant period following the correction, which may have more impact on the child’s and families life. Families need to be counselled prior to surgery about the loss of mobility and ability to self-care post operatively but that it does return by one year.

Aim: This study measures the outcomes of surgery for neuromuscular scoliosis using patient/ carer goal setting techniques.

Method and Results: In neuromuscular scoliosis, the objective of surgery is to maintain or improve sitting ability and to improve overall function. Measuring the outcome of surgery by patient/carer grading of patient/ carer set goals has not been used in this patient group.

A group of 20 children who underwent spinal fusion for neuromuscular scoliosis were assessed using a postural and functional measure pre-op, post-op, and at 3 and 12 months post-op. In addition, each patient was asked to record three goals for undergoing the surgery. At one year post op, patient/carers were asked to grade on a scale of 0 – 10, how satisfied they were that the goals had been achieved.

Nineteen patients had clear pre-op goals for the surgery relating to functional activities. The most frequent goals stated for the non-ambulant children were- sitting for longer periods (7/46), making dressing easier (7/46) and sitting more upright (6/38). There were 15 other functional goals stated. The ambulant children stated- appearing straighter (3/12), increase in confidence (2/12), reducing pain (2/12) and maintaining respiratory function (2/12). There were 3 other functional goals stated. Seventeen patients completed the study, 2 were lost to follow up, 1 died. The average satisfaction rate from goals achieved 1 year post-op was 7.9/10.

Conclusion: Establishing goals that are realistic and contribute positively to the functional ability or practical management of the child with neuromuscular scoliosis undergoing spinal surgery, encourages the family to be central in the decision making process. It also allows unrealistic expectations to be discussed pre-op and represents the most patient centred method of outcome assessment.