Outcomes after scoliosis surgery for children with cerebral palsy: a systematic review (original) (raw)
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Complication rate after scoliosis surgery in children with cerebral palsy
Acta Orthopaedica Belgica
Scoliosis is an important problem in children with cerebral palsy (CP). However, the choice for a spinal fusion has to be weighed against the risks of major surgery in this vulnerable population. Paediatricians are frequently consulted preoperatively to assess the (respiratory) risk involved, but data on this question specific for CP are rare. Therefore, we investigated the complication rate after scoliosis surgery in children with CP, compared to idiopathic scoliosis (IS), and we searched for risk factors for the most common complications. In a retrospective monocenter study we analyzed the medical records from all children with CP and IS undergoing scoliosis surgery from 2010 until 2014. Duration of hospitalization and postoperative complications were compared within a 6-month follow-up. Univariate and multivariate logistic regression models were used to identify risk factors. The study included 44 patients with CP (mean age 15y0mo) and 78 patients with IS (mean age 14y6mo). Child...
The management of scoliosis in children with cerebral palsy: a review
Journal of spine surgery (Hong Kong), 2016
Children who suffer with cerebral palsy (CP) have a significant chance of developing scoliosis during their early years and adolescence. The behavior of this scoliosis is closely associated with the severity of the CP disability and unlike idiopathic scoliosis, it continues to progress beyond skeletal maturity. Conservative measures may slow the progression of the curve, however, surgery remains the only definitive management option. Advances in surgical technique over the last 50 years have provided methods to effectively treat the deformity while also reducing complication rates. The increased risk of surgical complications with these complex patients make decisions about treatment challenging, however with careful pre-operative optimization and post-operative care, surgery can offer a significant improvement in quality of life. This review discusses the development of scoliosis in CP patient, evaluates conservative and surgical treatment options and assesses post-operative outcome.
Risk Factors for Developing Scoliosis in Cerebral Palsy: A Cross-Sectional Descriptive Study
Journal of Child Neurology, 2017
This study aims to identify the risk factors leading to the development of severe scoliosis among children with cerebral palsy. A cross-sectional descriptive study of 70 children (aged 12-18 years) with severe spastic and/or dystonic cerebral palsy treated in a single specialist unit is described. Statistical analysis included Fisher exact test and logistic regression analysis to identify risk factors. Severe scoliosis is more likely to occur in patients with intractable epilepsy ( P = .008), poor gross motor functional assessment scores ( P = .018), limb spasticity ( P = .045), a history of previous hip surgery ( P = .048), and nonambulatory patients ( P = .013). Logistic regression model confirms the major risk factors are previous hip surgery ( P = .001), moderate to severe epilepsy ( P = .007), and female gender ( P = .03). History of previous hip surgery, intractable epilepsy, and female gender are predictors of developing severe scoliosis in children with cerebral palsy. This ...
Co-Morbidities in Children with Cerebral Palsy Undergoing Early Spine Fusion for Scoliosis
Journal of Nobel Medical College, 2014
Introduction: Children with Cerebral Palsy (CP) may have multisystem involvement the occurrence of which increases with severity of involvement. Scoliosis is also found to be more prevalent in severely involved children with CP. Aims: This study aimed to describe co-morbidities in children with CP undergoing early spine fusion for scoliosis. Methods: A retrospective review of patients with CP Scoliosis between 1989 and 206 who were <10 years at spine fusion was done. Demographics, mental status, pre-operative weight and height and body-mass index (BMI), curve characteristics, geographic pattern of involvement and GMFCS level were reported. Co-morbidities were broadly categorized as those involving central nervous system, gastrointestinal system and respiratory system. Results: 42 patients (24 male and 18 female) with mean age of 8.1 ±1.6 years at surgery were identified. The mean preoperative weight, height, and BMI were 22 ±6.8 kilograms, 115 ±11.8 centimeters and 16 ±3.7 respec...
Global Spine Journal
Study Design: Retrospective cohort. Objective: To provide a national-level assessment of the short-term outcomes after spinal deformity surgery in pediatric patients with cerebral palsy. Methods: A national, prospectively collected database was queried to identify pediatric (≤18 years) patients with cerebral palsy, who underwent spinal fusion surgery from 2012 to 2017. Separate multivariate analyses were performed for the primary outcomes of interest including extended length of stay (>75th percentile, >8 days), and readmissions within 90 days after the index admission. Results: A total of 2856 patients were reviewed. The mean age ± standard deviation was 12.8 ± 2.9 years, and 49.4% of patients were female. The majority of patients underwent a posterior spinal fusion (97.0%) involving ≥8 levels (79.9%) at a teaching hospital (96.6%). Top medical complications (24.5%) included acute respiratory failure requiring mechanical ventilation (11.4%), paralytic ileus (8.2%), and urinar...
Spine Deformity
Study design Observational. Objectives To report on the rate of major complications following spinal fusion and instrumentation to treat spinal deformity in patients with cerebral palsy (CP). Summary of background data Understanding the risk of major complications following the surgical treatment of spine deformities in patients with CP is critical. Methods A prospectively collected, multicenter database of patients with CP who had surgical correction of their spinal deformity (scoliosis or kyphosis) was reviewed for all major complications. Patients with ≥ 2 year follow-up or who died ≤ 2 years of surgery were included. A complication was defined as major if it resulted in reoperation, re-admission to the hospital, prolongation of the hospital stay, was considered life-threatening, or resulted in residual disability. Overall complication and revision rates were calculated for the perioperative (Peri-op; occurring ≤ 90 days postoperative) and delayed postoperative (Delayed; > 90 days) time periods. Results Two hundred and fifty-seven patients met inclusion. Seventy-eight (30%) patients had a major complication, 18 (7%) had > 1. There were 92 (36%) major complications; 64 (24.9%) occurred Peri-op. The most common Peri-op complications were wound (n = 16, 6.2%) and pulmonary issues (n = 28, 10.9%), specifically deep infections (n = 12, 4.7%) and prolonged ventilator support (n = 21, 8.2%). Delayed complications (n = 28, 10.9%) were primarily deep infections (n = 8, 3.1%) and instrumentation-related (n = 6, 2.3%). There were 42 additional surgeries for an overall unplanned return to the operating room rate of 16% (Peri-op: 8.6%, Delayed: 7.8%). Thirty-six (14.0%) reoperations were spine related surgeries (wound or instrumentation-related). Eleven (4.3%) patients died between 3 months to 5.6 years postoperatively; 4 occurred ≤ 1 year of surgery. Two deaths were directly related to the spinal deformity surgery. Conclusion Spinal deformity surgery in CP patients with greater than 2 years of follow-up have a postoperative major complication rate of 36% with a spine-related reoperation rate of 14.0%. Level of evidence Therapeutic-IV.
Complications of the Luque–Galveston scoliosis correction technique in paediatric cerebral palsy
Orthopaedics & Traumatology: Surgery & Research, 2010
Purpose of the study: Severe scoliosis is a very frequent condition in cerebral palsy children (CP). It is surgically managed, with unit rod instrumentation being the gold standard in Englishspeaking countries. The purpose of this work was to report on a small, homogeneous series of non-ambulatory, quadriplegic, spastic patients treated by the Luque-Galveston technique in Strasbourg, France. We present the radiographic outcome of the technique along with a full description of any post-operative complications encountered. Materials and methods: Twenty-eight children were operated on according to the Luque-Galveston technique between January 1997 and January 2006. This instrumentation, with fusion, included the whole spine from the sacrum to level T2. All procedures were performed as a one-stage posterior arthrodesis. The spinal deformities were single thoraco-lumbar curvatures, except in one patient. Both curve magnitude and pelvic obliquity were measured by X-ray pre-operatively, post-operatively and after longest follow-up (over 24 months). Our study focused on the rate of complications of this treatment. Only 16 patients out of 28 were tracked since the remaining 12 were lost to follow-up. Results: Mean curve magnitude was corrected from 80 • to 34.8 • (mean correction, 56.5%), and pelvic obliquity, from 20.9 • to 4.2 • (mean correction, 79.6%). Loss of correction at average 3.46-year follow-up was 3.9 • of curve magnitude and 2.7 • of pelvic obliquity. Mean operating time was 301.5 minutes, and average blood loss was 861.9 ml. Patients were discharged from hospital after an average 19.5-day stay, including mean 8.4-day intensive care unit stay. A single major complication, monocular blindness, occurred during the procedure, probably resulting from air embolism. Post-operative complications (totaling 57.1% of our 28 patients) were: one death, three pneumothoraxes, six segmental atelectasias, seven pneumonias and one superficial wound infection. Late-onset complications (totaling 56.2% of our 16 patients at latest follow-up) were: seven broken sublaminar wires, one iliac perforation by the rod, one skin Complications of the Luque-Galveston scoliosis correction technique 355 irritation from extreme malnutrition needing hardware removal, and three superficial sacral decubitus ulcers. Discussion: Our correction rate in children affected by CP and manifesting severe scoliosis is similar to that reported in the literature by different surgical teams. Moreover, we did not observe any deep wound infection, haematoma, septicaemia, neurological and digestive complications. Late-onset complications mainly involved asymptomatic sublaminar wire breakage at the two uppermost levels, but no major complication was due to hardware failure, and vertebral fracture did not occur. There was no need for re-intervention because of the hardware, except for one case in which extreme malnutrition provoked skin conflict with the rod. We encountered 10 ''windshield wiper'' effects in the iliac bone, but we believe they cannot be considered as complications since they seemed to disappear after fusion was fully obtained. Last but not least, unit rod instrumentation is not very expensive compared to more modern techniques. Conclusion: Correction of scoliosis and pelvic obliquity, attributed to CP in non-ambulatory children, by the Luque-Galveston technique is both an effective and safe choice in such an indication. Moreover, it is far less expensive than most other techniques, an aspect which should be taken into consideration.Level of evidence: Level IV retrospective therapeutic study.
The Long-term Outcome of Early Spine Fusion for Scoliosis in Children With Cerebral Palsy
Clinical Spine Surgery: A Spine Publication, 2014
Study Design: Retrospective review of radiographs and charts (case-only). Objective: The aim of this study was to describe the long-term outcomes of spine fusion for neuromuscular scoliosis in children below 10 years of age with cerebral palsy (CP). Summary of Background Data: Severely involved children with CP may develop early-onset scoliosis. The outcome of spine fusion is not clear and there are no studies focused on spine fusion in this young patient population. Methods: This is a retrospective review of 33 children who underwent spine fusion with unit-rod instrumentation between 1989 and 2006 for CP neuromuscular scoliosis, aged below 10 years at spine fusion, and with follow-up >5 years. Demographic, medical, and radiographic data were retrospectively assessed. Repeated measure analysis of variance and Kaplan-Meier survival estimates were used for data assessment. Results: Thirty-three of 42 patients who underwent spine fusion in this period, 19 boys and 14 girls, met the ...
Spine, 2016
Prospective longitudinal cohort OBJECTIVE.: Evaluate changes in caregivers' perceptions of health related quality of life (HRQOL) and caregiver burden in children with severe cerebral palsy (CP) following spinal fusion. Progressive scoliosis is common in non-ambulatory children with CP; the utility of spine fusion has been long debated and prospective evaluations of patient reported outcomes are limited. Children 3-21 years old, GMFCS IV-V CP, scheduled for spine fusion were enrolled consecutively from September 2011-March 2014. Caregivers completed the CPCHILD and ACEND pre-operatively and at 6 weeks, 3, 6, 12, and 24 months post-operatively. Changes in CPCHILD™ and ACEND scores from pre-operative to 1 and 2 years after surgery were assessed using paired t-tests. Correlations between pre-operative Cobb angle and CPCHILD™ and ACEND scores were evaluated using Pearson's correlation analysis. Twenty-six GMFCS IV-V CP patients with severe scoliosis treated with spine fusion wer...
Developmental Medicine & Child Neurology, 2021
Study Design: Prospective longitudinal cohort Objective:Evaluate changes in caregivers' perceptions of health related quality of life (HRQOL) and caregiver burden in children with severe cerebral palsy (CP) following spinal fusion. Summary of Background Data: Progressive scoliosis is common in non-ambulatory children with CP;the utility of spine fusion has been long debated and prospective evaluations of patient reported outcomes are limited. Methods:Children3-21 years old, GMFCS IV-V CP, scheduled for spine fusion were enrolled consecutively from September 2011-March 2014. Caregivers completed the CPCHILD ™ and ACEND pre-operatively and at 6 weeks, 3, 6, 12, and 24 months post-operatively.Changes in CPCHILD™ and ACEND scores from pre-operativeto 1 and 2 years after surgery were assessed using paired t-tests. Correlationsbetween pre-operative Cobb angle and CPCHILD™ and ACEND scores wereevaluated using Pearson's correlation analysis. Results:Twenty-six GMFCS IV-V CP patients with severe scoliosis treated with spine fusionwere included. Mean age was 14 years, 50% male, 46% had instrumentation to the pelvis. Average preoperative Cobb angle was 68.9° (SD 25.68) with an average improvement of 76%. The CPCHILD™ score increased by 9.8 points above baseline (95% CI: 3.4 to 16.2) at 1 year post-operatively (p=0.005). However, at 2 years, the CPCHILD™ score regressed to baseline (p=0.40).ACEND scores did not change from baseline scores at 1 year (p=0.09) and 2 year (0.72) follow-up; reflecting that caregiver burden is little changed by spine fusion. While there was no correlation between pre-operative Cobb angle and CPCHILD™ score (p=0.52) or ACEND score (p=0.56) at 1 year or 2 year follow-up (p=0.69, p=0.90). Children with Cob ≤ 75° experienced more improvement 1 year after surgery than children with Cobb >75°.