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[Experience in operations for scoliosis in patients with cerebral palsy]
N Schmelzer-Schmied1, B G Ochs, C Carstens
1Sektion Kinder-, und Wirbelsäulenchirurgie, Stiftung Orthopädische Universitätsklinik Heidelberg. Nicole.Schmelzer-Schmied@ok.uni-heidelberg.de
Aim:
Experiences in operation of scoliosis in cerebral palsy are very different. Therefore a therapeutic regiment does not exist. In this study we want to report our experiences.
Methods:
This retrospective-clinical study (1986-2003) includes 46 patients with cerebral palsy who had been operated for scoliosis. The data focus in particular on the therapeutic strategies and its success and complications. Publications from 1946 to 2003 were reviewed and served for comparison.
Results:
28 female and 18 men during one period by median 3.4 years were after-observed. The post office-operationally reached correction of the curvature of all operation procedures was appropriate for median between 51 and 68 % depending upon localization of the curvature. In the last re-examination median a correction loss of 3-25 % existed. A fusion to S1 corrected a thoraco-lumbale or lumbale scoliosis significantly better than a fusion to L5. The posterior and the combined posterior-anterior operation procedure showed comparable correction results. The total complication rate was with 35 %.
Conclusions:
Due to good correction successes and smaller complication rate we favor a posterior-anterior operation procedure. A fusion to S1 is indicated with thoraco-lumbale and lumbale fusion. Altogether complication rate was reduced in patients with scoliosis and cerebral palsy after operation at the spinal column in the last years.
