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Scoliosis surgery in cerebral palsy: differences between unit rod and custom rods
Paul D Sponseller1, Suken A Shah, Mark F Abel
1Departments of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287-0882, USA. psponse@jhmi.edu
Study Design:
Retrospective review.
Objective:
To evaluate the differences in intraoperative factors and postoperative results between pediatric patients with cerebral palsy (CP) treated with unit rods and those treated with custom-bent rods.
Summary Of Background Data:
No prior study has directly compared unit and custom-bent rods for CP.
Methods:
We retrospectively analyzed the clinical and radiographic data of 157 children with CP who underwent posterior spinal fusion. Of those 157, we treated 79 with unit rods and 78 with custom-bent rods. Minimum follow-up was 2 years.
Results:
Intraoperatively, unit rod surgeries were associated with significantly shorter mean surgical time (339 and 379 minutes, respectively; P = 0.04), longer mean intensive care unit stay (4 vs. 3 days, respectively; P = 0.001), and longer mean hospital stay (14 vs. 13 days; P = 0.006) than custom-bent rod procedures. The mean estimated blood loss was higher for unit rods (2124 vs. 1885 mL, respectively), but not significantly so. After surgery, unit rod surgeries were associated with significantly more mean pelvic obliquity correction (74% vs. 22%, respectively; P = 0.002), more mean clinically apparent implant prominence at 2-year follow-up (12 vs. 2 instances; P = 0.03; most were proximal), and a higher mean infection rate (15% vs. 5%, respectively; P = 0.03). There were no significant differences in final major Cobb correction, curves with an apex above or below T10, implant-related reoperations, or neurologic complications. The only factor that was statistically correlated with the overall complication rate for both groups was absolute curve magnitude (P = 0.04).
Conclusion:
Compared with custom-bent rods, unit rods provided superior correction of pelvic obliquity but were associated with higher transfusion requirements, higher infection rates, more proximal fixation problems, and longer intensive care unit and hospital stays.
