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Surgical correction of spinal deformity using a unit rod in children with cerebral palsy
Insights
Posterior spinal fusion effectively corrects scoliosis and pelvic obliquity in cerebral palsy patients. Most caretakers reported improved sitting comfort and recommended the procedure for other children.
Area of Science:
- Orthopedic Surgery
- Pediatric Spine Deformity
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) frequently leads to neuromuscular scoliosis, significantly impacting patient function and comfort.
- Spinal fusion is a common surgical intervention for severe spinal deformities in this population.
Purpose of the Study:
- To evaluate the efficacy and outcomes of posterior spinal fusion using unit rod instrumentation with sublaminar wires for cerebral palsy patients with neuromuscular scoliosis.
- To assess the correction of spinal curvature and pelvic obliquity, as well as patient-reported functional improvements and complication rates.
Main Methods:
- A retrospective analysis of 31 patients with CP and neuromuscular scoliosis who underwent posterior spinal fusion with unit rod and sublaminar wires.
- Surgical techniques included one-stage posterior fusion or combined anterior-posterior fusion.
- Outcomes measured included curve correction, pelvic obliquity correction, complications, and caretaker-reported functional status via questionnaires.
Main Results:
- Significant correction of scoliosis (mean 79° to 18°) and pelvic obliquity (mean 25° to 4°) was achieved and maintained.
- No cases of pseudarthrosis or hardware failure were reported.
- Complications included two deep-wound infections.
- 65% of patients experienced improved sitting comfort, and 86% of caretakers recommended spinal fusion for other children.
Conclusions:
- Posterior spinal fusion with unit rod and sublaminar wires is an effective surgical option for correcting neuromuscular scoliosis in cerebral palsy.
- The procedure yields significant and durable spinal and pelvic alignment correction.
- Functional improvements in sitting comfort and high caretaker satisfaction support the recommendation of this surgical approach.
Abstract:
Thirty-one patients with cerebral palsy and neuromuscular scoliosis underwent instrumentation with a unit rod fixed with sublaminar wires and posterior spine fusion. The mean curve measured 79 degrees preoperatively, 19 degrees immediately postoperatively, and 18 degrees at final follow-up of 2.8 years, excluding two patients who died and four who were lost to follow-up after < 12 months. The preoperative pelvic obliquity was 25 degrees, which was initially corrected to 3 degrees and remained unchanged at 4 degrees at final follow-up. Twenty-four patients underwent a one-stage posterior fusion, and seven patients underwent both anterior and posterior fusions. Complications included one acute deep-wound infection and one late deep-wound infection seeded from the urinary tract. No pseud-arthroses or hardware failures have occurred to date. Seven children with open triadiate cartilages had a posterior spinal fusion only and were followed up to skeletal maturity with a 3 degrees loss of correction of the scoliosis and a 0 degree loss of correction of pelvic obliquity. Questionnaires filled out by primary caretakers demonstrated that the objective of improving the child's ability to sit more comfortably was accomplished for the majority (65%) of patients. Spinal fusion was recommended for other children by 86% of interviewed caretakers.