Revision spine surgery in children with cerebral palsy

Ten children with neuromuscular scoliosis and pelvic obliquity had revision spinal instrumentations and fusions performed at an average age of 14.7 years. The initial spinal deformity in all children was the result of static encephalopathy with nine children diagnosed as having spastic cerebral palsy without another specific diagnosis and one child diagnosed as also having Noonan syndrome. All 10 children had a revision performed after the first surgery, and two of the 10 children underwent a second revision because of failure of rod cross-links. The indications for revision surgery were symptomatic recurrent deformity, symptomatic pseudoarthrosis, or perforation of one leg of the unit rod through the pelvis. The average time between the first and second surgery was 2.7 years, and from revision to final follow-up was 2.5 years. The goal of providing symptomatic relief and correction of deformity was accomplished in nine of 10 children; however, two of the nine required two revisions. One patient continues to have a residual painful pseudoarthrosis. The two postoperative complications requiring further surgery were related to the failure of rod connectors.