Surgical correction of spinal deformity in patients with cerebral palsy using pedicle screw instrumentation.

STUDY

DESIGN

Retrospective review of a prospectively collected single surgeon's series.

OBJECTIVE

To investigate the efficacy of pedicle screw instrumentation in correcting spinal deformity in patients with quadriplegic cerebral palsy. In addition to assess quality-of-life and functional improvement after deformity correction as perceived by the parents of our patients.

SUMMARY OF BACKGROUND DATA: All pedicle screw constructs have been commonly used to correct adolescent idiopathic scoliosis. There is limited information on their effectiveness in treating patients with cerebral palsy and neuromuscular scoliosis.

METHODS

We reviewed the medical records and serial radiographs of 45 consecutive patients with quadriplegia who underwent spinal arthrodesis using pedicle screw/rod instrumentation and a standardized surgical technique. All patients were wheelchair bound with collapsing thoracolumbar scoliosis and pelvic obliquity. Twenty-eight patients had associated sagittal deformities. A telephone survey was performed by an independent investigator to assess parents' perception on surgical outcome.

RESULTS

Thirty-eight patients underwent posterior-only and 7 staged anteroposterior spinal arthrodesis. Mean age at surgery was 13.4 years (range: 9 to 18.3 y) and mean postoperative follow-up was 3.5 years (range: 2.8 to 5 y). Pedicle screw instrumentation extended from T2/T3 to L5 with bilateral pelvic fixation using iliac bolts. Scoliosis was corrected from mean 82.5 to 21.4 degree (74.1%). Pelvic obliquity was corrected from mean 24 to 4 degree (83.3%). In posterior-only procedures, average blood loss was 0.8 blood volumes, intensive care unit stay 3.5 days, and hospital stay 17.6 days. In anteroposterior procedures, average blood loss was 0.9 blood volumes, intensive care unit stay 8.9 days, and hospital stay 27.4 days. Major complications included 1 deep infection and 1 reoperation to remove prominent implants but no deaths, no neurological deficit, and no detected pseudarthrosis. Parents' survey showed 100% satisfaction rate.

CONCLUSIONS

Pedicle screw instrumentation can achieve excellent correction of spinal deformity in quadriplegic cerebral palsy with low complication and re-operation rates and high parent satisfaction.