Definitive fusion for scoliosis in late juvenile cerebral palsy patients is durable at 5 years postoperatively.

Abstract

Given the challenges associated with managing progressive scoliosis in patients with cerebral palsy (CP), the purpose of this study was to evaluate deformity correction and HRQOL 5 years post-spinal fusion in CP patients who were skeletally immature at the time of surgical correction. CP patients who underwent definitive fusion before age 11 with minimum 5-years follow-up from a prospective, multicenter registry were included. Preoperative, initial postoperative, and 5-years radiographic data were collected. Preoperative and 5-years demographic, surgical data, complications, and CPCHILD outcome scores were analyzed. Repeated measures ANOVA with Bonferroni adjustment were used to analyze radiographic measures. Paired t test was utilized to compare outcomes. Significance was set at p = 0.05. Twenty patients met inclusion-17 females, 3 males. The mean age was 9 (range 8-10) years. Eight-five percent had spastic CP with GMFCS Level V. Eighteen patients underwent posterior fusion; distal fixation was to the ilium in 80% and to L4-S1 in 20%. Significant correction of the primary curve (p ≤ 0.001) and pelvic obliquity (p ≤ 0.001) were obtained. From initial postoperative to 5-years follow-up there were no significant changes in major curve magnitude (p = 0.638), thoracic kyphosis (p = 0.09) or pelvic obliquity (p = 0.28). CPCHILD personal care, mobility, comfort, and total scores improved from preoperative to 5-years (p < 0.05). One patient needed a reoperation. Surgical decision making for scoliosis in patients with CP can be difficult given the desire to maximize growth while minimizing adverse events. Performing a definitive fusion is a viable option that achieves good correction which remains stable 5 years postoperatively.