Mortality and Causes of Death in Children With Cerebral Palsy With Scoliosis Treated With and Without Surgery.

Abstract

To compare mortality and causes of death in scoliotic children with cerebral palsy (CP) with and without scoliosis surgery. National population-based registries were searched for children with CP and scoliosis with and without surgery for scoliosis and were analyzed for comorbidities, mortality, and causes of death. Two hundred thirty-six had not been operated and 238 had been operated on for scoliosis during the median follow-up of 17.8 (interquartile range [IQR] 11.7-25.7) and 23.0 (IQR 18.4-28.2) years, respectively. Both groups had similar comorbidities. During the follow-up, mortality was higher in the nonsurgically treated group than in the surgically treated group (n = 38/236, 16% and 8.7 per 1,000 follow-up years vs n = 29/238, 12% and 5.3 per 1,000 follow-up years, <i>p</i> = 0.047). In patients with nonsurgical treatment, the cause of death was respiratory in 76.3% (29/38) and 37.9% (11/29) in patients with surgical treatment of scoliosis (6.6 and 2.0 per 1,000 follow-up years, <i>p</i> = 0.002). Neurologic causes of death were more common in surgically treated patients than in nonsurgically treated patients, 44.8% (13/29) and 15.8% (6/38), respectively (3.0 and 1.1 per 1,000 follow-up years, <i>p</i> = 0.009). Surgical treatment of scoliosis associates to reduced mortality because of respiratory causes in children with CP and scoliosis. This study provides Class IV evidence of the effects of spinal fusion on mortality of children with severe scoliosis due to CP.