TY - JOUR
T1 - Growing rods for the treatment of scoliosis in children with cerebral palsy
T2 - A critical assessment
AU - McElroy, Mark J.
AU - Sponseller, Paul D.
AU - Dattilo, Jonathan R.
AU - Thompson, George H.
AU - Akbarnia, Behrooz A.
AU - Shah, Suken A.
AU - Snyder, Brian D.
PY - 2012/11/15
Y1 - 2012/11/15
N2 - STUDY DESIGN.: Retrospective analysis. OBJECTIVE.: To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. SUMMARY OF BACKGROUND DATA.: Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. METHODS.: From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. RESULTS.: Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14°± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43°± 28°; PO, 2°± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P < 0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45% were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30%). CONCLUSION.: GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30% of patients experienced deep wound infection.
AB - STUDY DESIGN.: Retrospective analysis. OBJECTIVE.: To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. SUMMARY OF BACKGROUND DATA.: Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. METHODS.: From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. RESULTS.: Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14°± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43°± 28°; PO, 2°± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P < 0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45% were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30%). CONCLUSION.: GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30% of patients experienced deep wound infection.
KW - cerebral palsy
KW - complication
KW - growing rods
KW - pelvic obliquity
KW - scoliosis
UR - http://www.scopus.com/inward/record.url?scp=84870248707&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84870248707&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e31826fabd3
DO - 10.1097/BRS.0b013e31826fabd3
M3 - Article
C2 - 22926278
AN - SCOPUS:84870248707
SN - 0362-2436
VL - 37
SP - E1504-E1510
JO - Spine
JF - Spine
IS - 24
ER -