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Post-operative steroids in patients with patients with severe cerebral palsy undergoing posterior spinal fusion

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Abstract

Introduction

Posterior spinal fusion (PSF) represents a large physiologic challenge for children with neuromuscular scoliosis (NMS). Perioperative complications are numerous with many occurring in the post-operative period due to pain and relative immobilization. This study assessed the impact of steroids on patients undergoing PSF for NMS.

Methods

A retrospective review of consecutive patients managed at a single center with PSF for NMS was reviewed. Clinical and radiographic analysis was used to evaluate baseline demographics, curve characteristics, and post-operative course.

Results

Eighty-nine patients who underwent PSF for NMS were included. Fifty-seven of these patients did not receive post-operative steroids (NS) while 32 patients were treated with post-operative steroids (dexamethasone, WS) for a median of 3 doses (median 6.0 mg/dose every 8 h after surgery). The demographic variables of the cohorts were similar with no difference in curve magnitude, number of vertebrae fused, number of osteotomies, or EBL between groups. A 70% decrease in the median post-operative morphine equivalents was observed in the steroid cohort (0.50 mg/kg WS vs 1.65 mg/kg NS, p value < 0.001). There was an association between post-operative morphine equivalents and length of stay (Spearman’s rho = 0.22, p value = 0.04). There was no difference in wound healing, infection, and pulmonary or gastrointestinal complications between groups. No difference was found in pain at discharge, 30-day ED returns, or 30-day OR returns between groups.

Conclusions

Post-operative dexamethasone resulted in a 70% decrease in morphine equivalent use after PSF for NMS without any increase in perioperative wound infections.

Level of evidence

Level 3: case–control series.

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Data availability

Deidentified data are available on request.

Code availability

Not applicable.

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Funding

Funding was provided through the Harrison Foundation.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Clinical Practice Group, Children’s Healthcare of Atlanta, 1400 Tullie Rd NE, Atlanta, GA, 30329, USA

    Tracy Ruska, Robert W. Bruce Jr & Nicholas D. Fletcher

  2. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, 32610, USA

    Thomas M. Austin

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  4. Nicholas D. Fletcher
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Contributions

NDF: study design, data collection, writing original draft preparation, approval of final version of manuscript, and agreed to be accountable for the work. TA: conducted statistical analyses, wrote “Data Analysis” section of the manuscript and provided revisions to the manuscript, and agreed to be accountable for the work. RWB: contributed to the research design, edited and approved final version of manuscript, and agreed to be accountable for the work. TR: study design, data collection, approval of final version of manuscript, and agreed to be accountable for the work.

Corresponding author

Correspondence to Nicholas D. Fletcher.

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Conflict of interest

NF: reports consulting fees from Orthopaediatrics, Nuvasive, and Medtronic; speakers fees from Orthopaediatrics, Nuvasive, and Zimmer Biomet; grant support from the Harrison Foundation and POSNA; Board Membership with the Children’s Healthcare of Atlanta. TR, RB, and TA: declare no conflicts of interest.

Ethical approval

This study received full approval from the institutional review board (IRB) including review by the IRB ethics committee.

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As this study was retrospective, need for consent was waived.

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IRB approval was obtained.

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Ruska, T., Austin, T.M., Bruce, R.W. et al. Post-operative steroids in patients with patients with severe cerebral palsy undergoing posterior spinal fusion. Spine Deform 11, 415–422 (2023). https://doi.org/10.1007/s43390-022-00603-8

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