European Spine Journal

, Volume 28, Issue 3, pp 567–580 | Cite as

Factors associated with surgical approach and outcomes in cerebral palsy scoliosis

  • Taylor Jackson
  • Burt Yaszay
  • Paul D. Sponseller
  • Peter O. Newton
  • Suken A. Shah
  • Firoz Miyanji
  • Patrick J. CahillEmail author
  • The Harms Study Group
Original Article



Neuromuscular scoliosis is often treated with posterior spinal fusion, with or without anterior release, and either a same-day or staged, 2-day procedure.


We retrospectively reviewed 222 patients from a prospectively collected, multi-center database of patients with cerebral palsy scoliosis with 2-year follow-up. Baseline characteristics, perioperative, radiographic, and HRQoL measures were compared in six sub-analyses: (1) staged versus same-day surgeries, (2) posterior-only fusion (PSF) versus anterior–posterior spinal fusion (APSF), (3) same-day versus staged PSF, (4) staged versus same-day APSF, (5) same-day PSF versus same-day APSF, (6) staged PSF versus staged APSF.


Staged patients had larger curves and more pelvic obliquity, longer anesthesia and surgical times, longer hospital and ICU stays (p < 0.001), and more days intubated (p = 0.021). The staged PSF group had larger curves (p = 0.006), longer anesthesia (p = 0.020) and surgeries (p = 0.007), hospital (p = 0.009) and ICU stays (p = 0.028) compared to same-day PSF. The staged APSF group had longer hospital (p < 0.001) and ICU stays (p = 0.004) and anesthesia and surgeries (p < 0.001). Same-day APSF was associated with larger curves (p < 0.002), longer anesthesia (p = 0.012) and surgeries (p = 0.042), greater residual curves (p = 0.035), and greater absolute correction (p = 0.007) compared to same-day PSF. The staged APSF group had longer anesthesia times (p < 0.001) compared to the staged PSF group. No sub-analysis revealed significant differences in baseline characteristics, complications, or HRQoL.


Staged and circumferential approaches tend to be used for greater deformity, but were not associated with superior deformity correction, and were associated with longer operative time, hospital stays, ICU stays, and days intubated. However, for the most severe deformity, other patient factors may play more important roles in treatment decisions given that patients treated with a staged PSF or an APSF, whether staged or not, were similar at baseline.

Level of evidence


Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Cerebral palsy Neuromuscular scoliosis Posterior spinal fusion Anterior spinal fusion Staged fusion 



Research grants from DePuy Synthes Spine and from K2M to Setting Scoliosis Straight Foundation for Harms Study Group research efforts were received in support of this work.

Compliance with ethical standards

Conflict of interest

Disclosures relevant to submitted: Grant from the Setting Scoliosis Foundation, with research grants from DePuy Synthes Spine and K2M in support of Harms Study Group research. Disclosures outside of submitted: Consultancy/Personal fee—DePuy Synthes Spine, DePuy Synthes Canada, Cubist, K2M, Ellipse Technologies Inc., NuVasive, Medtronic Inc., Orthopediatrics, Stryker, Globus Medical; Royalties—DePuy Synthes Spine, Thieme Publishing, K2M; Investments/Options—Electrocore; Board membership—Setting Scoliosis Straight Foundation, Rady Children’s Specialists, AAOS, Scoliosis Research Society, International Pediatric Orthopedic Think Tank, Cubist, POSNA; Editorial Boards—JBJS-American, Spine Deformity; Other Financial/Research/Institutional Support—DePuy Synthes Spine, EOS Imaging, NuVasive, Orthopediatrics, K2M, Alphatech, Medtronic Inc. Patents/Product Development—DePuy Synthes Spine, Inc., K2M.

Supplementary material

586_2018_5745_MOESM1_ESM.pptx (140 kb)
Supplementary material 1 (PPTX 139 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Taylor Jackson
    • 1
  • Burt Yaszay
    • 2
  • Paul D. Sponseller
    • 3
  • Peter O. Newton
    • 4
  • Suken A. Shah
    • 5
  • Firoz Miyanji
    • 6
  • Patrick J. Cahill
    • 1
    Email author
  • The Harms Study Group
    • 7
  1. 1.Division of OrthopedicsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.San DiegoUSA
  3. 3.Johns Hopkins UniversityBaltimoreUSA
  4. 4.Rady Children’s Hospital, San DiegoSan DiegoUSA
  5. 5.Nemours/Alfred I duPont Hospital for ChildrenWilmingtonUSA
  6. 6.British Columbia Children’s HospitalVancouverCanada
  7. 7.Setting Scoliosis Straight FoundationSan DiegoUSA

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