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Residual lumbar hyperlordosis is associated with worsened hip status 5 years after scoliosis correction in non-ambulant patients with cerebral palsy

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Abstract

Background

Cerebral palsy (CP) is a static encephalopathy with progressive musculoskeletal pathology. Non-ambulant children (GMFCS IV and V) with CP have high rates of spastic hip disease and neuromuscular scoliosis. The effect of spinal fusion and spinal deformity on hip dislocation following total hip arthroplasty has been well studied, however in CP this remains largely unknown. This study aimed to identify factors associated with worsening postoperative hip status (WHS) following corrective spinal fusion in children with GMFCS IV and V CP.

Methods

Retrospective review of GMFSC IV and V CP patients in a prospective multicenter database undergoing spinal fusion, with 5 years follow-up. WHS was determined by permutations of baseline (BL), 1 year, 2 years, and 5 years hip status and defined by a change from an enlocated hip at BL that became subluxated, dislocated or resected post-op, or a subluxated hip that became dislocated or resected. Hip status was analyzed against patient demographics, hip position, surgical variables, and coronal and sagittal spinal alignment parameters. Cutoff values for parameters at which the relationship with hip status was significant was determined using receiver operating characteristic curves. Logistic regression determined odds ratios for predictors of WHS.

Results

Eighty four patients were included. 37 (44%) had WHS postoperatively. ROC analysis and logistic regression demonstrated that the only spinopelvic alignment parameter that significantly correlated with WHS was lumbar hyperlordosis (T12-L5) > 60° (p = 0.028), OR = 2.77 (CI 1.10–6.94). All patients showed an increase in pre-to-postop LL. Change in LL pre-to-postop was no different between groups (p = 0.318), however the WHS group was more lordotic at BL and postop (pre44°/post58° vs pre32°/post51° in the no change group). Age, sex, Risser, hip position, levels fused, coronal parameters, global sagittal alignment (SVA), thoracic kyphosis, and reoperation were not associated with WHS.

Conclusion

Postoperative hyperlordosis(> 60°) is a risk factor for WHS at 5 years after spinal fusion in non-ambulant CP patients. WHS likely relates to anterior pelvic tilt and functional acetabular retroversion due to hyperlordosis, as well as loss of protective lumbopelvic motion causing anterior femoracetabular impingement.

Level of evidence

III.

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Funding

Support provided by The Harms Study Group (HSG) and the Setting Scoliosis Straight Foundation. The collaboration and non-financial support of the NHMRC funded Centre of Research Excellence in Cerebral Palsy (CPAchieve) is acknowledged.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA

    Aaron J. Buckland, Dainn Woo, Dennis Vasquez-Montes & Thomas J. Errico

  2. The Royal Children’s Hospital, University of Melbourne, Melbourne, Australia

    Aaron J. Buckland & H. Kerr Graham

  3. Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Patrick Cahill

  4. Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA

    Paul D. Sponseller

  5. Melbourne Orthopaedic Group, Melbourne, Australia

    Aaron J. Buckland

Authors
  1. Aaron J. Buckland
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Harms Study Group

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DW, DVM and AJB. The first draft of the manuscript was written by DW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript, and agree to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Aaron J. Buckland.

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IRB approval

IRB approval was obtained at each participating site and informed consent was given by each patient. Spine Research Center - NYU Langone Health, Department of Orthopaedic Surgery, Spine Division.

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Buckland, A.J., Woo, D., Kerr Graham, H. et al. Residual lumbar hyperlordosis is associated with worsened hip status 5 years after scoliosis correction in non-ambulant patients with cerebral palsy. Spine Deform 9, 1125–1136 (2021). https://doi.org/10.1007/s43390-020-00281-4

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  • DOI: https://doi.org/10.1007/s43390-020-00281-4

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