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Definitive fusion for scoliosis in late juvenile cerebral palsy patients is durable at 5 years postoperatively

Abstract

Purpose

Given the challenges associated with managing progressive scoliosis in patients with cerebral palsy (CP), the purpose of this study was to evaluate deformity correction and HRQOL 5 years post-spinal fusion in CP patients who were skeletally immature at the time of surgical correction.

Methods

CP patients who underwent definitive fusion before age 11 with minimum 5-years follow-up from a prospective, multicenter registry were included. Preoperative, initial postoperative, and 5-years radiographic data were collected. Preoperative and 5-years demographic, surgical data, complications, and CPCHILD outcome scores were analyzed. Repeated measures ANOVA with Bonferroni adjustment were used to analyze radiographic measures. Paired t test was utilized to compare outcomes. Significance was set at p = 0.05.

Results

Twenty patients met inclusion—17 females, 3 males. The mean age was 9 (range 8–10) years. Eight-five percent had spastic CP with GMFCS Level V. Eighteen patients underwent posterior fusion; distal fixation was to the ilium in 80% and to L4-S1 in 20%. Significant correction of the primary curve (p ≤ 0.001) and pelvic obliquity (p ≤ 0.001) were obtained. From initial postoperative to 5-years follow-up there were no significant changes in major curve magnitude (p = 0.638), thoracic kyphosis (p = 0.09) or pelvic obliquity (p = 0.28). CPCHILD personal care, mobility, comfort, and total scores improved from preoperative to 5-years (p < 0.05). One patient needed a reoperation.

Conclusion

Surgical decision making for scoliosis in patients with CP can be difficult given the desire to maximize growth while minimizing adverse events. Performing a definitive fusion is a viable option that achieves good correction which remains stable 5 years postoperatively.

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Acknowledgements

This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration.

Harms Study Group Investigators: Aaron Buckland, MD; Royal Children’s Hospital – Melbourne Australia; Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia; Amit Jain, MD; Johns Hopkins Hospital; Baron Lonner, MD; Mount Sinai Hospital; Benjamin Roye, MD; Columbia University; Burt Yaszay, MD; Rady Children’s Hospital; Chris Reilly, MD; BC Children’s Hospital; Daniel Hedequist, MD; Boston Children’s Hospital; Daniel Sucato, MD; Texas Scottish Rite Hospital; David Clements, MD; Cooper Bone & Joint Institute New Jersey; Firoz Miyanji, MD; BC Children’s Hospital; Harry Shufflebarger, MD; Paley Orthopedic & Spine Institute; Jack Flynn, MD; Children’s Hospital of Philadelphia; John Asghar, MD; Paley Orthopedic & Spine Institute; Jean Marc Mac Thiong, MD; CHU Sainte-Justine; Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia; Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad; Keith Bachmann, MD; University of Virginia; Lawrence Lenke, MD; Columbia University; Lori Karol, MD; Children’s Hospital, Denver Colorado; Mark Abel, MD; University of Virginia; Mark Erickson, MD; Children’s Hospital, Denver Colorado; Michael Glotzbecker, MD; Rainbow Children’s Hospital, Cleveland; Michael Kelly, MD; Washington University; Michael Vitale, MD; Columbia University; Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation; Munish Gupta, MD; Washington University; Nicholas Fletcher, MD; Emory University; Noelle Larson, MD; Mayo Clinic Rochester Minnesota; Patrick Cahill, MD; Children’s Hospital of Philadelphia; Paul Sponseller, MD; Johns Hopkins Hospital; Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children; Peter Newton, MD; Rady Children’s Hospital; Peter Sturm, MD; Cincinnati Children’s Hospital; Randal Betz, MD; Institute for Spine & Scoliosis; Stefan Parent, MD: CHU Sainte-Justine; Stephen George, MD; Nicklaus Children's Hospital; Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia; Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children; Sumeet Garg, MD; Children’s Hospital, Denver Colorado; Tom Errico, MD; Nicklaus Children's Hospital; Vidyadhar Upasani, MD; Rady Children’s Hospital.

Funding

No funding was received for this work.

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Authors and Affiliations

Authors

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Contributions

BY, PDS, SAS, FM, AFS, RH, PON: conception or design of the work; or acquisition, analysis, or interpretation of data for the work; BY, PDS, SAS, FM, AFS, RH, PON: drafting or critically revising the work; BY, PDS, SAS, FM, AFS, RH, PON: final approval of the version to be published.

Corresponding author

Correspondence to Burt Yaszay.

Ethics declarations

Conflict of interest

Roland Howard, MD: No Conflicts; Paul Sponseller, MD: During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from DePuy Synthes Spine. Suken A. Shah, MD: During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from DePuy Synthes Spine. Firoz Miyanji, MD: During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from Depuy Synthes Spine, personal fees from Stryker Spine, personal fees from Zimmer Biomet. Amer F. Samdani, MD: During the conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the submitted work: personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet. Peter O. Newton, MD: During the conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the submitted work: grants and other from Setting Scoliosis Straight Foundation, other from Rady Children's Specialists, grants, personal fees and non-financial support from DePuy Synthes Spine, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, grants from NuVasive, other from Electrocore, personal fees from Cubist, other from International Pediatric Orthopedic Think Tank, grants, non-financial support and other from Orthopediatrics, grants, personal fees and non-financial support from Stryker/K2M, grants and non-financial support from Alphatech, grants from Mazor Robotics, personal fees from MiRus, personal fees from Globus Medical, personal fees from Pacira, from Scoliosis Research Society. In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) licensed to DePuy Spine, Inc., a patent Screw placement guide (7981117) licensed to DePuy Spine, Inc., a patent Compressor for use in minimally invasive surgery (7189244) licensed to DePuy Spine, Inc., and a patent Posterior spinal fixation pending to K2M. Burt Yaszay, MD: During the conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the submitted work: grants and personal fees from DePuy Synthes Spine, grants and personal fees from Nuvasive, personal fees from Medtronic, grants and personal fees from Orthopediatrics, grants and personal fees from K2M/Stryker, personal fees from Globus, grants from Setting Scoliosis Straight Foundation, personal fees from Biogen. In addition, Dr. Yaszay has a patent K2M/Stryker with royalties paid.

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IRB approval was obtained for this study and consent was obtained from all subjects.

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The members of the Harms Study Group Investigators was processed under acknowledgements section.

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Howard, R., Sponseller, P.D., Shah, S.A. et al. Definitive fusion for scoliosis in late juvenile cerebral palsy patients is durable at 5 years postoperatively. Spine Deform (2022). https://doi.org/10.1007/s43390-022-00530-8

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Keywords

  • Juvenile
  • Cerebral Palsy
  • Neuromuscular scoliosis
  • Definitive fusion