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Distal level in scoliosis surgery for non-ambulatory patients with cerebral palsy: is L5 an option? A case series study

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Abstract

Purpose

This study aimed to determine the radiographic outcomes of patients with cerebral palsy (CP) who underwent posterior spinal fusion from T2/3 to L5 at two quaternary hospitals.

Methods

From January 2010 to January 2020, 167 non-ambulatory patients with CP scoliosis underwent posterior spinal fusion using pedicle screws from T2/3 to L5 in both centers, with a minimum of 2 years follow-up (FU). Radiological measurements and chart reviews were performed.

Results

A total of 106 patients aged 15.6 ± 0.4 years were included. None of the patients was lost to FU. All patients had significant correction of the Cobb angle (MC) and pelvic obliquity (PO), thoracic kyphosis (TK), and lumbar lordosis (LL), without loss of correction at the last FU (LFU). The mean values for preoperative, immediate postoperative, and LFU were MC 93.4°, 37.5°, and 42.8°; PO 25.8°, 9.9°, and 12.7°; TK 52.2°, 44.3°, and 45°; and LL − 40.9°, − 52.4°, and − 52.9°, respectively. Higher residual PO at LFU was associated with more severe MC and PO baselines, lower implant density, and an apex located at L3.

Conclusions

CP scoliosis and PO can be corrected, and this correction is maintained over time with posterior spinal fusion using pedicle screws, with L5 as the lowest instrumented vertebra. Larger preoperative MC and PO values associated with the apex at L3 appear to be related to residual PO. Comparative large-scale studies of patient-related clinical outcomes are required to determine whether this intervention is associated with improved surgical outcomes and reduced complication rates.

Level of evidence

IV.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK

    Ruben Alejandro Morales Ciancio, Stewart Tucker, Thomas Ember, Mark Harris & Edel Broomfield

  2. Paediatric Spine Department, Evelina London Children Hospital, London, UK

    Jonathan Lucas

Authors
  1. Ruben Alejandro Morales Ciancio
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  2. Jonathan Lucas
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  3. Stewart Tucker
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  4. Thomas Ember
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  5. Mark Harris
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  6. Edel Broomfield
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Contributions

RAMC: made substantial contributions to the conception, design, analysis, major revisions and interpretation of data; drafted and critically revised the work, approved the version to be published, and agrees to be accountable for all aspects of the work. JL, ST, MH: made substantial contributions to the analysis, and revision and interpretation of data; drafted and revised the work, approved the version to be published, and agree to be accountable for all aspects of the work. ST, TE, MH, EB: revised the work, approved the version to be published, and agree to be accountable for all aspects of the work. TE: made substantial contributions to the analysis and interpretation of data and revised the manuscript. EB: made substantial contributions to the design, analysis, revision, and interpretation of data.

Corresponding author

Correspondence to Ruben Alejandro Morales Ciancio.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare relevant to the content of this article.

Ethics approval

Ethical approval was waived by the local Ethics Committee of Great Ormond Street Hospital under the number GOSH3034 in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Morales Ciancio, R.A., Lucas, J., Tucker, S. et al. Distal level in scoliosis surgery for non-ambulatory patients with cerebral palsy: is L5 an option? A case series study. Spine Deform 11, 1467–1475 (2023). https://doi.org/10.1007/s43390-023-00722-w

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  • DOI: https://doi.org/10.1007/s43390-023-00722-w

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