Skip to main content

Advertisement

SpringerLink
Log in

Surgical Treatment of Scoliosis in Non-Ambulatory Spastic Quadriplegic Cerebral Palsy Patients: A Matched Cohort Comparison of Unit Rod Technique and All-Pedicle Screw Constructs

  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Matched cohort.

Objective

To compare the unit rod instrumentation (UR) technique with all—pedicle screw (PS) constructs in the surgical care of scoliosis in Gross Motor Function Classification System IV/V non-ambulatory spastic quadriplegic cerebral palsy patients.

Summary of Background Data

Over the past 20 years, there has been a transition from the UR technique to the use of pedicle screws and iliac screws in neuromuscular scoliosis. To date, no head-to-head comparative analysis has been reported between the UR technique and PS constructs for posterior segmental spinal instrumentation and fusion in cerebral palsy patients.

Methods

A matched cohort study was performed between 2 tertiary-care pediatric centers: 1 using UR technique and the other PS constructs. Minimum follow-up was 2 years postoperatively (PS 2.5 years, UR 4.6 years, not significant). Fourteen patients were matched from each center based on age (mean age: PS 15.4 years, UR 15.5 years), preoperative pelvic obliquity (mean: PS 33.8°, UR 29.1°) and major coronal Cobb angle (mean: PS 100.9°, UR 100.1°).

Results

There was posterior-only surgery in 14 of 14 PS and 11 of 14 UR surgeries. The final follow-up Cobb angle was lower in the PS group (13.5° vs. 34.3°, p <.05), with 86.5% correction in the PS group and 65.7% in the UR group. Final follow-up pelvic obliquity was similar (PS 8.5° vs. UR 3.3°; not significant). There were no major complications in the PS group. In the UR group, there was 1 deep infection and 1 reoperation for removal of a prominent sublaminar wire.

Conclusions

This is the first study to directly compare UR with PS constructs using matched patient cohorts in this patient population. All—pedicle screw constructs had better correction of coronal Cobb angle, lower blood loss, and shorter hospital stays. There was no difference in the correction of pelvic obliquity, complications, or reoperations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214–23.

    Article  CAS  Google Scholar 

  2. Sink EL, Newton PO, Mubarak SJ, Wenger DR. Maintenance of sagittal plane alignment after surgical correction of spinal deformity in patients with cerebral palsy. Spine (Phila Pa 1976) 2003;28:1396–403.

    Google Scholar 

  3. Ferguson RL, Allen Jr BL. Considerations in the treatment of cerebral palsy patients with spinal deformities. Orthop Clin North Am 1988;19:419–25.

    CAS  PubMed  Google Scholar 

  4. McCarthy RE. Management of neuromuscular scoliosis. Orthop Clin North Am 1999;30:435–49; viii.

    Article  CAS  Google Scholar 

  5. Miller A, Temple T, Miller F. Impact of orthoses on the rate of scoliosis progression in children with cerebral palsy. J Pediatr Orthop 1996;16:332–5.

    Article  CAS  Google Scholar 

  6. Thometz JG, Simon SR. Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy. J Bone Joint Surg Am 1988;70:1290–6.

    Article  CAS  Google Scholar 

  7. Zimbler S, Craig C, Harris S. Orthotic management of severe scoliosis in spastic neuromuscular disease: results of treatment. Orthop Trans 1982;6:70.

    Google Scholar 

  8. Garrett AL, Perry J, Nickel VL. Paralytic scoliosis. Clin Orthop 1961;21:117–24.

    CAS  PubMed  Google Scholar 

  9. Benson ER, Thomson JD, Smith BG, Banta JV. Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis. Spine (Phila Pa 1976) 1998;23:2308–17; discussion 18.

    Article  CAS  Google Scholar 

  10. Drummond D, Breed AL, Narechania R. Relationship of spine deformity and pelvic obliquity on sitting pressure distributions and decubitus ulceration. J Pediatr Orthop 1985;5:396–402.

    Article  CAS  Google Scholar 

  11. Majd ME, Muldowny DS, Holt RT. Natural history of scoliosis in the institutionalized adult cerebral palsy population. Spine (Phila Pa 1976) 1997;22:1461–6.

    Article  CAS  Google Scholar 

  12. Jones KB, Sponseller PD, Shindle MK, McCarthy ML. Longitudinal parental perceptions of spinal fusion for neuromuscular spine deformity in patients with totally involved cerebral palsy. J Pediatr Orthop 2003;23:143–9.

    PubMed  Google Scholar 

  13. Westerlund LE, Gill SS, Jarosz TS, et al. Posterior-only unit rod instrumentation and fusion for neuromuscular scoliosis. Spine (Phila Pa 1976) 2001;26:1984–9.

    Article  CAS  Google Scholar 

  14. Bell DF, Moseley CF, Koreska J. Unit rod segmental spinal instrumentation in the management of patients with progressive neuromuscular spinal deformity. Spine (Phila Pa 1976) 1989;14:1301–7.

    Article  CAS  Google Scholar 

  15. Dias RC, Miller F, Dabney K, et al. Surgical correction of spinal deformity using a unit rod in children with cerebral palsy. J Pediatr Orthop 1996;16:734–40.

    Article  CAS  Google Scholar 

  16. Gau YL, Lonstein JE, Winter RB, et al. Luque-Galveston procedure for correction and stabilization of neuromuscular scoliosis and pelvic obliquity: a review of 68 patients. J Spinal Disord 1991;4:399–410.

    Article  CAS  Google Scholar 

  17. Lonstein JE, Akbarnia A. Operative treatment of spinal deformities in patients with cerebral palsy or mental retardation: an analysis of one hundred and seven cases. J Bone Joint Surg Am 1983;65:43–55.

    Article  CAS  Google Scholar 

  18. Alman BA, Jhaveri S, Wright J, et al. Long term outcomes and complications of unit rod instrumentation in the surgical management of neuromuscular scoliosis. Paper presented at the Pediatric Orthopaedic Society of North America annual meeting; May 24, 2007; Hollywood, FL.

    Google Scholar 

  19. Maloney WJ, Rinsky LA, Gamble JG. Simultaneous correction of pelvic obliquity, frontal plane, and sagittal plane deformities in neuromuscular scoliosis using a unit rod with segmental sublaminar wires: a preliminary report. J Pediatr Orthop 1990;10:742–9.

    Article  CAS  Google Scholar 

  20. Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (>100 degrees). Spine (Phila Pa 1976) 2008;33:979–83.

    Article  Google Scholar 

  21. Huang MJ, Lenke LG. Scoliosis and severe pelvic obliquity in a patient with cerebral palsy: surgical treatment utilizing halofemoral traction. Spine (Phila Pa 1976) 2001;26:2168–70.

    Article  CAS  Google Scholar 

  22. Tsirikos AI, Lipton G, Chang WN, et al. Surgical correction of scoliosis in pediatric patients with cerebral palsy using the unit rod instrumentation. Spine (Phila Pa 1976) 2008;33:1133–40.

    Article  Google Scholar 

  23. Allen Jr BL, Ferguson RL. The operative treatment of myelomeningocele spinal deformityd1979. Orthop Clin North Am 1979;10:845–62.

    PubMed  Google Scholar 

  24. Luque ER. Segmental spinal instrumentation for correction of scoliosis. Clin Orthop Relat Res 1982;163:192–8.

    Google Scholar 

  25. Keeler KA, Lenke LG, Good CR, et al. Spinal fusion for spastic neuromuscular scoliosis: is anterior releasing necessary when intraoperative halo-femoral traction is used? Spine (Phila Pa 1976) 2010;35:E427–33.

    Article  Google Scholar 

  26. Szoke G, Lipton G, Miller F, Dabney K. Wound infection after spinal fusion in children with cerebral palsy. J Pediatr Orthop 1998;18:727–33.

    CAS  PubMed  Google Scholar 

  27. Lipton GE, Miller F, Dabney KW, et al. Factors predicting postoperative complications following spinal fusions in children with cerebral palsy. J Spinal Disord 1999;12:197–205.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Sara K. Fuhrhop BS, Kathryn A. Keeler MD, Keith H. Bridwell MD, Lawrence G. Lenke MD & Scott J. Luhmann MD

  2. St. Louis Children’s Hospital, 4S-60 St. Louis Children’s Hospital, 1 Children’s Place, St. Louis, MO, 63110, USA

    Kathryn A. Keeler MD, Keith H. Bridwell MD, Lawrence G. Lenke MD & Scott J. Luhmann MD

  3. St. Louis Shriners Hospital, St. Louis, MO, USA

    Kathryn A. Keeler MD, Keith H. Bridwell MD, Lawrence G. Lenke MD & Scott J. Luhmann MD

  4. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Murat Oto MD, Freeman Miller MD & Kirk W. Dabney MD

Authors
  1. Sara K. Fuhrhop BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathryn A. Keeler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Murat Oto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Freeman Miller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kirk W. Dabney MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keith H. Bridwell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lawrence G. Lenke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Scott J. Luhmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott J. Luhmann MD.

Additional information

Author disclosures: SKF (none); MO (none); FM (none); KWD (none); KHB (grant from NIH); LGL (board membership with Journal of Spinal Disorders and Techniques, Spine Journal, www.spineuniverse.com, www.iscoliosis.com, The Spine Journal, The Journal of Pediatric Orthopaedics, Scoliosis, Backtalk, Journal of Neurosurgery: Spine; grants from Axial Biotech, DePuy; patents from Medtronic; royalties from Medtronic, Quality Medical Publishing; travel/accommodations/meeting expenses from Broadwater, Scoliosis Research Society, Medtronic); KAK (none); SJL (consultancy for Medtronic and Watermark Research; payment for lectures including service on speakers bureaus from Medtronic, Stryker Spine; royalties from Globus Medical).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fuhrhop, S.K., Keeler, K.A., Oto, M. et al. Surgical Treatment of Scoliosis in Non-Ambulatory Spastic Quadriplegic Cerebral Palsy Patients: A Matched Cohort Comparison of Unit Rod Technique and All-Pedicle Screw Constructs. Spine Deform 1, 389–394 (2013). https://doi.org/10.1016/j.jspd.2013.07.006

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2013.07.006

Keywords

Search

Navigation