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The Pros and Cons of Operating Early Versus Late in the Progression of Cerebral Palsy Scoliosis

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Abstract

Study Design

Retrospective review of prospective data.

Objective

To delineate a curve threshold where further delay of surgery significantly increased the risks for patients with cerebral palsy (CP) scoliosis.

Summary of Background Data

Two approaches exist in the management of CP scoliosis: a proactive one where surgery is recommended once there is a risk of progression (Cobb > 50°) and a reactive one where surgery is recommended after the patient/caregiver may have significant challenges caused by a large deformity.

Methods

A prospectively collected CP scoliosis surgical registry was queried for patients with minimum two years of follow-up. Three groups were delineated based on the distribution of curve magnitudes: <70° (proactive), 70°–90°, and >90° (reactive). Radiographic, surgical, and quality of life outcome data were compared between the groups using analysis of variance and chi-square analyses.

Results

There were 38 patients in the <70° group, 44 in the 70°—90° group, and 42 in the >90° group. They were similar in age. The >90° group had significantly longer operative time (p < .001), a higher percentage of anterior/posterior procedures (31% vs 5%), and a higher infection rate requiring I&D (16.7%) than the other groups (<70°: 5.3%; 70°–90°: 6.8%; p < .05). The percentage blood volume loss was significantly higher in the >90° group compared to <70°. There were no differences in length of hospitalization or intensive care unit stay. Preoperatively, the Caregiver Priorities and Child Health Index of Life with Disabilities (CPchild) QOL score was significantly higher for the <70° group. At two years, the <70° and 70°–90° groups reached similar QOL scores, whereas the >90° trended toward a lower postoperative QOL.

Conclusions

Being proactive (Cobb <70°) has no advantage in terms of decreasing risks or improving outcomes compared to curves 70°–90°. However, delaying surgery to a curve greater than 90° increases the risk of infection, blood loss, and the need for anterior/ posterior procedures. Ideally, surgery should be recommended for curves less than 90°.

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Author information

Authors and Affiliations

  1. Kansas Orthopedic Center, 7550 W. Village Circle, S-l, 67205, Wichita, KS, USA

    Steven M. Hollenbeck MD

  2. Rady Children’s Hospital-San Diego, 3020 Children’s Way, MC5062, 92123, San Diego, CA, USA

    Burt Yaszay MD, Carrie E. Bartley MA & Peter O. Newton MD

  3. Johns Hopkins Hospital, 1800 Orleans St, 21287, Baltimore, MD, USA

    Paul D. Sponseller MD

  4. Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, 19803, Wilmington, DE, USA

    Suken A. Shah MD

  5. Nicklaus Children’s Hospital, 3100 SW 62nd Ave, 33155, Miami, FL, USA

    Jahangir Asghar MD

  6. University of Virginia Medical Center, 1215 Lee St, 22908, Charlottesville, VA, USA

    Mark F. Abel MD

  7. British Columbia Children’s Hospital, 4480 Oak St, V6H 3N1, Vancouver, BC, Canada

    Firoz Miyanji MD

Authors
  1. Steven M. Hollenbeck MD
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  2. Burt Yaszay MD
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  3. Paul D. Sponseller MD
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  4. Carrie E. Bartley MA
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  5. Suken A. Shah MD
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  6. Jahangir Asghar MD
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  7. Mark F. Abel MD
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  8. Firoz Miyanji MD
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  9. Peter O. Newton MD
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Corresponding author

Correspondence to Burt Yaszay MD.

Additional information

Author disclosures: SMH (none), BY (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M and DePuy Synthes Spine; personal fees from NuVasive, Medtronic, Orthopediatrics, Stryker, and Globus; grants from Setting Scoliosis Straight Foundation, outside the submitted work; in addition, BY has a patent K2M with royalties paid), PDS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine and Globus, outside the submitted work), CEB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), SAS (grants from Setting Scoliosis Straight Foundation and from DePuy Synthes Spine and K2M in support of Harms Study Group research, during the conduct of the study; personal fees from DePuy Synthes Spine, K2M, and NuVasive, outside the submitted work), JA (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), MFA (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), FM (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation and Scoliosis Research Society; other from Rady Children’s Specialists; grants, personal fees, and nonfi-nancial support from DePuy Synthes Spine and K2M; grants from EOS imaging and NuVasive; personal fees from Thieme Publishing and Cubist; other from Electrocore and International Pediatric Orthopedic Think Tank; grants, nonfinancial support, and other from Orthopediatrics; grants and nonfinancial support from Alphatech, outside the submitted work; in addition, PON 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).The study was conducted at Rady Children’s Hospital, San Diego, CA.IRB approval was obtained for this study.

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Hollenbeck, S.M., Yaszay, B., Sponseller, P.D. et al. The Pros and Cons of Operating Early Versus Late in the Progression of Cerebral Palsy Scoliosis. Spine Deform 7, 489–493 (2019). https://doi.org/10.1016/j.jspd.2018.09.002

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  • DOI: https://doi.org/10.1016/j.jspd.2018.09.002

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