Surgical Correction and Fusion Using Posterior-Only Pedicle Screw Construct for Neuropathic Scoliosis in Patients With Cerebral Palsy A Three-Year Follow-up Study

Abstract

Study Design. It is a retrospective study of 52 neuromuscular scoliosis patients with cerebral palsy (CP). Objective. To determine the effectiveness and amount of correction using posterior-only pedicle screw construct. Summary of Background Data. Although there have been many reports in literature supporting the use of pedicle screw-only constructs for the correction of adolescent idiopathic scoliosis, similar studies have not been reported in patients with CP. Methods. We retrospectively evaluated outcomes of 52 neuropathic scoliosis patients (28 males and 24 females) with CP over minimum 2 years of follow-up. All patients underwent pedicle screw fixation without any anterior procedure for the correction. Pelvic fixation was done in 10 patients who had pelvis obliquity more than 15. All coronal and sagittal parameters were noted after surgery and at final follow-up. Patient's functional outcome was measured using modified Rancho Los Amigos Hospital system criteria. Complications were recorded from record sheets and any change in the ambulatory status was also recorded. Results. Mean age was 22 years at the time of operation and average follow-up was 36.1 month. Cobb's angle was improved to 62.9% (P < 0.0001) from 76.8 to 30.1 after surgery and 31.5 at final follow- up. This correction of scoliosis (41%similar to 92%) was found to be statistically significant (P < 0.0001). Overall correction in pelvic obliquity was 56.2% from 9.2 before surgery to 4.0 after surgery which was 43.1% at final follow- up to 5.2. Twenty-one patients (42%) improved their functional ability by grade 1 with 2 patients by grade 2. After the operation parent or caretakers of patients exhibited better sitting balance and nursing care. There were 32% complications in the series major being pulmonary. There were 2 perioperative deaths and 1 patient developed neurologic deficit due to screw impingement in canal, which was resolved after removal. Conclusion. We reported satisfactory coronal and sagittal correction with posterior-only pedicle screw fixation without higher complication rate in CP patients. Further long-term study is recommended to evaluate the success of pedicle screw in this population.