Growing rods for the treatment of scoliosis in children with cerebral palsy: a critical assessment

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2012-11, Vol.37 (24), p.E1504-E1510
• Main Authors: McElroy, Mark J, Sponseller, Paul D, Dattilo, Jonathan R, Thompson, George H, Akbarnia, Behrooz A, Shah, Suken A, Snyder, Brian D
• Format: Article
• Language: English
• Subjects: Adolescent; Cerebral Palsy - complications; Cerebral Palsy - diagnostic imaging; Cerebral Palsy - surgery; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Length of Stay; Male; Radiography; Retrospective Studies; Scoliosis - complications; Scoliosis - diagnostic imaging; Scoliosis - surgery; Spinal Fusion - instrumentation; Spinal Fusion - methods; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e31826fabd3

Retrospective analysis. To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14° ± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43° ± 28°; PO, 2° ± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P < 0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45% were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30%). GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30% of patients experienced deep wound infection.