Spinal Realignment in Pediatric Patients with Cerebral Palsy Using the Unit Rod Instrumentation

Purpose: To evaluate a group of 147 patients with mean age at surgery 13.2 years (SD: 2.5) operated by the two senior authors using the same surgical technique, with more than 2 years follow-up.

Methods: The medical charts and radiographs were reviewed and a survey assessing patients’ functional improvement was conducted.

Results: The mean radiographic follow-up was 3.8 years (range: 2-9.9). In 23 patients anterior-posterior fusion was performed and in 124 only posterior. The preop. Cobb angle was 800(range: 6-176o) corrected by 68% to 22o (p<.01) and increased by 2.7o in the last follow-up (p<.01). The preop. pelvic obliquity was 18o(range: 0-57o), corrected by 74% to 4.7o (p<.01) and increased by 1o at follow-up. The preop. kyphosis angle was 54o(range: -44-122o), corrected by 37% to 34o (p<.01) and increased by 2o at follow-up. The preop. lordosis angle was 35o(range: -45-140o), corrected by 22% to 43o (p<.05) and increased by 1o at follow-up. There was a high correlation between hyperlordosis and days of hospitalization, blood loss and surgical time (r= -.27, .25, .23). Patients with lordotic angle >60o developed 19% technical problems related to pelvic fixation, whereas only 6.4% of those with <60o. Mean days of hospitalization were 22, mean blood loss 3.6lt (1.2BV), mean surgical time 4.3h (Anterior-Posterior: 7h, Posterior: 3.8h) and mean ICU stay 5 days. There was difference in surgical time (p<.01) if an anterior procedure was required. Major complications included 10 deep infections, 9 (6.1%) reoperations for mechanical problems and no pseudarthrosis. The parental survey reported 99% positive responses, emphasizing the improvement in child’s appearance, sitting ability and respiration.

Conclusions: Spine surgery with unit rod instrumentation in patients with cerebral palsy was accompanied by a considerable blood loss and multiple medical complications. A very satisfactory correction of spinal curvatures was achieved and maintained in follow-up. Excessive lumbar lordosis was associated with a higher incidence of technical problems and an increased morbidity. There was no detected pseudarthrosis and the overall number of reoperations for technical reasons was very low. The caretakers were extremely pleased with the surgical outcome.