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

Sara K. Fuhrhop, Kathryn A. Keeler, Murat Oto, Freeman Miller, Kirk W. Dabney, Keith H. Bridwell, Lawrence G. Lenke, Scott J. Luhmann

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

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 comparativce 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.

Original languageEnglish
Pages (from-to)389-394
Number of pages6
JournalSpine deformity
Volume1
Issue number5
DOIs
StatePublished - Sep 2013

Keywords

  • Neuromuscular scoliosis
  • galveston technique
  • pedicle screws
  • surgical treatment
  • unit rod

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