Surgical correction of spinal deformity using a unit rod in children with cerebral palsy.
Thirty-one patients with cerebral palsy and neuromuscular scoliosis underwent instrumentation with a unit rod fixed with sublaminar wires and posterior spine fusion. The mean curve measured 79 degrees preoperatively, 19 degrees immediately postoperatively, and 18 degrees at final follow-up of 2.8 years, excluding two patients who died and four who were lost to follow-up after < 12 months. The preoperative pelvic obliquity was 25 degrees, which was initially corrected to 3 degrees and remained unchanged at 4 degrees at final follow-up. Twenty-four patients underwent a one-stage posterior fusion, and seven patients underwent both anterior and posterior fusions. Complications included one acute deep-wound infection and one late deep-wound infection seeded from the urinary tract. No pseud-arthroses or hardware failures have occurred to date. Seven children with open triadiate cartilages had a posterior spinal fusion only and were followed up to skeletal maturity with a 3 degrees loss of correction of the scoliosis and a 0 degree loss of correction of pelvic obliquity. Questionnaires filled out by primary caretakers demonstrated that the objective of improving the child's ability to sit more comfortably was accomplished for the majority (65%) of patients. Spinal fusion was recommended for other children by 86% of interviewed caretakers.
Alfred I. duPont Institute, Wilmington, Delaware 19899, USA.
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Dias
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Miller
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Dabney
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Lipton
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Temple
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D001858:Bone Nails; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome