title: Scoliosis in total-body-involvement cerebral palsy. Analysis of surgical treatment and patient and caregiver satisfaction.
abstract: METHODS
  A nonrandomized descriptive case series.
  
  
  OBJECTIVE
  To analyze the results of spinal fusion in patients with total-body-involvement cerebral palsy to determine early and late outcomes, including caregiver satisfaction.
  
  
  METHODS
  Data from 79 to 100 patients with total-body-involvement spastic cerebral palsy who underwent posterior Luque instrumentation, or anterior spinal fusion, or both, were adequate to be included in the study. Functional status was evaluated by physical examination, and a personal interview was conducted with the patient, parents, and primary caregiver.
  
  
  RESULTS
  Median follow-up was 4 years (range, 2-14 years). Late progression of scoliosis (> 10 degrees), pelvic obliquity (> 5 degrees), and decompensation (> 4cm ) were noted in more than 30% of the patients. More than 75% of patients with late progression were skeletally immature at the time of surgery and underwent a posterior procedure only. Twenty-one percent of the patients required a revision procedure because of disease progression. Progression was not noted in any patient who underwent anterior fusion (with or without anterior instrumentation) plus posterior instrumentation from the upper thoracic spine to the pelvis. Eighty-five percent of parents or caregivers were very satisfied with the results of surgery and noted a beneficial impact of the patient's sitting ability, physical appearance, ease of care, and comfort.
  
  
  CONCLUSIONS
  To avoid late progression of trunk deformity in skeletally immature patients, anterior spinal release and fusion combined with posterior segmental spinal instrumentation and fusion from the upper thoracic spine to the pelvis are recommended. Skeletally mature patients with good curve flexibility can be treated with posterior instrumentation and fusion only. Skeletally mature patients with large fixed curves benefit from an anterior-posterior procedure for better correction of the scoliosis and pelvis obliquity. Despite the surgical complexity and expected complications, the overall good surgical results and high patient and caregiver satisfaction confirm that corrective spinal surgery is indicated and is beneficial for most patients with total-body-involvement cerebral palsy and scoliosis.
authors.affiliation: Department of Pediatric Orthopedic Surgery, Children's Hospital, San Diego, California, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Comstock
authors.forename: J
authors.initials: J
authors.lastname: Leach
authors.forename: D R
authors.initials: DR
authors.lastname: Wenger
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007407:Interviews as Topic; D007431:Intraoperative Complications; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome