title: Spinal fusion with Cotrel-Dubousset instrumentation for neuropathic scoliosis in patients with cerebral palsy.
abstract: METHODS
  Retrospective.
  
  
  OBJECTIVE
  To report on the treatment of patients with cerebral palsy and neuropathic scoliosis with third-generation instrumented spinal fusion by Cotrel-Dubousset instrumentation.
  
  
  BACKGROUND
  Second-generation instrumented spinal fusion is considered the standard for progressive neuropathic scoliosis in cerebral palsy, despite high complication rates. Evidence is needed to evaluate the increasing use of third-generation instrumented spinal fusion in similar patients.
  
  
  METHODS
  Patients with cerebral palsy and spinal deformity treated consecutively by 1 surgeon with Cotrel-Dubousset instrumentation and minimum 2-year follow-up were reviewed. An outcome questionnaire was administered at final follow-up.
  
  
  RESULTS
  A total of 60 patients were included. Mean age was 15 years at surgery. Mean follow-up was 79 months. There were 26 anteroposterior and 34 posterior-only procedures. Correction of coronal deformity and pelvic obliquity averaged 60% and 40%, respectively. Major complications affected 13.5% of patients, and included implant loosening, deep infection, and pseudarthrosis. Minor complications affected 10% of patients. Outcome questionnaires showed marked improvements in the areas of satisfaction, function, and quality of life after surgery.
  
  
  CONCLUSIONS
  Segmental, third-generation instrumented spinal fusion provides lasting correction of spinal deformity and improved quality of life in patients with cerebral palsy and neuropathic scoliosis, with a lower pseudarthrosis rate compared to reports on second-generation instrumented spinal fusion.
authors.affiliation: Galeazzi Orthopaedic Institute, Milan, Italy. marcoteli@hotmail.com
authors.forename: Marco G A
authors.initials: MG
authors.lastname: Teli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Cinnella
authors.forename: Fiammetta
authors.initials: F
authors.lastname: Vincitorio
authors.forename: Alessio
authors.initials: A
authors.lastname: Lovi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grava
authors.forename: Marco
authors.initials: M
authors.lastname: Brayda-Bruno
mesh_terms: D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007239:Infections / Q000209:etiology; D016268:Internal Fixators / Q000009:adverse effects; D008297:Male; D017060:Patient Satisfaction; D011542:Pseudarthrosis / Q000453:epidemiology / Q000209:etiology; D011782:Quadriplegia / Q000150:complications; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome