Spinal fusion with Cotrel-Dubousset instrumentation for neuropathic scoliosis in patients with cerebral palsy.
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.
Teli
Marco G A
MG
Galeazzi Orthopaedic Institute, Milan, Italy. marcoteli@hotmail.com
Cinnella
Pasquale
P
Vincitorio
Fiammetta
F
Lovi
Alessio
A
Grava
Giuseppe
G
Brayda-Bruno
Marco
M
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