title: Is spine deformity surgery in patients with spastic cerebral palsy truly beneficial?: a patient/parent evaluation.
abstract: METHODS
  Retrospective clinical outcome study.
  
  
  OBJECTIVE
  To evaluate the clinical outcomes and satisfaction associated with the surgical treatment of neuromuscular spinal deformity secondary to cerebral palsy.
  
  
  BACKGROUND
  Controversy still exists regarding whether spinal deformity surgery is truly a beneficial surgery for patients with cerebral palsy (CP) since there is limited functional benefit and higher perioperative complications rates in this patient population.
  
  
  METHODS
  Neuromuscular patient evaluation questionnaires were answered retrospectively by 84 patients/families of spastic CP patients undergoing spinal fusion. The average follow-up was 6.2 years (range: 2-16). The questionnaires were designed to assess expectation, cosmesis, function, patient care, quality of life, pulmonary function, pain, health status, self-image, and satisfaction. Questionnaire results, complications, and radiographic data were divided into "satisfied group" and "less satisfied group" and we analyzed reasons of satisfaction and dissatisfaction.
  
  
  RESULTS
  The overall satisfaction rate was 92%. Ninety-three percent reported improvement with sitting balance, 94% with cosmesis, and 71% in patient's quality of life. Functional improvements seemed limited, but 8% to 40% of the patients still perceived the surgical results as improvement. The postoperative complication rate was 27%. The mean preoperative Cobb angle of the major curve was 88 degrees (range: 53 degrees-141 degrees), which corrected to 39 degrees (range: 5 degrees-88 degrees) after surgery. The less satisfied group had a significantly higher late complication rate, less correction of the major curve, greater residual major curve, and hyperlordosis of the lumbar spine after surgery.
  
  
  CONCLUSIONS
  Despite the perioperative difficulties seen with CP patients, the majority of the patient/parents were satisfied with the results of the spinal deformity surgery. Functional improvements were limited but 8% to 40% of the patients still perceived the results as improved. The reason for less than optimal satisfaction appears to be due to less correction of the major curve, greater residual major Cobb angle, hyperlordosis of the lumbar spine after surgery, and late postoperative complications.
authors.affiliation: Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Michael D
authors.initials: MD
authors.lastname: Daubs
authors.forename: Kei
authors.initials: K
authors.lastname: Watanabe
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Georgia
authors.initials: G
authors.lastname: Stobbs
authors.forename: Marsha
authors.initials: M
authors.lastname: Hensley
mesh_terms: D000293:Adolescent; D000328:Adult; D001828:Body Image; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010290:Parents; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011187:Posture; D011788:Quality of Life; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion; D011795:Surveys and Questionnaires; D055815:Young Adult