title: Surgical correction of scoliosis in patients with severe cerebral palsy.
abstract: BACKGROUND
  There is a lack of data in the literature on surgical correction of severe neuromuscular scoliosis in patients with serious extent of cerebral palsy. The purpose of this retrospective cohort study was to analyze the radiological and clinical results after posterior-only instrumentation (group P) and combined anterior-posterior instrumentation (group AP) in severe scoliosis in patients with Gross Motor Function Classification System grades IV and V.
  
  
  METHODS
  All eligible patients who underwent surgery in one institution between 1997 and 2012 were analyzed, and charts, surgical reports, and radiographs were evaluated with a minimum follow-up period of 2 years.
  
  
  RESULTS
  Fifty-seven patients were included (35 in group P, 22 in group AP), with a median follow-up period of 4.1 years. The preoperative mean Cobb angles were 84° (34 % flexibility) in group P and 109° (27 % flexibility) in group AP. In group P, the Cobb angle was 39° (54 % correction) at discharge and 43° at the final follow-up, while in group AP the figures were 54° (50 % correction) at discharge and 56° at the final follow-up. Major complications occurred in 23 vs. 46 % of the patients, respectively. Preoperative curve flexibility was an important predictor for relative curve correction, independently of the type of surgery.
  
  
  CONCLUSIONS
  Posterior-only surgery appears to lead to comparable radiological results, with shorter operating times and shorter intensive-care unit and hospital stays than combined surgery. The duration of surgery was a relevant predictor for complications.
authors.affiliation: Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany. klaas.beckmann@ukmuenster.de.
authors.forename: Klaas
authors.initials: K
authors.lastname: Beckmann
authors.affiliation: Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Lange
authors.affiliation: Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Gosheger
authors.affiliation: Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
authors.forename: Albert Schulze
authors.initials: AS
authors.lastname: Bövingloh
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Borowski
authors.affiliation: Department of Spine Surgery, St. Franziskus Hospital, Cologne, Germany.
authors.forename: Viola
authors.initials: V
authors.lastname: Bullmann
authors.affiliation: Department of Spine Surgery, St. Franziskus Hospital, Muenster, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Liljenqvist
authors.affiliation: Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
authors.forename: Tobias L
authors.initials: TL
authors.lastname: Schulte
mesh_terms: D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*
keywords: Cerebral palsy; Combined instrumentation; Neuromuscular scoliosis; Outcome; Posterior instrumentation; Surgery