title: Surgical Treatment of Scoliosis in Non-Ambulatory Spastic Quadriplegic Cerebral Palsy Patients: A Matched Cohort Comparison of Unit Rod Technique and All-Pedicle Screw Constructs.
abstract: METHODS
  Matched cohort.
  
  
  OBJECTIVE
  To compare the unit rod instrumentation (UR) technique with all-pedicle screw (PS) constructs in the surgical care of scoliosis in Gross Motor Function Classification System IV/V non-ambulatory spastic quadriplegic cerebral palsy patients.
  
  
  BACKGROUND
  Over the past 20 years, there has been a transition from the UR technique to the use of pedicle screws and iliac screws in neuromuscular scoliosis. To date, no head-to-head comparative analysis has been reported between the UR technique and PS constructs for posterior segmental spinal instrumentation and fusion in cerebral palsy patients.
  
  
  METHODS
  A matched cohort study was performed between 2 tertiary-care pediatric centers: 1 using UR technique and the other PS constructs. Minimum follow-up was 2 years postoperatively (PS 2.5 years, UR 4.6 years, not significant). Fourteen patients were matched from each center based on age (mean age: PS 15.4 years, UR 15.5 years), preoperative pelvic obliquity (mean: PS 33.8°, UR 29.1°) and major coronal Cobb angle (mean: PS 100.9°, UR 100.1°).
  
  
  RESULTS
  There was posterior-only surgery in 14 of 14 PS and 11 of 14 UR surgeries. The final follow-up Cobb angle was lower in the PS group (13.5° vs. 34.3°, p < .05), with 86.5% correction in the PS group and 65.7% in the UR group. Final follow-up pelvic obliquity was similar (PS 8.5° vs. UR 3.3°; not significant). There were no major complications in the PS group. In the UR group, there was 1 deep infection and 1 reoperation for removal of a prominent sublaminar wire.
  
  
  CONCLUSIONS
  This is the first study to directly compare UR with PS constructs using matched patient cohorts in this patient population. All-pedicle screw constructs had better correction of coronal Cobb angle, lower blood loss, and shorter hospital stays. There was no difference in the correction of pelvic obliquity, complications, or reoperations.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Fuhrhop
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA; St. Louis Children's Hospital, St. Louis, MO, USA; St. Louis Shriners Hospital, St. Louis, MO, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Keeler
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Murat
authors.initials: M
authors.lastname: Oto
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Freeman
authors.initials: F
authors.lastname: Miller
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Kirk W
authors.initials: KW
authors.lastname: Dabney
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA; St. Louis Children's Hospital, St. Louis, MO, USA; St. Louis Shriners Hospital, St. Louis, MO, USA.
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA; St. Louis Children's Hospital, St. Louis, MO, USA; St. Louis Shriners Hospital, St. Louis, MO, USA.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA; St. Louis Children's Hospital, St. Louis, MO, USA; St. Louis Shriners Hospital, St. Louis, MO, USA. Electronic address: luhmanns@wustl.edu.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Luhmann
keywords: Galveston technique; Neuromuscular scoliosis; Pedicle screws; Surgical treatment; Unit rod