Growing rods for the treatment of scoliosis in children with cerebral palsy: A critical assessment

Mark J. McElroy, Paul David Sponseller, Jonathan R. Dattilo, George H. Thompson, Behrooz A. Akbarnia, Suken A. Shah, Brian D. Snyder

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: Retrospective analysis. OBJECTIVE.: To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. SUMMARY OF BACKGROUND DATA.: Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. METHODS.: From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. RESULTS.: Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14°± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43°± 28°; PO, 2°± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P <0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45% were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30%). CONCLUSION.: GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30% of patients experienced deep wound infection.

Original languageEnglish (US)
JournalSpine
Volume37
Issue number24
DOIs
StatePublished - Nov 15 2012

Fingerprint

Scoliosis
Cerebral Palsy
Length of Stay
Wound Infection
Pelvis
Therapeutics
Lung
Spinal Fusion
Growth
Comorbidity
Spine
Outpatients
Odds Ratio
Students

Keywords

  • cerebral palsy
  • complication
  • growing rods
  • pelvic obliquity
  • scoliosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

McElroy, M. J., Sponseller, P. D., Dattilo, J. R., Thompson, G. H., Akbarnia, B. A., Shah, S. A., & Snyder, B. D. (2012). Growing rods for the treatment of scoliosis in children with cerebral palsy: A critical assessment. Spine, 37(24). https://doi.org/10.1097/BRS.0b013e31826fabd3

Growing rods for the treatment of scoliosis in children with cerebral palsy : A critical assessment. / McElroy, Mark J.; Sponseller, Paul David; Dattilo, Jonathan R.; Thompson, George H.; Akbarnia, Behrooz A.; Shah, Suken A.; Snyder, Brian D.

In: Spine, Vol. 37, No. 24, 15.11.2012.

Research output: Contribution to journalArticle

McElroy, Mark J. ; Sponseller, Paul David ; Dattilo, Jonathan R. ; Thompson, George H. ; Akbarnia, Behrooz A. ; Shah, Suken A. ; Snyder, Brian D. / Growing rods for the treatment of scoliosis in children with cerebral palsy : A critical assessment. In: Spine. 2012 ; Vol. 37, No. 24.
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abstract = "STUDY DESIGN.: Retrospective analysis. OBJECTIVE.: To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. SUMMARY OF BACKGROUND DATA.: Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. METHODS.: From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. RESULTS.: Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14°± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43°± 28°; PO, 2°± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P <0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45{\%} were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30{\%}). CONCLUSION.: GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30{\%} of patients experienced deep wound infection.",
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AU - McElroy, Mark J.

AU - Sponseller, Paul David

AU - Dattilo, Jonathan R.

AU - Thompson, George H.

AU - Akbarnia, Behrooz A.

AU - Shah, Suken A.

AU - Snyder, Brian D.

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N2 - STUDY DESIGN.: Retrospective analysis. OBJECTIVE.: To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. SUMMARY OF BACKGROUND DATA.: Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. METHODS.: From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. RESULTS.: Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14°± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43°± 28°; PO, 2°± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P <0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45% were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30%). CONCLUSION.: GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30% of patients experienced deep wound infection.

AB - STUDY DESIGN.: Retrospective analysis. OBJECTIVE.: To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. SUMMARY OF BACKGROUND DATA.: Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. METHODS.: From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. RESULTS.: Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14°± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43°± 28°; PO, 2°± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P <0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45% were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30%). CONCLUSION.: GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30% of patients experienced deep wound infection.

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