TY - JOUR
T1 - Scoliosis surgery in cerebral palsy
T2 - Differences between unit rod and custom rods
AU - Sponseller, Paul D.
AU - Shah, Suken A.
AU - Abel, Mark F.
AU - Sucato, Daniel
AU - Newton, Peter O.
AU - Shufflebarger, Harry
AU - Lenke, Lawrence G.
AU - Letko, Lynn
AU - Betz, Randal
AU - Marks, Michelle
AU - Bastrom, Tracey
PY - 2009/4/15
Y1 - 2009/4/15
N2 - STUDY DESIGN.: Retrospective review. OBJECTIVE.: To evaluate the differences in intraoperative factors and postoperative results between pediatric patients with cerebral palsy (CP) treated with unit rods and those treated with custom-bent rods. SUMMARY OF BACKGROUND DATA.: No prior study has directly compared unit and custom-bent rods for CP. METHODS.: We retrospectively analyzed the clinical and radiographic data of 157 children with CP who underwent posterior spinal fusion. Of those 157, we treated 79 with unit rods and 78 with custom-bent rods. Minimum follow-up was 2 years. RESULTS.: Intraoperatively, unit rod surgeries were associated with significantly shorter mean surgical time (339 and 379 minutes, respectively; P = 0.04), longer mean intensive care unit stay (4 vs. 3 days, respectively; P = 0.001), and longer mean hospital stay (14 vs. 13 days; P = 0.006) than custom-bent rod procedures. The mean estimated blood loss was higher for unit rods (2124 vs. 1885 mL, respectively), but not significantly so. After surgery, unit rod surgeries were associated with significantly more mean pelvic obliquity correction (74% vs. 22%, respectively; P = 0.002), more mean clinically apparent implant prominence at 2-year follow-up (12 vs. 2 instances; P = 0.03; most were proximal), and a higher mean infection rate (15% vs. 5%, respectively; P = 0.03). There were no significant differences in final major Cobb correction, curves with an apex above or below T10, implant-related reoperations, or neurologic complications. The only factor that was statistically correlated with the overall complication rate for both groups was absolute curve magnitude (P = 0.04). CONCLUSION.: Compared with custom-bent rods, unit rods provided superior correction of pelvic obliquity but were associated with higher transfusion requirements, higher infection rates, more proximal fixation problems, and longer intensive care unit and hospital stays.
AB - STUDY DESIGN.: Retrospective review. OBJECTIVE.: To evaluate the differences in intraoperative factors and postoperative results between pediatric patients with cerebral palsy (CP) treated with unit rods and those treated with custom-bent rods. SUMMARY OF BACKGROUND DATA.: No prior study has directly compared unit and custom-bent rods for CP. METHODS.: We retrospectively analyzed the clinical and radiographic data of 157 children with CP who underwent posterior spinal fusion. Of those 157, we treated 79 with unit rods and 78 with custom-bent rods. Minimum follow-up was 2 years. RESULTS.: Intraoperatively, unit rod surgeries were associated with significantly shorter mean surgical time (339 and 379 minutes, respectively; P = 0.04), longer mean intensive care unit stay (4 vs. 3 days, respectively; P = 0.001), and longer mean hospital stay (14 vs. 13 days; P = 0.006) than custom-bent rod procedures. The mean estimated blood loss was higher for unit rods (2124 vs. 1885 mL, respectively), but not significantly so. After surgery, unit rod surgeries were associated with significantly more mean pelvic obliquity correction (74% vs. 22%, respectively; P = 0.002), more mean clinically apparent implant prominence at 2-year follow-up (12 vs. 2 instances; P = 0.03; most were proximal), and a higher mean infection rate (15% vs. 5%, respectively; P = 0.03). There were no significant differences in final major Cobb correction, curves with an apex above or below T10, implant-related reoperations, or neurologic complications. The only factor that was statistically correlated with the overall complication rate for both groups was absolute curve magnitude (P = 0.04). CONCLUSION.: Compared with custom-bent rods, unit rods provided superior correction of pelvic obliquity but were associated with higher transfusion requirements, higher infection rates, more proximal fixation problems, and longer intensive care unit and hospital stays.
KW - Cerebral palsy
KW - Fusion
KW - Pelvic obliquity
KW - Scoliosis
UR - http://www.scopus.com/inward/record.url?scp=67650477114&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=67650477114&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e31819487b7
DO - 10.1097/BRS.0b013e31819487b7
M3 - Article
C2 - 19365254
AN - SCOPUS:67650477114
SN - 0362-2436
VL - 34
SP - 840
EP - 844
JO - Spine
JF - Spine
IS - 8
ER -