Three Methods of Pelvic Fixation for Scoliosis in Children with Cerebral Palsy

Objective. The aim of this study was to assess correction of pelvic obliquity in children with cerebral palsy (CP) scoliosis postoperatively and 5 years after posterior spinal fusion with pelvic fixation using unit rods, sacral-alar-iliac (SAI) screws, or iliac screws. Summary of Background Data. There are multiple options for pelvic fixation in children with scoliosis secondary to CP. The long-term differences in outcomes between these fixation methods are still unclear. Methods. A multicenter review identified records of 70 children with CP who underwent posterior spinal fusion for scoliosis using unit rods (n¼9), SAI screws (n¼19), or iliac screws (n¼42). Patients younger than 18 years with 5-year follow-up were included. Pelvic obliquity and major coronal curve measurements were compared using preoperative, (first erect) postoperative, and 5-year follow-up radiographs. Implant-related complications were noted. Alpha¼0.05. Results. For all groups, there was a significant difference between preoperative and postoperative pelvic obliquity that was maintained at 5 years. At 5-year follow-up, pelvic obliquity was significantly higher in the IS group (128) compared with the unit rod group (48, P =0.001) and SAI screw group (68) (P¼0.006). Implant-related complications were as follows: unit rod group, one patient (reoperation); SAI screw group, none; iliac screw group, six patients, including three cases of loss of connection between the rod and the iliac screw, two prominent screws, and one loose screw. Conclusion. Correction of pelvic obliquity for children with CP-related scoliosis was achieved postoperatively using unit rods, SAI screws, and iliac screws. Implant-related complications and reoperations were most common in the iliac screw group. At 5-year follow-up, the iliac screw group had loss of major curve correction and less correction of pelvic obliquity than the unit rod and SAI screw groups.