Outcomes after scoliosis surgery for children with cerebral palsy: a systematic review

Toovey, Rachel; Harvey, Adrienne; Johnson, Michael B.; Baker, Louise; Williams, Katrina

doi:10.1111/dmcn.13412

Cited by 35 publications

(25 citation statements)

References 72 publications

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“…The risk of pulmonary problems in neuromuscular patients following spinal surgery is well known and includes respiratory failure, aspiration, pneumonia, pneumothorax, or pleural effusion [ 2 , 6 , 7 ]. Rates between 17 and 50% have been reported in the literature [ 6 – 9 ]. Scoliosis surgery has been shown to produce a transient decrease in vital capacity in all patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Major complications following surgical correction of spine deformity in 257 patients with cerebral palsy

et al. 2020

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Study design Observational. Objectives To report on the rate of major complications following spinal fusion and instrumentation to treat spinal deformity in patients with cerebral palsy (CP). Summary of background data Understanding the risk of major complications following the surgical treatment of spine deformities in patients with CP is critical. Methods A prospectively collected, multicenter database of patients with CP who had surgical correction of their spinal deformity (scoliosis or kyphosis) was reviewed for all major complications. Patients with ≥ 2 year follow-up or who died ≤ 2 years of surgery were included. A complication was defined as major if it resulted in reoperation, re-admission to the hospital, prolongation of the hospital stay, was considered life-threatening, or resulted in residual disability. Overall complication and revision rates were calculated for the perioperative (Peri-op; occurring ≤ 90 days postoperative) and delayed postoperative (Delayed; > 90 days) time periods. Results Two hundred and fifty-seven patients met inclusion. Seventy-eight (30%) patients had a major complication, 18 (7%) had > 1. There were 92 (36%) major complications; 64 (24.9%) occurred Peri-op. The most common Peri-op complications were wound ( n = 16, 6.2%) and pulmonary issues ( n = 28, 10.9%), specifically deep infections ( n = 12, 4.7%) and prolonged ventilator support ( n = 21, 8.2%). Delayed complications ( n = 28, 10.9%) were primarily deep infections (n = 8, 3.1%) and instrumentation-related ( n = 6, 2.3%). There were 42 additional surgeries for an overall unplanned return to the operating room rate of 16% (Peri-op: 8.6%, Delayed: 7.8%). Thirty-six (14.0%) reoperations were spine related surgeries (wound or instrumentation-related). Eleven (4.3%) patients died between 3 months to 5.6 years postoperatively; 4 occurred ≤ 1 year of surgery. Two deaths were directly related to the spinal deformity surgery. Conclusion Spinal deformity surgery in CP patients with greater than 2 years of follow-up have a postoperative major complication rate of 36% with a spine-related reoperation rate of 14.0%. Level of evidence Therapeutic-IV.

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Section: Discussionmentioning

confidence: 99%

Major complications following surgical correction of spine deformity in 257 patients with cerebral palsy

et al. 2020

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“…A recent systematic review concluded that there is only limited high‐quality evidence for outcomes after scoliosis surgery in children with CP and that this procedure is associated with a moderately high complication rate. The intervention appears to be indicated for deformity correction, but currently there is insufficient evidence to make recommendations for this surgery as a way to also improve functional outcomes, caregiver outcomes, and quality of life . Another complication of these and other orthopaedic complications is chronic pain, which is highly prevalent in children with CP in a high GMFCS level .…”

Section: Recurrent Aspirationmentioning

confidence: 99%

“…The intervention appears to be indicated for deformity correction, but currently there is insufficient evidence to make recommendations for this surgery as a way to also improve functional outcomes, caregiver outcomes, and quality of life. 48 Another complication of these and other orthopaedic complications is chronic pain, which is highly prevalent in children with CP in a high GMFCS level. 49 The impact of chronic pain on the respiratory system, including the effects of analgesics, remains to be studied.…”

Section: Deformity Of the Spine And Chest Wallmentioning

confidence: 99%

Respiratory morbidity in children with cerebral palsy: an overview

Boel

Pernet²,

Toussaint³

et al. 2018

Develop Med Child Neuro

121

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Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. What this paper adds Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.

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“…Additional risk factors for scoliosis include being female, having undergone hip surgery, moderate to severe epilepsy, poor muscle control, muscle weakness and spasticity . Treatment modalities for scoliosis can be either surgical (segmental spinal fusion) or nonsurgical (spinal bracing) . Although surgery appears indicated for deformity correction, in a recent review article, insufficient evidence in terms of functional outcomes, caregiver outcomes and quality of life were reported …”

Section: Introductionmentioning

confidence: 99%

“…Treatment modalities for scoliosis can be either surgical (segmental spinal fusion) or nonsurgical (spinal bracing) . Although surgery appears indicated for deformity correction, in a recent review article, insufficient evidence in terms of functional outcomes, caregiver outcomes and quality of life were reported …”

Section: Introductionmentioning

confidence: 99%

Back pain is more frequent in girls and in children with scoliosis in the context of cerebral palsy

2019

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AimTo investigate the prevalence of general and back pain in children with cerebral palsy and the relationships between scoliosis and back pain.MethodsCross‐sectional register study based on data from the Swedish Cerebral Palsy Follow‐Up Programme. Descriptive analyses and logistic regression to regress age, sex, gross motor function, windswept, hip extension and source of report on the presence of pain.ResultsThe study included 3783 children (58% boys) 1‐18 (mean 10.0) years of age. General pain was reported in 1538 (44% girls, 38% boys) and back pain in 226 (7% girls, 5% boys) children. The proportion of back pain increased from <4% prior to age 12 years to >12% from 16 years of age. Back pain increased from 4% in children without scoliosis to 16% in children with severe scoliosis. Moderate/severe back pain increased from 2% in children without scoliosis to 10% in children with severe scoliosis. Increased odds of reporting back pain were found for age, girls, low gross motor function and children with scoliosis.ConclusionThe proportion of children with general pain increased with age and was more frequent in girls. Age, female sex, low gross motor function and scoliosis were significant predictors of back pain.

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Outcomes after scoliosis surgery for children with cerebral palsy: a systematic review

Cited by 35 publications

References 72 publications

Major complications following surgical correction of spine deformity in 257 patients with cerebral palsy

Major complications following surgical correction of spine deformity in 257 patients with cerebral palsy

Respiratory morbidity in children with cerebral palsy: an overview

Back pain is more frequent in girls and in children with scoliosis in the context of cerebral palsy

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