Spinal Deformity Surgery in Pediatric Patients With Cerebral Palsy: A National-Level Analysis of Inpatient and Postdischarge Outcomes

Lee, Nathan J.; Fields, Mark; Boddapati, Venkat; Mathew, Justin; Hong, Daniel; Sardar, Zeeshan M.; Selber, Paulo; Roye, Benjamin; Vitale, Michael G.; Lenke, Lawrence G.

doi:10.1177/2192568220960075

Cited by 12 publications

(13 citation statements)

References 51 publications

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“…Major complication rates can be as high as 40% following surgery for scoliosis in patients with CP, and the reoperation rate is around 14%. [5][6][7] It is critical to understand patient characteristics and specific radiographic findings that place these patients at greater risk for morbidity.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis

Lau

Samdani

Pahys

et al. 2023

Spine

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Study Design. Retrospective review of a prospectively collected multicenter database Objective. To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis (NL) versus hyperlordosis. Summary of Background Data. Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood. Materials and Methods. A multicenter database was queried for CP patients who underwent surgery from 2008 to 2017. The minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° hyperlordosis (HL). Perioperative, radiographic, and clinical outcomes were compared. Results. Two hundred seventy-five patients were studied: 236 NL and 39 HL (−75 to −125°). The mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P=0.008) and higher CPCHILD scores (59.4 vs. 51.0, P=0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. −31.5°, P<0.001) and smaller sagittal vertical axis (−4.0 vs. 2.6 cm, P<0.001). Patients with hyperlordosis had greater estimated blood loss (2222.0 vs. 1460.7 mL, P<0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P=0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and sagittal vertical axis of −1.0 cm. At a 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P=0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in the reoperation rate between the groups. Conclusion. Surgical correction of scoliosis with hyperlordosis is associated with greater estimated blood loss but similar radiographic results, perioperative morbidity, and reoperation rate as normal lordosis. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory. Level of Evidence. 3

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Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis

Lau

Samdani

Pahys

et al. 2023

Spine

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“…Despite these benefits to children with CP, the decision to undergo spinal fusion surgery is challenging due to the heightened risk of postoperative complications seen in this complex patient population. Past literature has shown that postoperative complications are common in the patient population with CP 14 . This is often attributed to the overall complexity of performing spinal surgery on patients with CP who typically present with additional comorbidities and more pronounced spinal deformities 14 .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Infectious Complications in Pediatric Patients With Cerebral Palsy After Spinal Arthrodesis

Miśkiewicz

Perea

Magruder

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Objective:The main objective of this study was to investigate (1) whether pediatric patients with cerebral palsy (CP) have higher rates of postoperative infectious complications after spinal fusion and (2) risk factors for postoperative infections.Summary of Background Data: Prior studies have shown that patients with CP undergo corrective spine surgery more often than the general population, yet typically have worse postoperative outcomes. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative infectious complications.Patients and Methods: The 2019 "American College of Surgeons National Surgical Quality Improvement Program" Pediatric database was used for patient data. The univariable analysis compared the prevalence of preoperative comorbidities and perioperative factors between children with and without CP. Multivariable logistic regression modeling was used to ascertain independent risk factors for postoperative infectious complications.Results: A total of 4445 patients were included in the study; 606 (13.63%) patients had CP and 3839 (86.37%) did not. Patients with CP were more likely to have several notable preoperative comorbidities, and the rate of developing any infectious complication was more than 7 times greater in the CP cohort than in the control cohort (14.36% vs 1.88%; P < 0.001). Multivariable analysis revealed CP [odds ratio (OR): 3.55, CI: 2.25-5.60; P < 0.001], American Society of Anesthesiologists class 3 or higher (OR: 2.10, CI: 1.29-3.42; P = 0.003), and hematologic disorders (OR: 2.01, CI: 1.06-3.83; P = 0.033) to be independent risk factors for increased postoperative infectious complications.Conclusions: CP is an independent risk factor for the development of 30-day postoperative infectious complications in pediatric patients. In addition, the American Society of Anesthesiologists class 3 or higher and hematologic disorders were risk factors for postoperative infections after spinal fusion surgery.

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“…However, consideration of nutrition status decreases the postoperative complication and the incidence of surgical site infection in neuromuscular scoliosis decreased significantly (16.1% vs. 4.4%) after the implementation of the strategies mentioned in the 2013 Best Practice Guideline. [37][38][39] Postoperative fever is a frequent complication after surgery. Yousef et al 40 reviewed 76 patients who had undergone scoliosis surgery and 49 patients (64.5%) who developed postoperative fever with a temperature of > 38°C.…”

Section: A C C E P T E D a R T I C L E 10mentioning

confidence: 99%

“…Deep surgical site infections were more common in neuromuscular scoliosis (10.0%) than in adolescent idiopathic scoliosis, kyphosis (2.7%), or genetic and syndromic scoliosis (4.2%). However, consideration of nutrition status decreases the postoperative complication and the incidence of surgical site infection in neuromuscular scoliosis decreased significantly (16.1% vs. 4.4%) after the implementation of the strategies mentioned in the 2013 Best Practice Guideline [ 38 - 40 ]. Postoperative fever is a frequent complication after surgery.…”

Section: Outcomes and Complications After Surgerymentioning

confidence: 99%

Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era

2022

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Surgical treatment for neuromuscular scoliosis has evolved with pedicle screw instrumentation and the improvement of perioperative management. We aimed to review recent papers related to posterior surgical correction with a pedicle screw system for neuromuscular scoliosis, particularly cerebral palsy and muscular dystrophy, in terms of indication, correction method, and outcomes. The most remarkable change was the posterior-only operation with all pedicle screw fixations. With this change, operation time, blood loss, and postoperative complications decreased. Furthermore, spinal osteotomy could be performed with the pedicle screw system for severe scoliosis. S2-alar-iliac screws demonstrated favorable outcomes in terms of stability and complication, but a question remains about saving the mobile segment for sitting balance, interaction between the hip and spine, effect to the sagittal balance, and proximal junctional problem. The quality of life improvement was more definite in patients with cerebral palsy. The improvement of respiratory function in Duchenne muscular dystrophy was not certain, although an increase of spinal height, thoracic cavity size, and absolute forced vital capacity have been reported. Further prospective studies or randomized clinical trials are needed to evaluate the long-term outcomes of lumbosacral fixation, preservation of the lumbosacral joint, or functional improvement considering the different etiology.

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Spinal Deformity Surgery in Pediatric Patients With Cerebral Palsy: A National-Level Analysis of Inpatient and Postdischarge Outcomes

Cited by 12 publications

References 51 publications

Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis

Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis

Risk Factors of Infectious Complications in Pediatric Patients With Cerebral Palsy After Spinal Arthrodesis

Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era

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