To our knowledge, there have been no previous studies addressing the indications for and the results of treatment of patients with cerebral palsy and concomitant kyphosis or lordosis without scoliosis. The purpose of the present study was to identify the indications for and the results of treatment of patients with cerebral palsy who have a spinal curve deformity solely in the sagittal plane.
We conducted a retrospective review of the data on all patients with cerebral palsy who had a sagittal plane spinal deformity but no coronal plane deformity, had undergone posterior spinal fusion with unit rod instrumentation at our institution, and had been followed for at least two years. Medical records and radiographs were reviewed for symptoms, type and magnitude of deformity, age at surgery, duration of surgery, nutritional status, complications, and concomitant medical problems.
Twenty-four patients-—ten boys and fourteen girls-—were identified. Eight patients had a hyperlordotic deformity, fourteen had a hyperkyphotic deformity, and two exhibited both. Surgical indications included severe seating problems that could not be rectified with wheelchair modifications (eighteen patients), severe back pain (four patients), superior mesenteric artery syndrome that was refractory to conservative treatment (two patients), and a hyperlordotic deformity with a loss of bowel and bladder control (one patient).
It was found that specific technical concerns had to be addressed when the unit rod instrumentation was used. The mean preoperative hyperkyphotic curve of 93.8° was corrected to a mean of 35.8° postoperatively and was a mean of 34.8° at the last visit. The mean preoperative hyperlordotic curve of 91.8° was corrected to a mean of 43.6° postoperatively and was a mean of 48.6° at the last visit. All patients with seating problems and back pain had improvement or resolution of the problem after the surgery. The superior mesenteric artery syndromes, losses of bowel and bladder function, and malnutrition all resolved completely after the surgery.
Patients with cerebral palsy and a severe sagittal plane deformity (≥70°) can be treated successfully with posterior spinal fusion with use of unit rod instrumentation. Indications for treatment include loss of sitting ability or balance, back pain, loss of bowel or bladder function, and superior mesenteric artery syndrome that is unresponsive to medical management.
1 Division of Orthopaedics, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19899. E-mail address for K.W. Dabney: email@example.com
2 Department of Orthopaedic Surgery, Drexel University College of Medicine, Broad and Vine Streets, Mail Stop 420, Philadelphia, PA 19102
3 Department of Orthopaedic Surgery, St. John Oakland Hospital, 27351 Dequindre Road, Madison Heights, MI 48071