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Changes in Health-Related Quality of Life After Spinal Fusion and Scoliosis Correction in Patients With Cerebral Palsy

Bohtz, Christina MD*; Meyer-Heim, Andreas MD*; Min, Kan MD

Journal of Pediatric Orthopaedics: September 2011 - Volume 31 - Issue 6 - p 668–673
doi: 10.1097/BPO.0b013e318221093c

Background The literature is scarce on the impact of spinal fusion for scoliosis in patients with cerebral palsy (CP) regarding the health-related quality of life (HRQL). The purpose of this study was to evaluate the outcome of surgical scoliosis correction measured by the subjective change in the HRQL and the objective radiologic changes. Factors that could influence the subjective outcome were examined to investigate their correlation to the results of HRQL.

Methods A retrospective review of 50 consecutive patients with CP, who had spinal fusion for scoliosis with minimal 2-year follow-up was carried out. Radiographic data were obtained from preoperative, postoperative, and last follow-up examinations. The assessment of the HRQL was done through a modified version of the “Caregiver Priorities and Child Health Index of Life with Disabilities” questionnaire, assessed by the caregivers of the patients.

Results There was a significant improvement (P=0.001) of HRQL after the operation. The satisfaction rate of the patients with the outcome of the operation was 91.7%. There was an average of 64.3% scoliosis correction, 57.7% pelvic tilt correction, 53% improvement of apical vertebral rotation, and 67.2% improvement of apical vertebral translation. At the last follow-up, the average scoliosis angle was 32.0 degrees and pelvic tilt was 8.8 degrees. Weak but not significant correlation between the amount of scoliosis correction and the subjective change in the HRQL could be established (R2=0.321, P=0.078). No correlation between the occurrence of complications and changes in the HRQL (P=0.122) or the satisfaction rate with the outcome of the operation (P=0.764) was found. Extension of spinal fusion to sacropelvis had no influence on the occurrence of complications (P=0.42) or on the changes in HRQL (P=0.71).

Conclusions Life quality improved after surgical scoliosis correction in patients with CP. There is a high satisfaction rate of patients and their caregivers. Subjective changes in HRQL after the operation do not correlate with objective radiographic changes brought about by the operation, which indicates that the present operation indications and achieved correction are adequate to achieve an improvement of the subjective HRQL in this patient group.

Level of Evidence Therapeutic level IV, retrospective study.

*Department of Rehabilitation, University Children's Hospital Zurich

Department of Orthopaedic Surgery, Balgrist Clinic, University of Zurich, Switzerland

None of the authors received financial support for this study.

Reprints: Kan Min, MD, Department of Orthopaedics, Balgrist Clinic, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland. e-mail:

The authors declare no conflict of interest.

© 2011 Lippincott Williams & Wilkins, Inc.