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Is Spine Deformity Surgery in Patients With Spastic Cerebral Palsy Truly Beneficial?: A Patient/Parent Evaluation

Watanabe, Kota, MD*; Lenke, Lawrence G., MD; Daubs, Michael D., MD; Watanabe, Kei, MD§; Bridwell, Keith H., MD; Stobbs, Georgia, RN; Hensley, Marsha, RN, BS

doi: 10.1097/BRS.0b013e3181948c8f
Surgery
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SDC

Study Design. Retrospective clinical outcome study.

Objective. To evaluate the clinical outcomes and satisfaction associated with the surgical treatment of neuromuscular spinal deformity secondary to cerebral palsy.

Summary of Background Data. Controversy still exists regarding whether spinal deformity surgery is truly a beneficial surgery for patients with cerebral palsy (CP) since there is limited functional benefit and higher perioperative complications rates in this patient population.

Methods. Neuromuscular patient evaluation questionnaires were answered retrospectively by 84 patients/families of spastic CP patients undergoing spinal fusion. The average follow-up was 6.2 years (range: 2–16). The questionnaires were designed to assess expectation, cosmesis, function, patient care, quality of life, pulmonary function, pain, health status, self-image, and satisfaction. Questionnaire results, complications, and radiographic data were divided into “satisfied group” and “less satisfied group” and we analyzed reasons of satisfaction and dissatisfaction.

Results. The overall satisfaction rate was 92%. Ninety-three percent reported improvement with sitting balance, 94% with cosmesis, and 71% in patient's quality of life. Functional improvements seemed limited, but 8% to 40% of the patients still perceived the surgical results as improvement. The postoperative complication rate was 27%. The mean preoperative Cobb angle of the major curve was 88° (range: 53°–141°), which corrected to 39° (range: 5°–88°) after surgery. The less satisfied group had a significantly higher late complication rate, less correction of the major curve, greater residual major curve, and hyperlordosis of the lumbar spine after surgery.

Conclusion. Despite the perioperative difficulties seen with CP patients, the majority of the patient/parents were satisfied with the results of the spinal deformity surgery. Functional improvements were limited but 8% to 40% of the patients still perceived the results as improved. The reason for less than optimal satisfaction appears to be due to less correction of the major curve, greater residual major Cobb angle, hyperlordosis of the lumbar spine after surgery, and late postoperative complications.

Eighty-four patients with neuromuscular spinal deformity treated operatively were evaluated with a patient/parent questionnaire. The reasons for less than optimal satisfaction appears to be due to less than expected correction of the major curve, greater residual major Cobb angle, hyperlordosis of the lumbar spine after surgery, and late postoperative complications.

From the *Keio University School of Medicine, Tokyo, Japan; †Washington University School of Medicine, St. Louis, MO; ‡University of Utah, Salt Lake City, UT; §Niigata University, Niigata, Japan, and ¶St. Louis Unit, Shriners Hospital, St. Louis, MO.

Acknowledgment date: March 8, 2008. Revision date: August 28, 2008. Acceptance date: September 2, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision making position.

Address correspondence and reprint requests to Lawrence G. Lenke, MD, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110; E-mail: lenkel@wudosis.wustl.edu

© 2009 Lippincott Williams & Wilkins, Inc.