Summary: In this long term follow‐up case controlled study, patients with scoliosis and cerebral palsy who underwent instrumented spinal fusion had improved life expectancy over those treated non‐operatively.
Introduction: For decades spine surgeons and others who care for patients with cerebral palsy and scoliosis have been trying to obtain evidence that spine fusion helps these children. There is little agreement that we are able to improve spinal balance and reduce curve magnitudes but there is scant evidence that this improves the many other factors involved in the care of these patients, including life expectancy.
Methods: Thirty‐seven subjects were identified from a homogeneous cohort of patients identified and reported on in 1994. Subjects had scoliosis, greater then 50° or previous spinal fusion and profound cerebral palsy, GMFCS Level V. Two groups were identified, those that underwent instrumented spinal fusion and those treated non‐operatively. Medical records were reviewed. Statistical analysis included Chi square and relative risk assessment, and Cox Hazard ratio and Kaplan‐Meier survival.
Results: 100% follow‐up was obtained. Fifteen were currently residing at the same institution, 13 moved to local residences and 19 died. The overall mortality rate of this cohort was 51%. In the non‐fused group maximal coronal curve measured 76°, in the fused group, pre‐operative maximal coronal curve measured 69°, post‐operative curve measured 34°(ns). In the non‐fused group: 8 (40%) of subjects were living, mean age 23.4 years; 12 (60%) had died, mean age 35.9 years. In this group, 6 (50%) of the deaths were due to pulmonary complications.
In the fused group: 10 (59%) of the subjects were living, mean age 25.1 years; 4 (41%) had died, mean age 37.2 years. In this group, 3 (37%) of deaths were due to pulmonary complications.
Age weighted Chi square analysis of these two groups noted a significant difference with respect to death (p<0.0001). Risk difference assessment noted an 18.8% improvement in survival following spinal fusion, with and Odds ratio of 2.1. Kaplan‐Meier and Cox Hazard analysis also demonstrated an improvement in survival in those who underwent fusion (Hazard ratio of 0.572) (figure 1).
Conclusion: In profoundly involved patients with CP and severe scoliosis, spinal fusion improves life expectancy.
Significance: This study provides further support for the surgical management of severe spinal deformity in this high‐risk population.
‡Goldstein Award Nominee for Best Clinical Poster or E‐Poster Ω Moe Award Nominee for Best Basic Science Poster or E‐Poster Cited Here