Surgical correction and fusion using posterior-only pedicle screw construct for neuropathic scoliosis in patients with cerebral palsy: A three-year follow-up study

STUDY DESIGN.: It is a retrospective study of 52 neuromuscular scoliosis patients with cerebral palsy (CP). OBJECTIVE.: To determine the effectiveness and amount of correction using posterior-only pedicle screw construct. SUMMARY OF BACKGROUND DATA.: Although there have been many reports in literature supporting the use of pedicle screw-only constructs for the correction of adolescent idiopathic scoliosis, similar studies have not been reported in patients with CP. METHODS.: We retrospectively evaluated outcomes of 52 neuropathic scoliosis patients (28 males and 24 females) with CP over minimum 2 years of follow-up. All patients underwent pedicle screw fixation without any anterior procedure for the correction. Pelvic fixation was done in 10 patients who had pelvis obliquity more than 15°. All coronal and sagittal parameters were noted after surgery and at final follow-up. Patient's functional outcome was measured using modified Rancho Los Amigos Hospital system criteria. Complications were recorded from record sheets and any change in the ambulatory status was also recorded. RESULTS.: Mean age was 22 years at the time of operation and average follow-up was 36.1 month. Cobb's angle was improved to 62.9% (P < 0.0001) from 76.8° to 30.1° after surgery and 31.5° at final follow-up. This correction of scoliosis (41%∼92%) was found to be statistically significant (P < 0.0001). Overall correction in pelvic obliquity was 56.2% from 9.2° before surgery to 4.0° after surgery which was 43.1% at final follow-up to 5.2°. Twenty-one patients (42%) improved their functional ability by grade 1 with 2 patients by grade 2. After the operation parent or caretakers of patients exhibited better sitting balance and nursing care. There were 32% complications in the series major being pulmonary. There were 2 perioperative deaths and 1 patient developed neurologic deficit due to screw impingement in canal, which was resolved after removal. CONCLUSION.: We reported satisfactory coronal and sagittal correction with posterior-only pedicle screw fixation without higher complication rate in CP patients. Further long-term study is recommended to evaluate the success of pedicle screw in this population.