Steven M Hollenbeck1, Burt Yaszay2, Paul D Sponseller3, Carrie E Bartley4, Suken A Shah5, Jahangir Asghar6, Mark F Abel7, Firoz Miyanji8, Peter O Newton4. 1. Kansas Orthopedic Center, 7550 W. Village Circle, S-1, Wichita, KS 67205, USA. 2. Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA 92123, USA. Electronic address: byaszay.rady@gmail.com. 3. Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA. 4. Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA 92123, USA. 5. Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA. 6. Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA. 7. University of Virginia Medical Center, 1215 Lee St, Charlottesville, VA 22908, USA. 8. British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC V6H 3N1, Canada.
Abstract
STUDY DESIGN: Retrospective review of prospective data. OBJECTIVE: To delineate a curve threshold where further delay of surgery significantly increased the risks for patients with cerebral palsy (CP) scoliosis. SUMMARY OF BACKGROUND DATA: Two approaches exist in the management of CP scoliosis: a proactive one where surgery is recommended once there is a risk of progression (Cobb > 50°) and a reactive one where surgery is recommended after the patient/caregiver may have significant challenges caused by a large deformity. METHODS: A prospectively collected CP scoliosis surgical registry was queried for patients with minimum two years of follow-up. Three groups were delineated based on the distribution of curve magnitudes: <70° (proactive), 70°-90°, and >90° (reactive). Radiographic, surgical, and quality of life outcome data were compared between the groups using analysis of variance and chi-square analyses. RESULTS: There were 38 patients in the <70° group, 44 in the 70°-90° group, and 42 in the >90° group. They were similar in age. The >90° group had significantly longer operative time (p < .001), a higher percentage of anterior/posterior procedures (31% vs 5%), and a higher infection rate requiring I&D (16.7%) than the other groups (<70°: 5.3%; 70°-90°: 6.8%; p < .05). The percentage blood volume loss was significantly higher in the >90° group compared to <70°. There were no differences in length of hospitalization or intensive care unit stay. Preoperatively, the Caregiver Priorities and Child Health Index of Life with Disabilities (CPchild) QOL score was significantly higher for the <70° group. At two years, the <70° and 70°-90° groups reached similar QOL scores, whereas the >90° trended toward a lower postoperative QOL. CONCLUSIONS: Being proactive (Cobb <70°) has no advantage in terms of decreasing risks or improving outcomes compared to curves 70°-90°. However, delaying surgery to a curve greater than 90° increases the risk of infection, blood loss, and the need for anterior/posterior procedures. Ideally, surgery should be recommended for curves less than 90°.
STUDY DESIGN: Retrospective review of prospective data. OBJECTIVE: To delineate a curve threshold where further delay of surgery significantly increased the risks for patients with cerebral palsy (CP) scoliosis. SUMMARY OF BACKGROUND DATA: Two approaches exist in the management of CP scoliosis: a proactive one where surgery is recommended once there is a risk of progression (Cobb > 50°) and a reactive one where surgery is recommended after the patient/caregiver may have significant challenges caused by a large deformity. METHODS: A prospectively collected CP scoliosis surgical registry was queried for patients with minimum two years of follow-up. Three groups were delineated based on the distribution of curve magnitudes: <70° (proactive), 70°-90°, and >90° (reactive). Radiographic, surgical, and quality of life outcome data were compared between the groups using analysis of variance and chi-square analyses. RESULTS: There were 38 patients in the <70° group, 44 in the 70°-90° group, and 42 in the >90° group. They were similar in age. The >90° group had significantly longer operative time (p < .001), a higher percentage of anterior/posterior procedures (31% vs 5%), and a higher infection rate requiring I&D (16.7%) than the other groups (<70°: 5.3%; 70°-90°: 6.8%; p < .05). The percentage blood volume loss was significantly higher in the >90° group compared to <70°. There were no differences in length of hospitalization or intensive care unit stay. Preoperatively, the Caregiver Priorities and Child Health Index of Life with Disabilities (CPchild) QOL score was significantly higher for the <70° group. At two years, the <70° and 70°-90° groups reached similar QOL scores, whereas the >90° trended toward a lower postoperative QOL. CONCLUSIONS: Being proactive (Cobb <70°) has no advantage in terms of decreasing risks or improving outcomes compared to curves 70°-90°. However, delaying surgery to a curve greater than 90° increases the risk of infection, blood loss, and the need for anterior/posterior procedures. Ideally, surgery should be recommended for curves less than 90°.
Authors: Arun R Hariharan; Suken A Shah; Paul D Sponseller; Burt Yaszay; Michael P Glotzbecker; George H Thompson; Patrick J Cahill; Tracey P Bastrom Journal: Spine Deform Date: 2022-09-26
Authors: Ariana T Meltzer-Bruhn; Matthew R Landrum; David A Spiegel; Patrick J Cahill; Jason B Anari; Keith D Baldwin Journal: Spine Deform Date: 2021-08-24