BACKGROUND:
To our knowledge, there have been no previous studies addressing the
indications for and the results of treatment of patients with cerebral palsy
and concomitant kyphosis or lordosis without scoliosis. The purpose of the
present study was to identify the indications for and the results of treatment
of patients with cerebral palsy who have a spinal curve deformity solely in
the sagittal plane.
METHODS:
We conducted a retrospective review of the data on all patients with
cerebral palsy who had a sagittal plane spinal deformity but no coronal plane
deformity, had undergone posterior spinal fusion with unit rod instrumentation
at our institution, and had been followed for at least two years. Medical
records and radiographs were reviewed for symptoms, type and magnitude of
deformity, age at surgery, duration of surgery, nutritional status,
complications, and concomitant medical problems.
RESULTS:
Twenty-four patients-—ten boys and fourteen girls-—were
identified. Eight patients had a hyperlordotic deformity, fourteen had a
hyperkyphotic deformity, and two exhibited both. Surgical indications included
severe seating problems that could not be rectified with wheelchair
modifications (eighteen patients), severe back pain (four patients), superior
mesenteric artery syndrome that was refractory to conservative treatment (two
patients), and a hyperlordotic deformity with a loss of bowel and bladder
control (one patient).
It was found that specific technical concerns had to be addressed when the
unit rod instrumentation was used. The mean preoperative hyperkyphotic curve
of 93.8° was corrected to a mean of 35.8° postoperatively and was a
mean of 34.8° at the last visit. The mean preoperative hyperlordotic curve
of 91.8° was corrected to a mean of 43.6° postoperatively and was a
mean of 48.6° at the last visit. All patients with seating problems and
back pain had improvement or resolution of the problem after the surgery. The
superior mesenteric artery syndromes, losses of bowel and bladder function,
and malnutrition all resolved completely after the surgery.
CONCLUSIONS:
Patients with cerebral palsy and a severe sagittal plane deformity
(=70°) can be treated successfully with posterior spinal fusion with
use of unit rod instrumentation. Indications for treatment include loss of
sitting ability or balance, back pain, loss of bowel or bladder function, and
superior mesenteric artery syndrome that is unresponsive to medical
management.