Surgical correction and fusion using posterior-only pedicle screw in
patients with cerebral palsy
Seung Woo Suh, Jae Young Hong
Scoliosis Research Institute, Korea University Guro Hospital
Introduction
Many reports support the use of pedicle
screw-only constructs for the correction of
AIS, similar studies have not been reported in
patients with CP
Galveston technique Unit Rod fix Iliac screw
Aims of Study
To determine the effectiveness of
correction using posterior-only pedicle
screw construct in cerebral palsy.
Material and Methods
52 CP patients M : F = 28 : 24
Mean FU 36.1 Month (24-65 M)
Mean age 22 Y (8-34 Y)
Spastic CP and scoliosis >40 (average 76.8)
Operative technique
Post only pedicle screw fix - no ant procedure
Pelvic fixation if pelvic obliquity >15 (10 pt)
Free hand pedicle screw insertion
Correction by rod derotation & in situ contouring15 15
Patient Analysis
Cobb angle / Pelvic obliquity / Thoracic kyphosis
/ Lumbar lordosis – Pre, Post, and Final FU
Functional Status (modified Rancho classification)
- class 1 (independent ambulatory)
- class 2 (ambulation with support)
- class 3 (sitting without support).
Mean op time 323 min (120-600) Mean Blood loss 3,091ml (500-8,000) Hospital stay 22.1 D ay (11-47)
Fixation levels Pelvic fixation 10pt
Results
Results
Pre op Post op Final FU
Cobb angle 76.8±2830.2±18.5
(62.9%)31.6±18.4
Pelvic obliquity
9.2±8.44±3.9
(59.3%)5.2±6.4
Thoracic kyphosis
38±22.9 26.8±13.7 29.2±18
Lumbar lordosis
35.1±28.3 33.7±14 32.3±15.1
Results
Functional Status Pre op Post op
Class 1 (independent ambulator) 6 명 11 명Class 2 (ambulation with support) 22 명 18 명
Class 3 (sitting without support) 3 명 8 명
Class 4 (sitting with support) 6 명 8 명
Class 5 (confined to bed) 15 명 5 명
Complications
17 complications (15pt) - 32.7%
Pleural effusion 2 Screw impingement
1
Hemothorax 2 Death 2
Pulm edema 2 Arrythmia 1
UTI 2 Bronchitis 1
Sup infection 2
Gastroenteritis 1
Drug Fever 1
42% (21 patients)- improved functional ability by grade one with two patients by grade two.
Overall 32.7% complication -not higher than others.
No deep wound infections.
No implant related complications.
Discussion