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

Operative technique

Free hand pedicle screw insertion

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

Case 1 M / 32

120 120

120

120

68

Case 2 M / 34

110

110

47

Case 3 M / 27

127

150

62127

127 150

62

3 level vertebrotomy

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

Conclusion

Pedicle screws with posterior-only

correction can bear good results

in cerebral palsy.

Thank You