Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2022; 13(4): 365-372
Published online Apr 18, 2022. doi: 10.5312/wjo.v13.i4.365
Is it necessary to fuse to the pelvis when correcting scoliosis in cerebral palsy?
Shane F Strom, Matthew C Hess, Achraf H Jardaly, Michael J Conklin, Shawn R Gilbert
Shane F Strom, Matthew C Hess, Michael J Conklin, Shawn R Gilbert, Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Al 35294, United States
Achraf H Jardaly, Department of Orthopaedics, The Hughston Clinic/Hughston Foundation, Columbus, GA 31908, United States
Author contributions: Jardaly AH, Conklin MJ, and Gilbert SR designed the research study; Strom SF, Hess MC, Jardaly AH, Conklin MJ, and Gilbert SR performed the data collection; Jardaly AH analyzed the data; Strom SS, Hess MC, and Jardaly AH wrote the manuscript; all authors thoroughly edited the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The University of Alabama’s Institutional Review Board approved this study. The approval ID is IRB-300005435.
Informed consent statement: Informed consent was waived as per the University of Alabama at Birmingham’s IRB guidelines.
Conflict-of-interest statement: All authors declare that they do not have any conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shawn R Gilbert, MD, Surgeon, Department of Orthopaedics, University of Alabama at Birmingham, ACC Suite 316, Children’s Hospital, 1600 7th Avenue South, Birmingham, Al 35294, United States. srgilbert@uabmc.edu
Received: July 27, 2021
Peer-review started: July 27, 2021
First decision: November 11, 2021
Revised: November 30, 2021
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 18, 2022
ARTICLE HIGHLIGHTS
Research background

The distal extent of the fusion in children with cerebral palsy scoliosis is a controversial topic. There is not enough evidence on whether it is necessary to include the pelvis in the distal fusion to correct for pelvic obliquity in these patients.

Research motivation

This study was carried out to fill the gap in the literature on whether it is necessary to fuse to the pelvis when correcting cerebral palsy scoliosis. The need for a homogeneous cohort (i.e. children with cerebral palsy and not other forms of neuromuscular scoliosis) was an additional reason for carrying out the study.

Research objectives

The primary objective was to compare the radiographic outcome (Cobb angles and pelvic obliquity) of cerebral palsy scoliosis treatment in children who were fused to the pelvis vs those who were fused to L4/L5. The secondary objective was to determine the complications associated with each of the two procedures.

Research methods

The study was a retrospective, cohort study that utilized chart and radiographic review to determine the outcomes and complications associated with cerebral palsy scoliosis correction in children who were fused to L4/L5 as compared to those fused to the pelvis.

Research results

In the analysis of 47 patients, the L5 tilt was corrected by 60% in patients fused to the pelvis, comparable to the 67% achieved in patients fused to L4/L5 (P = 0.22). The pelvic obliquity was also corrected by a similar degree; 43% in patients fused to the pelvis and 36% in patients fused to L4/L5 (P = 0.12). As for complications, patients fused to the pelvis had a higher number of total complications (63.0% vs 30%, respectively, P = 0.025).

Research conclusions

Fusing to the pelvis in cerebral palsy scoliosis did not achieve better correction of patients' pelvic obliquity and L5 tilt. However, it did increase the risk of postoperative complications. Therefore, spinal fusion can be stopped at the distal lumbar levels in a select patient population, without necessarily compromising the surgical outcomes.

Research perspectives

Future studies can investigate delineating specifically which patients might benefit from including the pelvis in their distal fusion. This might aid the surgeons in their preoperative planning and in guiding their choice of surgical technique.