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2014 ; 5
(1
): 38-51
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Surgical correction of scoliosis in children with spastic quadriplegia: benefits,
adverse effects, and patient selection
#MMPMID24715871
Legg J
; Davies E
; Raich AL
; Dettori JR
; Sherry N
Evid Based Spine Care J
2014[Apr]; 5
(1
): 38-51
PMID24715871
show ga
STUDY RATIONALE: Cerebral palsy (CP) is a group of nonprogressive syndromes of
posture and motor impairment associated with lesions of the immature brain.
Spastic quadriplegia is the most severe form with a high incidence of scoliosis,
back pain, respiratory compromise, pelvic obliquity, and poor sitting balance.
Surgical stabilization of the spine is an effective technique for correcting
deformity and restoring sitting posture. The decision to operate in this group of
patients is challenging. OBJECTIVES: The aim of this study is to determine the
benefits of surgical correction of scoliosis in children with spastic
quadriplegia, the adverse effects of this treatment, and what preoperative
factors affect patient outcome after surgical correction. MATERIALS AND METHODS:
A systematic review was undertaken to identify studies describing benefits and
adverse effects of surgery in spastic quadriplegia. Factors affecting patient
outcome following surgical correction of scoliosis were assessed. Studies
involving adults and nonspastic quadriplegia were excluded. RESULTS: A total of
10 case series and 1 prospective and 3 retrospective cohort studies met inclusion
criteria. There was significant variation in the overall risk of complications
(range, 10.9-70.9%), mortality (range, 2.8-19%), respiratory/pulmonary
complications (range, 26.9-57.1%), and infection (range, 2.5-56.8%). Factors
associated with a worse outcome were a significant degree of thoracic kyphosis,
days in the intensive care unit, and poor nutritional status. CONCLUSION:
Caregivers report a high degree of satisfaction with scoliosis surgery for
children with spastic quadriplegia. There is limited evidence of preoperative
factors that can predict patient outcome after scoliosis. There is a need for
well-designed prospective studies of scoliosis surgery in spastic quadriplegia.
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