Surgical Correction of Scoliosis in Children with Spastic Quadriplegia: Benefits, Adverse Effects, and Patient Selection

Legg, Julian; Davies, Evan; Raich, Annie; Dettori, Joseph R; Sherry, Ned

doi:10.1055/s-0034-1370898

Cited by 29 publications

(10 citation statements)

References 23 publications

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“…For seach (4), 116 items were found, and 26 items were identified as relevant (Aghdasi et al 2020 ; Bettany-Saltikov et al 2015 , 2016 ; Cho et al 2014 ; Drazin et al 2011 ; Evaniew et al 2015 ; Figueiredo et al 2016 ; Guan et al 2020 ; Hawes & O’Brien 2008 ; Kim et al 2012 ; Larson et al 2013 ; Lau et al 2014 ; Ledonio, Polly & Crawford 2013 ; Legg et al 2014 ; Liang et al 2012 ; Sharma et al 2013 ; Theis, Gerdhem & Abbott 2015 ; Toovey et al 2017 ; Weiss 2008 ; Weiss & Goodall 2008a , 2009 ; Wu et al 2019 ; Yadla et al 2010 ; Yang et al 2016 ; Yoshihara 2019 ; Zanirato et al 2018 ).…”

Section: Resultsmentioning

confidence: 99%

“…High rates of early complications have been found mainly in surgery applied for paediatric deformities as well as for adult deformities (Cho et al 2014 ; Drazin et al 2011 ; Figueiredo et al 2016 ; Fu at al. 2016 ; Guan et al 2020 ; Hawes & O’Brien 2008 ; Kim et al 2012 ; Ledonio et al 2013 ; Legg et al 2014 ; Sharma 2013 ; Toovey et al 2017 ; Wu et al 2019 :682–693; Yadla et al 2010 ; Zanirato et al 2018 ). In the systematic review by Zanirato et al ( 2018 ), the rate of complications for patients with adult spine deformity (ASD) is dependent on the surgical technique applied, between 24% and 36% perioperative plus 11% and 15% late complications.…”

Section: Resultsmentioning

confidence: 99%

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Is there an indication for surgery in patients with spinal deformities? – A critical appraisal

Weiss¹,

Nan²,

Potts

2021

South African Journal of Physiotherapy

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Background: High-quality evidence exists to support physiotherapy and brace treatment for scoliosis and other spinal deformities. However, according to previous systematic reviews, it seems that no evidence exists for surgery. Nevertheless, the number of research articles focussing on spinal surgery highly exceeds the number of articles focussing on conservative treatment.Objective: The purpose of this study is to conduct an updated search for systematic reviews providing high-quality evidence for spinal surgery in patients with spinal deformities.Method: A narrative review including PubMed and the Cochrane database was conducted on April 12, 2020, with the following search terms: (1) spinal deformities, surgery, systematic review and outcome; (2) kyphosis, surgery, systematic review and outcome; (3) Scheuermann’s disease, surgery, systematic review and outcome, and (4) scoliosis, surgery, systematic review and outcome.Results: No reviews containing prospective controlled or randomised controlled studies were found providing evidence for surgery.Conclusions: A general indication for spine surgery just based on the Cobb angle is not given. In view of the long-term unknown variables and the possible long-term complications of such treatment, a surgical indication for patients with spinal deformities must be reviewed on an individual basis and considered carefully. A current systematic review appears necessary in order to be able to draw final conclusions on the indication for surgery in patients with spinal deformities.Clinical implications: In view of the increasing number of surgeons with an affiliation to industry, the indication for surgery needs to be given by independent conservative specialists for spinal deformities in order to provide an objective recommendation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Is there an indication for surgery in patients with spinal deformities? – A critical appraisal

Weiss¹,

Nan²,

Potts

2021

South African Journal of Physiotherapy

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“…reported that 3.5% (7/199) of patients with CP in GMFCS level V died within 2 years after spinal surgery. In a systematic review of patients with CP undergoing spinal surgery, Legg et al 26 . observed morality rates of 2.8% to 19% from less than 1 year to 8 years 7 months after spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Health‐related quality of life and caregiver burden after hip reconstruction and spinal fusion in children with spastic cerebral palsy

DiFazio

Vessey

Miller

et al. 2021

Develop Med Child Neuro

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Aim To evaluate the effect of hip reconstruction or spinal fusion on health‐related quality of life (HRQoL) in non‐ambulatory children with spastic cerebral palsy (CP) and caregiver burden. Method This was a prospective, longitudinal study of changes in HRQoL and caregiver burden over the 5 years after surgical correction of hip instability or scoliosis in children with bilateral spastic CP classified in Gross Motor Function Classification levels IV or V. Serial parent proxy measures of HRQoL and caregiver burden were obtained before and 6 weeks, and 3, 6, 9, 12, 24, and 60 months after surgery using the Caregiver Priorities and Child Health Index of Life with Disabilities and the Assessment of Caregiver Experience with Neuromuscular Disease. Scores 5 years or more after surgery were compared to pre‐surgery scores using paired Student’s t‐tests. Serial outcome trajectories were estimated by linear mixed modeling. Results Of 69 participants (40 males, 29 females; mean age 11y 6mo, SD 4y 1mo, range 3y 10mo–20y 7mo), 43 had hip reconstruction and 26 had spinal fusion. Clinically significant improvements in HRQoL were detected (average increase 7.6 points) 5 years or more postoperatively, with hip reconstruction providing greater benefit. Domains improved by surgery included positioning, transferring/mobility, comfort/emotions, and health. Caregiver burden did not change as these children remain maximally dependent. Interpretation Surgical treatment of hip and spine deformity improves HRQoL, especially for painful hip instability, but does not change caregiver burden.

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“…In addition, a systematic review conducted by Legg et al 12 reported that the overall complication rate after spinal fusion at the last follow-up in pediatric patients with CP ranged from 10.9% to 70.9%. Infections and surgical site infection (SSI) were the most prevalent postoperative complications encountered 12 …”

mentioning

confidence: 99%

Risk Factors of Infectious Complications in Pediatric Patients With Cerebral Palsy After Spinal Arthrodesis

Miśkiewicz

Perea

Magruder

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Objective:The main objective of this study was to investigate (1) whether pediatric patients with cerebral palsy (CP) have higher rates of postoperative infectious complications after spinal fusion and (2) risk factors for postoperative infections.Summary of Background Data: Prior studies have shown that patients with CP undergo corrective spine surgery more often than the general population, yet typically have worse postoperative outcomes. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative infectious complications.Patients and Methods: The 2019 "American College of Surgeons National Surgical Quality Improvement Program" Pediatric database was used for patient data. The univariable analysis compared the prevalence of preoperative comorbidities and perioperative factors between children with and without CP. Multivariable logistic regression modeling was used to ascertain independent risk factors for postoperative infectious complications.Results: A total of 4445 patients were included in the study; 606 (13.63%) patients had CP and 3839 (86.37%) did not. Patients with CP were more likely to have several notable preoperative comorbidities, and the rate of developing any infectious complication was more than 7 times greater in the CP cohort than in the control cohort (14.36% vs 1.88%; P < 0.001). Multivariable analysis revealed CP [odds ratio (OR): 3.55, CI: 2.25-5.60; P < 0.001], American Society of Anesthesiologists class 3 or higher (OR: 2.10, CI: 1.29-3.42; P = 0.003), and hematologic disorders (OR: 2.01, CI: 1.06-3.83; P = 0.033) to be independent risk factors for increased postoperative infectious complications.Conclusions: CP is an independent risk factor for the development of 30-day postoperative infectious complications in pediatric patients. In addition, the American Society of Anesthesiologists class 3 or higher and hematologic disorders were risk factors for postoperative infections after spinal fusion surgery.

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Surgical Correction of Scoliosis in Children with Spastic Quadriplegia: Benefits, Adverse Effects, and Patient Selection

Cited by 29 publications

References 23 publications

Is there an indication for surgery in patients with spinal deformities? – A critical appraisal

Is there an indication for surgery in patients with spinal deformities? – A critical appraisal

Health‐related quality of life and caregiver burden after hip reconstruction and spinal fusion in children with spastic cerebral palsy

Risk Factors of Infectious Complications in Pediatric Patients With Cerebral Palsy After Spinal Arthrodesis

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