Published online Apr 18, 2022. doi: 10.5312/wjo.v13.i4.365
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
Processing time: 258 Days and 7.8 Hours
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.
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.
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.
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.
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).
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.
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.