ADVANTAGES OF DOUBLE SPINAL FIXATION FOR CEREBRAL PALSY PATIENTS OPERATED LATE

Abstract

Purpose: The purpose of this work was to compare outcome after simple posterior fusion with that after double anterior and posterior fusion for the treatment of scoliosis in cerebral palsy children.

Material and methods: We reviewed the files of 33 cerebral palsy children (mean age 16 years). Twenty-one children had a posterior fusion and twelve a double anterior-posterior fusion. The classical causes of cerebral palsy were represented. Simple posterior fusion was used for more moderate scoliosis (Cobb angle 50–80°), 31% could be reduced during the bending test. Double fusion was used for more severe cases (Cobb > 80°), 18% reducible. Classical procedures were used: CD instrumentation posteriorly, simple release or Colorado rod anteriorly. Thoracophreno-laparotomy (n=6) or thoracoscopy (n=3) was used for anterior fusion. For the double fusions, the posterior procedure was performed the same day in 11/12 patients.

Results: Operative time for double fusion was twice that for posterior fusions. There was no significant difference in blood loss between the two techniques. Complications were more frequent for double fusion but there were no deaths (one death due to respiratory failure after posterior fusion). All the double fusion patients remained in the intensive care unit for 2.5 – 21 days (mean 6.5 days). There was no significant difference between hospital stay (mean 18 days). Gain was better for double fusion (62% versus 52%).

Discussion: Double fusion for cerebral palsy scoliosis treated late is a major operation with significant but tolerable morbidity, particularly for major scoliosis > 80°. The double procedure enables good reduction and quality fusion. Considering the current reduction and fixation options, isolated posterior fusion can still be indicated in younger children with a reducible curvature.