15 Years of Spinal Fusion Outcomes in Children with Cerebral Palsy: Are We Getting Better?

STUDY DESIGN: Retrospective Multicenter Study.

OBJECTIVE: We reviewed 15-year trends in operative factors, radiographic and quality-of-life outcomes, and complication rates in children with cerebral palsy (CP) related scoliosis who underwent spinal fusion.

SUMMARY OF BACKGROUND DATA: Over the past 2 decades, significant efforts have been made to decrease complications and improve outcomes of this population.

METHODS: We retrospectively reviewed a multicenter registry of pediatric CP patients who underwent spinal fusion from 2008 to 2020. We evaluated baseline and operative, hospitalization, and complication data as well as radiographic and quality-of-life outcomes at a minimum 2-year follow-up.

RESULTS: Mean estimated blood loss and transfusion volume declined from 2.7±2.0 L in 2008 to 0.71±0.34 L in 2020 and 1.0±0.5 L in 2008 to 0.5±0.2 L in 2020, respectively, with a concomitant increase in antifibrinolytic use from 58% to 97% (all, P<0.01). Unit rod and pelvic fusion use declined from 33% in 2008 to 0% in 2020 and 96% in 2008 to 79% in 2020, respectively (both, P<0.05). Mean postoperative intubation time declined from 2.5±2.6 days to 0.42±0.63 days (P<0.01). No changes were observed in pre- and post-operative coronal angle and pelvic obliquity, operative time, frequency of anterior/anterior-posterior approach, and durations of hospital and intensive care unit stays. Improvements in the Caregiver Priorities and Child Health Index of Life with Disabilities postoperatively did not change significantly over the study period. Complication rates, including reoperation, superficial and deep surgical site infection, and gastrointestinal and medical complications remained stable over the study period.

CONCLUSIONS: Over the past 15 years of CP-scoliosis surgery, surgical blood loss, transfusion volumes, duration of postoperative intubation, and pelvic fusion rates have decreased. However, the degree of radiographic correction, the rates of surgical and medical complications (including infection), and health-related quality-of-life measures have broadly remained constant.

LEVEL OF EVIDENCE: 3.