Surgical and health outcomes of non-ambulatory children with cerebral palsy and severe scoliosis: A population-based, longitudinal study.

Abstract

Aim: To evaluate medium-term surgical outcomes, complications, mortality, and health-related quality of life (HRQoL) in non-ambulatory children with cerebral palsy (CP) and severe scoliosis, and to analyse outcomes and mortality rates in children who had not undergone surgery.

Method: Data on non-ambulatory children with CP and severe scoliosis born from 2002 to 2008 were extracted from the Norwegian Quality and Surveillance Registry for Cerebral Palsy. Seventy-five children (44 males, 31 females) were included. Thirty-eight (51%; mean age at surgery 14 years 4 months; SD = 2 years 4 months; range = 8-18 years) underwent surgical correction and posterior spinal fusion, with a mean preoperative Cobb angle of 90° (range = 49°-140°), while 37 (49%) children had non-surgical treatment. HRQoL was measured with the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD).

Results: Eighteen children (47%) had postoperative complications; 5 of 38 (13%) children underwent further surgery. Surgical treatment improved sitting posture and back pain. The mean CPCHILD score was 49.0 (range = 19-84). Among non-surgically treated children, 15 of the 31 children considered too fragile to undergo spinal surgery (48%) died during the follow-up; the mean CPCHILD score for the remaining children was 36.4 points (range = 9-59).

Interpretation: Although surgical correction of scoliosis in non-ambulatory children with CP carried a high risk of complications and re-operations, it resulted in improved sitting posture and reduced back pain. Children who were not eligible for surgical treatment had a high mortality rate.