Children with severe cerebral palsy (CP) often develop progressive scoliosis, or abnormal spinal curvature. Scoliosis causes a variety of health issues, such as problems with balance while sitting, pain, and complications affecting function of the lungs, heart, and gastrointestinal system.
Spinal fusion surgery has been considered standard of care for children whose scoliosis cannot be controlled with seating modifications or orthoses, but some have debated whether it is truly worthwhile. Firoz Miyanji and colleagues from British Columbia Children’s Hospital in Vancouver recently published a paper discussing the risks and benefits of scoliosis surgery in children with CP.
They included 69 subjects with an average age of 13.4, and GMFCS level IV or V cerebral palsy. Parents/caregivers were asked to complete the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire prior to surgery, as well as in follow-ups at 1, 2, and 5 years post-operative.
Surgery significantly reduced spinal curvature, and improvement was maintained in each follow-up. Miyanji et al. also saw an increase in quality of life for both the patients and their caregivers. In particular, there were improvements in personal care, positioning, and comfort.
Complications were also common, especially in the first year after surgery. 46.4 percent of subjects experienced a complication, such as pneumonia or surgical site infection, within the first year. 1.4 percent had complications between 1 and 2 years, and 4.3 percent experienced issues between 2 and 5 years. In total, eight children required surgical interventions.
Although the risks associated with scoliosis surgery are substantial, Miyanji et al. stress that potential improvements to quality of life outweigh these risks for children with severe cerebral palsy and progressive scoliosis.