Surgical Treatment of Scoliosis With Pelvic Obliquity in Cerebral Palsy

Abstract

In Brief Study Design. Continuous retrospective series. Objectives. To compare two techniques sequentially used for surgical correction of neuromuscular scoliosis with pelvic obliquity in children with cerebral palsy. Summary of Background Data. In nonwalking patients with cerebral palsy, scoliosis is frequently associated with pelvic obliquity. We compared intraoperative traction with no traction with instrumentation to the pelvis to correct pelvic obliquity. Methods. The initial 59 patients had surgery in the knee-chest position with pelvic obliquity correction by posterior vertebral instrumentation distraction, rotation, and compression. The sequential 51 patients were placed prone and had asymmetric traction applied between a halo and the high pelvic side lower extremity with pelvic correction maneuvers done before posterior surgery and instrumentation. Results. Anesthetic duration was longer in Group 1 because of complexity of the intraoperative correction maneuvers, which also produced less correction of scoliosis and pelvic obliquity compared with the asymmetric traction technique. At 8.6 years of follow-up, frontal and sagittal plane correction improved in all surviving patients. Conclusion. We think that intraoperative reduction by asymmetric traction is a reliable and safe technique to correct neuromuscular scoliosis and pelvic obliquity in nonwalking spastic quadriplegic patients. Intraoperative pelvic obliquity correction by instrumentation maneuvers was compared with preoperative and intraoperative asymmetrical traction in nonambulatory cerebral palsy patients. The asymmetric traction technique provided better correction of the scoliosis and pelvic obliquity while simultaneously reducing the operative time.