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Is it necessary to fuse to the pelvis when correcting scoliosis in cerebral palsy?

World Journal of Orthopedics 2022年第4期13卷 365-372页

作者： Shane F Strom Matthew C Hess Achraf H Jardaly Michael J Conklin Shawn R Gilbert Department of Orthopaedics University of Alabama at BirminghamBirminghamAl 35294United States Department of Orthopaedics The Hughston Clinic/Hughston FoundationColumbusGA 31908United States

BACKGROUND Neuromuscular scoliosis is commonly associated with a large pelvic *** in children with cerebral palsy is most commonly managed with posterior spinal instrumentation and *** consensus is reached regarding the proximal starting point of fusion,controversy exists as to whether the distal level of spinal fusion should include the pelvis to correct the pelvic *** To assess the role of pelvic fusion in posterior spinal instrumentation and fusion,particularly it impact on pelvic obliquity correction,and to assess if the rate of complications differed as a function of pelvic *** This was a retrospective,cohort study in which we reviewed the medical records of children with cerebral palsy scoliosis treated with posterior instrumentation and fusion at a single *** follow-up was six *** were stratified into two groups:Those who were fused to the pelvis and those fused to L4/*** major outcomes were complications and radiographic *** former were stratified into major and minor complications,and the latter consisted of preoperative and final Cobb angles,L5-S1 tilt and pelvic *** The study included 47 *** correction of the L5 tilt was 60%in patients fused to the pelvis and 67%in patients fused to L4/L5(P=0.22).The pelvic obliquity was corrected by 43%and 36%in each group,respectively(P=0.12).Regarding complications,patients fused to the pelvis had more total complications as compared to the other group(63.0%vs 30%,respectively,P=0.025).After adjusting for differences in radiographic parameters(lumbar curve,L5 tilt,and pelvic obliquity),these patients had a 79%increased chance of developing complications(Relative risk=1.79;95%CI:1.011-3.41).CONCLUSION Including the pelvis in the distal level of fusion for cerebral palsy scoliosis places patients at an increased risk of postoperative *** added value that pelvic fusion offers in terms of correcting

关键词： Cerebral palsy Scoliosis pelvic fusion pelvic obliquity Spinal fusion Distal lumbar level

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