Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep;12(5):1393-1401.
doi: 10.1007/s43390-024-00878-z. Epub 2024 Apr 29.

Long-term reoperation rates following spinal fusion for neuromuscular scoliosis in nonambulatory patients with cerebral palsy

Christopher D Seaver  1   2 , Sara J Morgan  1   3   4 , Candice S Legister  1   5 , Casey L Palmer  2 , Eduardo C Beauchamp  6   7 , Tenner J Guillaume  6 , Walter H Truong  5   6 , Steven E Koop  5   6 , Joseph H Perra  6   7 , John E Lonstein  7 , Daniel J Miller  8   9
Affiliations

Long-term reoperation rates following spinal fusion for neuromuscular scoliosis in nonambulatory patients with cerebral palsy

Christopher D Seaver et al. Spine Deform. 2024 Sep.

Abstract

Purpose: To describe the incidence of reoperation and factors contributing to surgical revision within a minimum of 10 years after spinal fusion for scoliosis in patients with nonambulatory cerebral palsy (CP).

Methods: We conducted a retrospective review of consecutive nonambulatory patients with CP who underwent primary spinal fusion at a single specialty care center with a minimum of 10 years from their index surgery (surgery dates 2001-2011). Causes of reoperation were classified as implant failure/pseudoarthrosis, surgical site infection (SSI), proximal junctional kyphosis, prominent/symptomatic implants, and implant removal. Reoperation rates with 95% confidence intervals were calculated for each time interval, and an actuarial survival curve was generated.

Results: 144 patients met inclusion criteria (mean age = 14.3 ± 2.6 years, 62.5% male); 85.4% had 5 years follow-up data; and 66.0% had 10 years follow-up data. Estimates from the actuarial analysis suggest that 14.9% (95% CI: 10.0-22.0) underwent reoperation by 5 years postsurgery, and 21.7% (95% CI: 15.4-30.1) underwent reoperation by 10 years postsurgery. The most common causes for reoperation were implant failure/pseudoarthrosis, SSI, and prominent/symptomatic implants.

Conclusions: To our knowledge, this study is the largest long-term follow-up of nonambulatory patients with CP and neuromuscular scoliosis who underwent spinal fusion. Approximately 22% of these patients required reoperation 10 years after their index surgery, primarily due to implant failure/pseudoarthrosis, SSI, and prominent/symptomatic implants. Complications and reoperations continued throughout the 10 years period after index surgery, reinforcing the need for long-term follow-up as these patients transition into adulthood.

Level of evidence: III.

Keywords: Cerebral palsy; Neuromuscular scoliosis; Nonambulatory; Reoperation; Spinal fusion.

PubMed Disclaimer

Conflict of interest statement

Dr. Guillaume is a consultant for Nuvasive and ZimVie. Dr. Perra and Dr. Beauchamp are consultants for Medtronic. All other authors have no interests to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of patients and reasons for exclusion from the study
Fig. 2
Fig. 2
Survival curve based on the actuarial analysis of patients with cerebral palsy who underwent fusion surgery for neuromuscular scoliosis. This curve displays the probability that patients with neuromuscular scoliosis will not have a reoperation (i.e., survival) over a 10 years follow-up period following fusion surgery
See this image and copyright information in PMC

References

    1. Berven S, Bradford DS (2002) Neuromuscular scoliosis: causes of deformity and principles for evaluation and management. Semin Neurol 22(2):167–178. 10.1055/s-2002-36540 10.1055/s-2002-36540 - DOI - PubMed
    1. Roberts SB, Tsirikos AI (2016) Factors influencing the evaluation and management of neuromuscular scoliosis: a review of the literature. J Back Musculoskelet Rehabil 29(4):613–623. 10.3233/bmr-160675 10.3233/bmr-160675 - DOI - PubMed
    1. Vialle R, Thévenin-Lemoine C, Mary P (2013) Neuromuscular scoliosis. Orthop Traumatol Surg Res 99(1 Suppl):S124–S139. 10.1016/j.otsr.2012.11.002 10.1016/j.otsr.2012.11.002 - DOI - PubMed
    1. Mercado E, Alman B, Wright JG (2007) Does spinal fusion influence quality of life in neuromuscular scoliosis? Spine 32(19 Suppl):S120–S125. 10.1097/BRS.0b013e318134eabe 10.1097/BRS.0b013e318134eabe - DOI - PubMed
    1. Saito N, Ebara S, Ohotsuka K, Kumeta H, Takaoka K (1998) Natural history of scoliosis in spastic cerebral palsy. Lancet 351(9117):1687–1692. 10.1016/s0140-6736(98)01302-6 10.1016/s0140-6736(98)01302-6 - DOI - PubMed

MeSH terms