Surgical correction and fusion using
posterior-only pedicle screw in patients
with cerebral palsy
Seung Woo Suh, Jae Young Hong
Scoliosis Research Institute, Korea University Guro Hospital
Introduction

Many reports support the use of pedicle screw-only
constructs for the correction of AIS, similar studies
have not been reported in patients with CP
Galveston technique
Unit Rod fix
Iliac screw
Aims of Study

To determine the effectiveness of correction
using posterior-only pedicle screw construct
in cerebral palsy.
Material and Methods

52 CP patients M : F = 28 : 24

Mean FU
36.1 Month (24-65 M)

Mean age
22 Y (8-34 Y)

Spastic CP and scoliosis >40 (average 76.8)
Operative technique

Post only pedicle screw fix - no ant procedure

Pelvic fixation if pelvic obliquity >15 (10 pt)
15

Free hand pedicle screw insertion

Correction by rod derotation & in situ contouring
Operative technique

Free hand pedicle screw insertion
Patient Analysis

Cobb angle / Pelvic obliquity / Thoracic kyphosis /
Lumbar lordosis – Pre, Post, and Final FU

Functional Status (modified Rancho classification)
- class 1 (independent ambulatory)
- class 2 (ambulation with support)
- class 3 (sitting without support).
Results




Mean op time
323 min
Mean Blood loss 3,091ml
Hospital stay
22.1 Day
Fixation levels
 Pelvic fixation
10pt
(120-600)
(500-8,000)
(11-47)
Results
Pre op
Post op
Final FU
76.8±28
30.2±18.5
(62.9%)
31.6±18.4
Pelvic obliquity
9.2±8.4
4±3.9
(59.3%)
5.2±6.4
Thoracic
kyphosis
38±22.9
26.8±13.7
29.2±18
Lumbar
lordosis
35.1±28.3
33.7±14
32.3±15.1
Cobb angle
Results
Functional Status
Pre op
Post op
Class 1 (independent ambulator)
6명
11명
Class 2 (ambulation with support)
22명
18명
Class 3 (sitting without support)
3명
8명
Class 4 (sitting with support)
6명
8명
15명
5명
Class 5 (confined to bed)
Complications

17 complications (15pt)
- 32.7%
Pleural effusion
2
Screw impingement 1
Hemothorax
Pulm edema
2
2
Death 2
Arrythmia 1
UTI
Sup infection
2
2
Bronchitis 1
Gastroenteritis
1
Drug Fever
1
Case 1 M / 32
120
120
68
120
120
Case 2 M / 34
110
110
47
Case 3 M / 27
127
150
62
127
127
62
150
3 level vertebrotomy
Discussion

42% (21 patients)- improved functional ability by grade
one with two patients by grade two.

Overall 32.7% complication -not higher than others.

No deep wound infections.

No implant related complications.
Conclusion

Pedicle screws with posterior-only
correction can bear good results in
cerebral palsy.
Thank You