Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis: A Comparative Analysis With 2-year Minimum Follow-up

Darryl Lau; Amer F. Samdani; Joshua M. Pahys; Firoz Miyanji; Suken A. Shah; Baron S. Lonner; Paul D. Sponseller; Burt Yaszay; Steven W. Hwang; Aaron Buckland; Amer Samdani; Amit Jain; Baron Lonner; Benjamin Roye; Burt Yaszay; Chris Reilly; Daniel Hedequist; Daniel Sucato; David Clements; Harry Shufflebarger; Jack Flynn; John Asghar; Jean Marc Mac Thiong; Joshua Pahys; Juergen Harms; Keith Bachmann; Lawrence Lenke; Lori Karol; Mark Abel; Mark Erickson; Michael Glotzbecker; Michael Kelly; Michael Vitale; Michelle Marks; Munish Gupta; Nicholas Fletcher; Noelle Larson; Patrick Cahill; Peter Gabos; Peter Newton; Peter Sturm; Randal Betz; Stefan Parent; Stephen George; Steven Hwang; Sumeet Garg; Tom Errico; Vidyadhar Upasani

doi:10.1097/BRS.0000000000004655

Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis: A Comparative Analysis With 2-year Minimum Follow-up

Darryl Lau, Amer F. Samdani, Joshua M. Pahys, Firoz Miyanji, Suken A. Shah, Baron S. Lonner, Paul D. Sponseller, Burt Yaszay, Steven W. Hwang, Aaron Buckland, Amer Samdani, Amit Jain, Baron Lonner, Benjamin Roye, Burt Yaszay, Chris Reilly, Daniel Hedequist, Daniel Sucato, David Clements, Harry ShufflebargerJack Flynn, John Asghar, Jean Marc Mac Thiong, Joshua Pahys, Juergen Harms, Keith Bachmann, Lawrence Lenke, Lori Karol, Mark Abel, Mark Erickson, Michael Glotzbecker, Michael Kelly, Michael Vitale, Michelle Marks, Munish Gupta, Nicholas Fletcher, Noelle Larson, Patrick Cahill, Peter Gabos, Peter Newton, Peter Sturm, Randal Betz, Stefan Parent, Stephen George, Steven Hwang, Sumeet Garg, Tom Errico, Vidyadhar Upasani

Research output: Contribution to journal › Article › peer-review

Abstract

Study Design. Retrospective review of a prospectively collected multicenter database Objective. To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis (NL) versus hyperlordosis. Summary of Background Data. Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood. Materials and Methods. A multicenter database was queried for CP patients who underwent surgery from 2008 to 2017. The minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° hyperlordosis (HL). Perioperative, radiographic, and clinical outcomes were compared. Results. Two hundred seventy-five patients were studied: 236 NL and 39 HL (-75 to -125°). The mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P=0.008) and higher CPCHILD scores (59.4 vs. 51.0, P=0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. -31.5°, P<0.001) and smaller sagittal vertical axis (-4.0 vs. 2.6 cm, P<0.001). Patients with hyperlordosis had greater estimated blood loss (2222.0 vs. 1460.7 mL, P<0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P=0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and sagittal vertical axis of -1.0 cm. At a 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P=0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in the reoperation rate between the groups. Conclusion. Surgical correction of scoliosis with hyperlordosis is associated with greater estimated blood loss but similar radiographic results, perioperative morbidity, and reoperation rate as normal lordosis. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory. Level of Evidence. 3.

Original language	English (US)
Pages (from-to)	E374-E381
Journal	Spine
Volume	48
Issue number	22
DOIs	https://doi.org/10.1097/BRS.0000000000004655
State	Published - Nov 15 2023

Keywords

blood loss
cerebral palsy
complications
hyperlordosis
neuromuscular scoliosis

ASJC Scopus subject areas

Orthopedics and Sports Medicine
Clinical Neurology

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10.1097/BRS.0000000000004655

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Lau, D., Samdani, A. F., Pahys, J. M., Miyanji, F., Shah, S. A., Lonner, B. S., Sponseller, P. D., Yaszay, B., Hwang, S. W., Buckland, A., Samdani, A., Jain, A., Lonner, B., Roye, B., Yaszay, B., Reilly, C., Hedequist, D., Sucato, D., Clements, D., ... Upasani, V. (2023). Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis: A Comparative Analysis With 2-year Minimum Follow-up. Spine, 48(22), E374-E381. https://doi.org/10.1097/BRS.0000000000004655

Lau, D, Samdani, AF, Pahys, JM, Miyanji, F, Shah, SA, Lonner, BS, Sponseller, PD, Yaszay, B, Hwang, SW, Buckland, A, Samdani, A, Jain, A, Lonner, B, Roye, B, Yaszay, B, Reilly, C, Hedequist, D, Sucato, D, Clements, D, Shufflebarger, H, Flynn, J, Asghar, J, Mac Thiong, JM, Pahys, J, Harms, J, Bachmann, K, Lenke, L, Karol, L, Abel, M, Erickson, M, Glotzbecker, M, Kelly, M, Vitale, M, Marks, M, Gupta, M, Fletcher, N, Larson, N, Cahill, P, Gabos, P, Newton, P, Sturm, P, Betz, R, Parent, S, George, S, Hwang, S, Garg, S, Errico, T & Upasani, V 2023, 'Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis: A Comparative Analysis With 2-year Minimum Follow-up', Spine, vol. 48, no. 22, pp. E374-E381. https://doi.org/10.1097/BRS.0000000000004655

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title = "Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis: A Comparative Analysis With 2-year Minimum Follow-up",

abstract = "Study Design. Retrospective review of a prospectively collected multicenter database Objective. To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis (NL) versus hyperlordosis. Summary of Background Data. Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood. Materials and Methods. A multicenter database was queried for CP patients who underwent surgery from 2008 to 2017. The minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° hyperlordosis (HL). Perioperative, radiographic, and clinical outcomes were compared. Results. Two hundred seventy-five patients were studied: 236 NL and 39 HL (-75 to -125°). The mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P=0.008) and higher CPCHILD scores (59.4 vs. 51.0, P=0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. -31.5°, P<0.001) and smaller sagittal vertical axis (-4.0 vs. 2.6 cm, P<0.001). Patients with hyperlordosis had greater estimated blood loss (2222.0 vs. 1460.7 mL, P<0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P=0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and sagittal vertical axis of -1.0 cm. At a 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P=0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in the reoperation rate between the groups. Conclusion. Surgical correction of scoliosis with hyperlordosis is associated with greater estimated blood loss but similar radiographic results, perioperative morbidity, and reoperation rate as normal lordosis. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory. Level of Evidence. 3.",

keywords = "blood loss, cerebral palsy, complications, hyperlordosis, neuromuscular scoliosis",

author = "Darryl Lau and Samdani, {Amer F.} and Pahys, {Joshua M.} and Firoz Miyanji and Shah, {Suken A.} and Lonner, {Baron S.} and Sponseller, {Paul D.} and Burt Yaszay and Hwang, {Steven W.} and Aaron Buckland and Amer Samdani and Amit Jain and Baron Lonner and Benjamin Roye and Burt Yaszay and Chris Reilly and Daniel Hedequist and Daniel Sucato and David Clements and Harry Shufflebarger and Jack Flynn and John Asghar and {Mac Thiong}, {Jean Marc} and Joshua Pahys and Juergen Harms and Keith Bachmann and Lawrence Lenke and Lori Karol and Mark Abel and Mark Erickson and Michael Glotzbecker and Michael Kelly and Michael Vitale and Michelle Marks and Munish Gupta and Nicholas Fletcher and Noelle Larson and Patrick Cahill and Peter Gabos and Peter Newton and Peter Sturm and Randal Betz and Stefan Parent and Stephen George and Steven Hwang and Sumeet Garg and Tom Errico and Vidyadhar Upasani",

year = "2023",

month = nov,

day = "15",

doi = "10.1097/BRS.0000000000004655",

language = "English (US)",

volume = "48",

pages = "E374--E381",

journal = "Spine",

issn = "0362-2436",

publisher = "Lippincott Williams and Wilkins",

number = "22",

}

TY - JOUR

T1 - Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis

T2 - A Comparative Analysis With 2-year Minimum Follow-up

AU - Lau, Darryl

AU - Samdani, Amer F.

AU - Pahys, Joshua M.

AU - Miyanji, Firoz

AU - Shah, Suken A.

AU - Lonner, Baron S.

AU - Sponseller, Paul D.

AU - Yaszay, Burt

AU - Hwang, Steven W.

AU - Buckland, Aaron

AU - Samdani, Amer

AU - Jain, Amit

AU - Lonner, Baron

AU - Roye, Benjamin

AU - Yaszay, Burt

AU - Reilly, Chris

AU - Hedequist, Daniel

AU - Sucato, Daniel

AU - Clements, David

AU - Shufflebarger, Harry

AU - Flynn, Jack

AU - Asghar, John

AU - Mac Thiong, Jean Marc

AU - Pahys, Joshua

AU - Harms, Juergen

AU - Bachmann, Keith

AU - Lenke, Lawrence

AU - Karol, Lori

AU - Abel, Mark

AU - Erickson, Mark

AU - Glotzbecker, Michael

AU - Kelly, Michael

AU - Vitale, Michael

AU - Marks, Michelle

AU - Gupta, Munish

AU - Fletcher, Nicholas

AU - Larson, Noelle

AU - Cahill, Patrick

AU - Gabos, Peter

AU - Newton, Peter

AU - Sturm, Peter

AU - Betz, Randal

AU - Parent, Stefan

AU - George, Stephen

AU - Hwang, Steven

AU - Garg, Sumeet

AU - Errico, Tom

AU - Upasani, Vidyadhar

PY - 2023/11/15

Y1 - 2023/11/15

N2 - Study Design. Retrospective review of a prospectively collected multicenter database Objective. To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis (NL) versus hyperlordosis. Summary of Background Data. Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood. Materials and Methods. A multicenter database was queried for CP patients who underwent surgery from 2008 to 2017. The minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° hyperlordosis (HL). Perioperative, radiographic, and clinical outcomes were compared. Results. Two hundred seventy-five patients were studied: 236 NL and 39 HL (-75 to -125°). The mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P=0.008) and higher CPCHILD scores (59.4 vs. 51.0, P=0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. -31.5°, P<0.001) and smaller sagittal vertical axis (-4.0 vs. 2.6 cm, P<0.001). Patients with hyperlordosis had greater estimated blood loss (2222.0 vs. 1460.7 mL, P<0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P=0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and sagittal vertical axis of -1.0 cm. At a 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P=0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in the reoperation rate between the groups. Conclusion. Surgical correction of scoliosis with hyperlordosis is associated with greater estimated blood loss but similar radiographic results, perioperative morbidity, and reoperation rate as normal lordosis. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory. Level of Evidence. 3.

AB - Study Design. Retrospective review of a prospectively collected multicenter database Objective. To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis (NL) versus hyperlordosis. Summary of Background Data. Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood. Materials and Methods. A multicenter database was queried for CP patients who underwent surgery from 2008 to 2017. The minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° hyperlordosis (HL). Perioperative, radiographic, and clinical outcomes were compared. Results. Two hundred seventy-five patients were studied: 236 NL and 39 HL (-75 to -125°). The mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P=0.008) and higher CPCHILD scores (59.4 vs. 51.0, P=0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. -31.5°, P<0.001) and smaller sagittal vertical axis (-4.0 vs. 2.6 cm, P<0.001). Patients with hyperlordosis had greater estimated blood loss (2222.0 vs. 1460.7 mL, P<0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P=0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and sagittal vertical axis of -1.0 cm. At a 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P=0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in the reoperation rate between the groups. Conclusion. Surgical correction of scoliosis with hyperlordosis is associated with greater estimated blood loss but similar radiographic results, perioperative morbidity, and reoperation rate as normal lordosis. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory. Level of Evidence. 3.

KW - blood loss

KW - cerebral palsy

KW - complications

KW - hyperlordosis

KW - neuromuscular scoliosis

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Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis: A Comparative Analysis With 2-year Minimum Follow-up

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