Some children with cerebral palsy scoliosis may not need pelvic
fixation, study shows
Inserting screws in the pelvis for growth-friendly treatment of scoliosis
can be painful and lead to infection in this patient population

Date:
April 18, 2022
Source:
Michigan Medicine - University of Michigan
Summary:
A new study finds that some children with cerebral palsy
and scoliosis do not require pelvic fixation when undergoing
growth-friendly treatment.

Researchers say those with a small enough pelvic and lower lumbar
spine tilt may not need screws inserted into the pelvis, potentially
avoiding several complications.



FULL STORY ==========================================================================
A new Michigan Medicine study finds that some children with cerebral
palsy and scoliosis do not require pelvic fixation when undergoing
growing rod treatment, potentially avoiding several complications.


========================================================================== Using data from around 20 health systems, researchers analyzed nearly
100 pediatric patients with cerebral palsy and scoliosis treated with
growth- friendly implants, in which expandable rods are inserted into
the back to help control the spinal curvature while still allowing the
spine to grow. They found that for children with a pelvic tilt and lower
lumbar spine tilt of fewer than 10 degrees, the pelvis did not need to
be included when inserting growing rods.

The results are published in Spine Deformity.

"Inserting screws into the pelvis to anchor the growing rods is not
benign; screws in that area tend to be more prominent," said G. Ying
Li, M.D., lead author of the paper and pediatric orthopaedic surgeon at University of Michigan Health C.S. Mott Children's Hospital.

"Prominent screws can be painful and can also cause overlying skin
breakdown, leading to infection. In the past, there has also been a
high rate of these screws failing. For these reasons, understanding
which kids have enough of a tilt in their pelvis and lower lumbar
spine to benefit from anchoring the rods into the pelvis is important." Children with cerebral palsy have abnormal nerve and muscle control,
and many of them are wheelchair users. When they develop scoliosis,
the curve in their spine tends to be longer and more sweeping than those without the condition.

The curve may extend into the pelvis, affecting standing and sitting
balance and causing pressure that can make sitting more painful or lead
to skin breakdown.

Patients treated with growing rods require more than one surgery,
and most children eventually need a spinal fusion. Growth-friendly
treatment is already associated with more complications than a single
spinal fusion. For patients with cerebral palsy who have a small enough
pelvic tilt, Li says, it is beneficial to avoid inserting screws into
the pelvis in the early stages of growth-friendly treatment.

"Even though we did see some children with growing rods anchored to
the spine who later needed to have the rods anchored to the pelvis,
we inserted those pelvic screws when kids were undergoing their final
spinal fusion procedure," she said.

"These findings provide fellow surgeons with more information to help
patients avoid complications while still correcting a curve that can
impact quality of life, pain and lung development for children with
cerebral palsy."

========================================================================== Story Source: Materials provided by
Michigan_Medicine_-_University_of_Michigan. Original written by Noah
Fromson. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Ying Li, Jennylee Swallow, Joel Gagnier, John T. Smith, Robert
F. Murphy,
Paul D. Sponseller, Patrick J. Cahill. Pelvic fixation is not
always necessary in children with cerebral palsy scoliosis treated
with growth- friendly instrumentation. Spine Deformity, 2022; DOI:
10.1007/s43390-022- 00474-z ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/04/220418085721.htm

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