May 17, 2022
2 min read
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Distal spine anchors may provide control of major curves in cerebral palsy scoliosis

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Published results showed distal spine anchors may provide better long-term control of the major curve than distal pelvic anchors in children with cerebral palsy scoliosis treated with growth-friendly instrumentation.

Perspective from David L. Skaggs, MD, MMM

“Inserting screws into the pelvis to anchor growing rods is not benign. Screws in that area tend to be more prominent. Prominent screws can be painful and can also cause overlying skin breakdown and lead to infection. In addition, these screws can have a high failure rate,” G. Ying Li, MD, told Healio. “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.”

Distal spine vs. pelvic anchors

Using a multicenter database, Li and colleagues identified children with cerebral palsy scoliosis treated with traditional growing rods, magnetically controlled growing rods or a vertical expandable prosthetic titanium rib with a minimum of 2 years of follow-up. Researchers collected radiographic data prior to the index surgery, immediately after the index surgery and at most recent follow-up. Researchers also collected demographic data, as well as the type of growth-friendly device, type and location of the distal anchors, number of patients with distal spine anchors who underwent extension to the pelvis, number of patients with complications, type of complications and number of patients with unplanned returns to the OR.

G. Ying Li
G. Ying Li

Of the 98 patients who met inclusion criteria, researchers found 27 patients had distal spine anchors and 71 patients had distal pelvic anchors placed at the index surgery. Results showed patients who received distal spine anchors had a lower pre-index pelvic obliquity. Although both groups had similar radiographic data at most recent follow-up, researchers noted patients in the distal spine anchor group had a smaller major curve.

Extension of instrumentation

Researchers found 22% of patients in the distal spine anchor group underwent extension of instrumentation to the pelvis, most commonly at final fusion. Patients in the distal spine anchor group who underwent extension of instrumentation to the pelvis had a higher pre-index L5 tilt compared with patients who did not require extension, according to results.

At most recent follow-up, patients in the distal spine anchor group who underwent extension of instrumentation had a lower major curve compared with the distal pelvic anchor group, according to subanalysis. Researchers found a higher number of complications per patient in the distal spine anchor group who underwent extension of instrumentation vs. the distal spine anchor group who did not undergo extension of instrumentation.

“Growth-friendly treatment for early onset scoliosis is already associated with more complications than a single spinal fusion. So, for patients with cerebral palsy who have a small enough pelvic tilt, it is beneficial to avoid inserting screws into the pelvis in the early stages of treatment,” Li said. “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. These findings provide 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.”