Can postoperative Cobb and pelvic obliquity corrections be predicted using supine traction X-rays in non-ambulatory patients with cerebral palsy fused to L5? A case series study

Ruben Alejandro Morales Ciancio; Jonathan Lucas; Stewart Tucker; Thomas Ember; Mark Harris; Edel Broomfield

doi:10.1007/s43390-024-00880-5

Can postoperative Cobb and pelvic obliquity corrections be predicted using supine traction X-rays in non-ambulatory patients with cerebral palsy fused to L5? A case series study

Spine Deform. 2024 Apr 29. doi: 10.1007/s43390-024-00880-5. Online ahead of print.

Authors

Ruben Alejandro Morales Ciancio¹, Jonathan Lucas², Stewart Tucker³, Thomas Ember³, Mark Harris³, Edel Broomfield³

Affiliations

¹ Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK. ale.moralesc@gmail.com.
² Paediatric Spine Department, Evelina London Children Hospital, London, UK.
³ Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.

PMID: 38683285
DOI: 10.1007/s43390-024-00880-5

Abstract

Purpose: This study aimed to determine whether Cobb and pelvic obliquity corrections can be predicted using supine traction radiographs in patients with cerebral palsy (CP) who underwent posterior spinal fusion (PSF) from T2/3 to L5.

Methods: From January 2010 to January 2020, 167 non-ambulatory patients with CP scoliosis underwent PSF using pedicle screws in two quaternary centers with a minimum of 2 years follow-up (FU). Radiological measurements and chart reviews were performed.

Results: A total of 106 patients aged 15.6 ± 0.4 years were included. All patients had significant correction of the Cobb angle (MC), pelvic obliquity (PO), thoracic kyphosis (TK), and lumbar lordosis (LL) without loss of correction at the last FU (LFU). Curve flexibility was significantly correlated with Cobb correction (δMC) immediately postoperatively (p < 0.0001, r = 0.8950), followed by the amount of correction in pelvic obliquity under traction (δPOT) (p = 0.0252, r = 0.2174). For correction in PO (δPO), the most significant variable was δPOT (p < 0.0001, r = 0.7553), followed by curve flexibility (p = 0.0059, r = 0.26) and the amount of correction in Cobb under traction (p = 0.0252, r = 0.2174).

Conclusions: Cobb and PO corrections can be predicted using supine traction films for non-ambulatory CP patients treated with PSF from T2/3 to L5. The variables evaluated were interconnected, reinforcing preoperative planning for these patients. Comparative large-scale studies on patient-related clinical outcomes are required to determine whether this predicted correction is associated with improved surgical outcomes and reduced complication rates.

Level of evidence: IV.

Keywords: Cerebral palsy; Neuromuscular scoliosis; Non-ambulatory; Pelvic obliquity correction; Scoliosis surgery.