SPINE Volume 34, Number 11, pp 1167–1175 ©2009, Lippincott Williams & Wilkins Surgical Correction and Fusion Using Posterior-Only Pedicle Screw Construct for Neuropathic Scoliosis in Patients With Cerebral Palsy A Three-Year Follow-up Study Hitesh N. Modi, MS,* Jae-Young Hong, MD,* Satyen S. Mehta, MS, MRCS,* S. Srinivasalu, DNB,* Seung-Woo Suh, MD, PhD,* Ju-Won Yi, MD,* Jae-Hyuk Yang, MD,* and Hae-Ryong Song, MD, PhD† Study Design. It is a retrospective study of 52 neuro- muscular scoliosis patients with cerebral palsy (CP). Objective. To determine the effectiveness and amount of correction using posterior-only pedicle screw con- struct. Summary of Background Data. Although there have been many reports in literature supporting the use of pedicle screw-only constructs for the correction of ado- lescent idiopathic scoliosis, similar studies have not been reported in patients with CP. Methods. We retrospectively evaluated outcomes of 52 neuropathic scoliosis patients (28 males and 24 fe- males) with CP over minimum 2 years of follow-up. All patients underwent pedicle screw fixation without any anterior procedure for the correction. Pelvic fixation was done in 10 patients who had pelvis obliquity more than 15°. All coronal and sagittal parameters were noted after surgery and at final follow-up. Patient’s functional out- come was measured using modified Rancho Los Amigos Hospital system criteria. Complications were recorded from record sheets and any change in the ambulatory status was also recorded. Results. Mean age was 22 years at the time of opera- tion and average follow-up was 36.1 month. Cobb’s angle was improved to 62.9% (P  0.0001) from 76.8° to 30.1° after surgery and 31.5° at final follow-up. This correction of scoliosis (41%92%) was found to be statistically sig- nificant (P  0.0001). Overall correction in pelvic obliquity was 56.2% from 9.2° before surgery to 4.0° after surgery which was 43.1% at final follow-up to 5.2°. Twenty-one patients (42%) improved their functional ability by grade 1 with 2 patients by grade 2. After the operation parent or caretakers of patients exhibited better sitting balance and nursing care. There were 32% complications in the series major being pulmonary. There were 2 perioperative deaths and 1 patient developed neurologic deficit due to screw impingement in canal, which was resolved after removal. Conclusion. We reported satisfactory coronal and sag- ittal correction with posterior-only pedicle screw fixation without higher complication rate in CP patients. Further long-term study is recommended to evaluate the success of pedicle screw in this population. Key words: cerebral palsy, scoliosis, posterior-only pedicle screw fixation, correction and fusion. Spine 2009; 34:1167–1175 Cerebral palsy (CP) is a static encephalopathy affecting the immature brain, which can lead to permanent motor disability and varying degrees of spinal deformity. 1,2 The prevalence of spinal deformities is proportional to the severity of neurologic impairment and inversely related to the level of ambulation with spinal deformities being present in 10% of ambulatory patients with spastic hemi- plegia and 65% of patients with spastic quadriplegia. 2–4 Bracing is ineffective in controlling the progression of sco- liosis in these patients and significant progression of deformity occurs after skeletal maturity as well. 1–3,5,6 In addition, pelvic obliquity, which is a frequent accom- paniment, may cause sitting imbalance. Surgical stabilization has proven to be a valuable method to stop progression of scoliosis in persons with CP. 7–13 Early operative stabilization has generally been recommended for these patients. 14 Over the years there have been improvements in the instrumentation tech- niques for treatment of scoliosis in CP patients. Har- rington instrumentation, which was introduced in the 1970s, was associated with a high incidence of pseudar- throsis and loss of reduction. 2,8 The introduction of seg- mental fixation with sublaminar wires by Luque saw a significant improvement in results. 2,15,16 Recent reports have shown good correction and maintenance rates with fewer complications with the use of hybrid instrumenta- tion using pedicle screws in thoracolumbar and lumbar levels. 3,14,17 Comparative studies have shown a better curve correction and maintenance rate, lesser periopera- tive blood loss, and improved postoperative pulmonary function values with use of pedicle screw instrumenta- tion as compared with hybrid constructs for adolescent idiopathic scoliosis (AIS). 17–20 This has been attributed to the 3 column control and higher stiffness provided by pedicle screws constructs. 20,21 From the *Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Seoul, Korea; and †Department of Orthopedics, Rare Disease Institute, Korea University Guro Hospital, Seoul, Korea. Acknowledgment date: August 18, 2008. Revision date: October 21, 2008. Acceptance date: November 17, 2008. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Address correspondence and reprint requests to Seung-Woo Suh, MD, PhD, Department of Orthopaedics, Scoliosis Research Institute, Korea University Guro Hospital, #80, Guro-Dong, Guro-Gu, Seoul, Korea 152-703; E-mail: spine@korea.ac.kr 1167