Impact of Spinal Deformity and Surgery on Health-Related Quality of Life in Cerebral Palsy: A Multicenter Prospective Controlled Trial.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8109053 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1539-2570 (Electronic) Linking ISSN: 02716798 NLM ISO Abbreviation: J Pediatr Orthop Subsets: MEDLINE

Publication: 2000- : Philadelphia : Lippincott Williams & Wilkins
Original Publication: New York Ny : Raven Press

Cerebral Palsy*/surgery ; Quality of Life* ; Scoliosis*/surgery ; Spinal Fusion*/methods; Humans ; Female ; Male ; Prospective Studies ; Child ; Treatment Outcome ; Child, Preschool ; Canada ; Surveys and Questionnaires ; Adolescent

Background: Spinal fusion for scoliosis associated with cerebral palsy (CP) is challenging to study because specialized outcome measures are needed. Therefore, evidence in favor of the benefits of surgery has not been firmly established. This study aimed to determine if corrective spinal fusion improves health-related quality of life (HRQoL) in children with CP scoliosis at 2 years.
Methods: Children with CP and scoliosis who met the criteria for posterior spinal fusion were offered enrollment at 16 US and Canada centers. Participants' families selected either operative intervention (OP) or nonoperative treatment (NON) in discussion with their surgeon with no influence by the decision to participate in the research study. Demographic, clinical data (function level, magnitude of deformity, comorbidities), and HRQoL (CPCHILD Questionnaire) were collected at baseline and 2 years. Change (from baseline) in total CPCHIL scores was the primary outcome.
Results: Three hundred one OP and 34 NON subjects had complete baseline and 2-year data. At baseline, both groups were comparable in function level, comorbid status, and CPCHILD scores (52.1 ±15.3 vs. 53.4 ±14.5; P =0.66). The OP group had a larger spinal deformity magnitude (84.5˚ ± 21.8˚ vs. 66.3˚ ± 18.1˚) ( P =0.001). The total CPCHILD score improved in the OP group by 6.6 points ( P <0.001). NON scores were unchanged (+1.2; P =0.65) during follow-up. There were also significant score increases in the OP group for 5 of 6 CPCHILD domains. The change in CPCHILD scores from enrollment to 2 years was more significant in the OP group ( P =0.05).
Conclusion: For children with CP who undergo spinal fusion, HRQoL improved over preoperative levels and an unchanged nonoperative control group.
Level of Evidence: Level II.
Competing Interests: This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet, and the Food and Drug Administration. Grants from Stryker and DePuy Synthes Spine have directly funded this article. P.C. holds a patent for dynamic lung magnetic resonance imaging, but this has not been commercialized, nor has he received money for it. He is on the editorial board for JBJS—American and Spine Deformity and is a committee member for the Pediatric Orthopaedic Society of North America and Scoliosis Research Society. U.N. is an unpaid consultant for the AO Foundation. He is a committee member for the Pediatric Orthopaedic Society of North America F.M. has received consulting fees from Depuy Synthes Spine and Stryker Spine. He received support for attending the IPOS 2021 Annual Meeting. J.M.P. has received consulting fees from DePuy Synthes, NuVasive, and Zimmer Biomet. S.A.S. has royalties from DePuy Synthes and Stryker and he has received consulting fees from DePuy Synthes. He is in leadership roles for the Scoliosis Research Society, the Pediatric Orthopaedic Society of North America, and the Nemours Foundation. B.Y. has received grants from Stryker, NuVasive, Orthopediatrics, and Globus, and has received consulting fees from Stryker, NuVasive, Medtronic, and Depuy Synthes. He has received payment for presentations from Stryker, Nuvasive, and Depuy Synthes. He has a patent paid to him by Stryker. He is involved in the Pediatric Orthopaedic Society of North America, the Scoliosis Research Society, and Global Spine Outreach. P.S. has received grants from Ipsen Pharmaceuticals. He has royalties from Globus has consulting fees from NuVasive and DePuy Synthes Spine. He also served as the president of the Scoliosis Research Society. The remaining authors declare no conflicts of interest.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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Date Created: 20240730 Date Completed: 20241028 Latest Revision: 20241028

20241028

10.1097/BPO.0000000000002774

39077879