Quality of Life after Scoliosis Surgery in Cerebral Palsy

Introduction Radiological correction of scoliosis in quadriplegic cerebral palsy (CP) after posterior instrumentation is well established but patient and caregiver outcomes are required to justify this high risk and high cost surgery. The aims of surgical correction is to improve the patients sitting postion and pain from costo-pelvic impingement by reducing the spinal deformity and pelvic obliquity. Material and Methods To use the modified DuPont Hospital questionnaire to evaluate the quality of life, physical function and caring demands of patients who had undergone instrumented scoliosis correction for CP. Patients were identified and after initial contact, the parent completed the modified DuPont Questionnaire. The outcome measures were DuPont Questionnaire, Cobb angle and pelvic obliquity from radiographs before and after surgery. Results Between Jan 2003 – Sept 2013, 83 operations were undertaken by 4 Spinal Surgeons at Sheffield Children's Hospital in patients with quadriplegic CP. Two died during surgery (cardiac arrest) and two had died by follow-up from causes unrelated to the surgery. 79 families were contacted and 63 families agreed to be involved (80% return rate). 87% felt that their child's deformity was very much improved. 77% felt that their child's overall appearance was much improved. 60% felt it had improved their child's ability to feed and breathe. 64% felt that it was easier to bathe and dress their child. 94% said they would recommend surgery to another member of their family in similar situation. Cobb angle improved from 70° to 30° (47%) and pelvic obliquity from 24° to 11° (46%). Conclusion Surgical correction is still reserved for significant and progressive deformity with decreasing function. This remains a high risk intervention in patients at the severe end of CP spectrum with an on table mortality of 2%. Parental satisfaction scores were high and similar to currently published literature. High Satifcaction levels were found in those families who chose to undertake surgery.