Medical Professional Publications

Should Children With Severe Cerebral Palsy Have Spinal Fusion Surgery for Scoliosis?

Columbus, OH — March 2017

Spinal fusion for adolescent idiopathic scoliosis has demonstrated benefits for the patient. A thoracic curve of 70 degree impairs lung function, and lung function improves after surgery, for example; patients report on surveys that quality of life has improved in other ways as well. But that data does not exist for children with globally involved cerebral palsy (CP) who have undergone spinal fusion for scoliosis, says Amanda T. Whitaker, MD, a member of the Department of Orthopaedic Surgery at Nationwide Children’s Hospital.

Dr. Whitaker was lead author of a 2015 ethical assessment of spinal fusions in patients with severe CP. Those patients are unable to participate in many outcomes measures, the assessment reported. Patients may not be able to consistently hold their breath and exhale during a pulmonary function test, and they may be nonverbal, meaning they cannot respond to quality-of-life questions.

So is it worth the known risks of these surgeries for patients with CP if many benefits are unknown? Dr. Whitaker is beginning a research project that may provide some of the first objective evidence of benefits.

“We want to quantitatively measure these areas, to see if this surgery is actually better for patients,” says Dr. Whitaker, who is also a clinical associate professor of Orthopaedic Surgery at The Ohio State University College of Medicine. “And we are already utilizing technology at Nationwide Children’s that I believe can help us do that.”

Nathalie L. Maitre, MD, PhD, a neonatologist and medical director of Neonatal Intensive Care Follow-up Programs at Nationwide Children’s, uses electroencephalogram (EEG)-based event-related potentials to study neurological responses to pictures and words. Her lab often tests children with cognitive, behavioral and motor impairments, including CP.

One clear result of spinal fusion surgery for patients with severe CP is improvement in head and body posture, which may improve the ability to receive communication. Drs. Whitaker and Maitre are working on a study that uses event-related potentials to measure social and environmental interactions before and after surgery. They also plan to explore the change in ability to use assistive communication devices.

“In the surgical decision-making process with parents and patients, we now rely on what we know about the value of the surgery for children with idiopathic scoliosis,” says Dr. Whitaker. “We also rely on what parents of other patients have reported about their subjective experiences after surgery. For the first time, these event-related potentials will give us quantitative data one what these patients with severe CP are experiencing themselves.”

Reference:
Whitaker AT, Sharkey M, Diab M. Spinal fusion for scoliosis in patients with globally involved cerebral palsy: an ethical assessment. The Journal of Bone & Joint Surgery. 2015 May 6; 97(9):782-7.

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