Does a delay of surgery due to a multidisciplinary screening process result in neuromuscular scoliosis curve progression in complex Cerebral Palsy?

Abstract

Purpose: While surgical intervention of scoliosis in cerebral palsy (CP) patients has shown notable improvements in quality of life, the high risk of post-operative complications in CP patients necessitates careful preoperative optimization. A preoperative multidisciplinary (Multi-D) pathway at our tertiary pediatric hospital in effect since 2014 led to a significant reduction in mortality at one year. However, such a strategy delays surgery, potentially increasing the risk of curve progression. This study aims to elucidate the impact of the Multi-D screening process on curve progression in neuromuscular scoliosis among complex CP patients.

Methods: A retrospective review of all CP patients with scoliosis at a tertiary care center from 2012 to 2020 was conducted. This assessment focused on the progression of the major Cobb angle from the time of the indications conference to surgery of patients who went through Multi-D screening. Patient demographics and perioperative variables were obtained from the electronic medical record (EPIC, Systems Verona, WI).

Results: After exclusion criteria were met, there were 85 patients who went through Multi-D, 78 of whom had surgery, and seven who did not. Surgery was delayed an average of 202 days for Multi-D optimization. We found a trend in increasing Cobb angle over time, but this correlation did not reach statistical significance (p = 0.079). 45 Multi-D surgery participants had a decrease or no change in Cobb angle and had surgery an average of 5.6 months after indications. 33 Multi-D surgery participants had an increase in Cobb angle and had surgery an average of 8.5 months after indications. Cobb angle progressed an average of 13.4° in the increased group, and - 0.4° in the decrease or no change group. There were no associations with change in Cobb angle and GMFCS, starting major curve angle, number of referrals, or intrathecal baclofen pump use according to this analysis.

Conclusions: Multi-D optimization resulted in an average delay in surgery of 6.7 months. Patients that did not have a change in Cobb angle had surgery within 5.6 months vs. patients that had an increase in Cobb angle had surgery on average 8.5 months after indicated for surgery, with an average increase of Cobb angle of 13.4°.

Level of evidence: Level III, retrospective comparative study.