A multicenter study published recently in The Journal of Bone & Joint Surgery, which included contributions from clinicians at Rady Children’s Hospital San Diego, provides important insights into the long-term outcomes of spinal fusion in children with severe cerebral palsy (GMFCS levels IV and V). These children face a high risk for progressive neuromuscular scoliosis and pelvic obliquity.
Findings confirm spinal fusion as an effective treatment option for appropriately selected patients, emphasizing individualized decision-making and multidisciplinary care.
The research, led by Vidyadhar Upasani, MD, director of Pediatric Orthopedics and Scoliosis Clinical Fellowship at Rady Children’s Hospital San Diego and professor at UC San Diego School of Medicine, and Peter Newton, MD, chief of the Division of Orthopedics and Scoliosis and surgeon-in-chief at Rady Children’s, examined five-year outcomes including radiographic correction, complications, and caregiver-reported quality of life.
Key Findings
- Durable correction: Mean Cobb angle improved from 82.8° preoperatively to 30.2° at five years, while pelvic obliquity decreased from 27.4° to 9.9°.
- Quality of life gains: Caregiver Priorities & Child Health Index of Life with Disabilities scores improved significantly across most domains and remained stable at five years, even in patients who experienced complications.
- Complication profile: Major complications occurred in 24.3% of patients, and 13.2% required unplanned return to the operating room, mostly within the first year. Importantly, these events did not lead to deterioration in quality-of-life scores.
“Even in a medically complex population, spinal fusion can deliver lasting improvements in sitting balance, quality of life and caregiver burden,” says Dr. Upasani. “These benefits persist despite the risk of complications, demonstrating durable radiographic and clinical outcomes in appropriately selected patients.”