Complications of Spine Surgery in Cerebral Palsy

Abstract

Children with severe cerebral palsy frequently develop scoliosis and other spinal deformities that require spinal fusion for correction. Because many of the children who develop spinal deformities have very severe neurologic deficits, the complication risks during and after the spinal fusion is high. Children with severe cerebral palsy who are not having aggressive nutritional management through gastrostomy tubes may have nutritional deficits. If these nutritional deficits are severe, the ability to tolerate a large surgical procedure and with a large wound is decreased. Management of the nutritional deficit may be with preoperative increased nutrition or the insertion of a gastrostomy or nasogastric tube. Alternatively, this can be managed with diligent attention to immediate postoperative nutritional intake. This acute postoperative nutritional intake may require insertion of a nasogastric or nasal jejunostomy tube for early feeding. In some rare cases, central venous hyperalimentation will be required. Other complications include high blood loss intraoperative requiring a diligent attention to a blood replacement. There are multiple other complications that need to be monitored such as sepsis, pancreatitis, cholangitis, and urinary tract infections in the immediate postoperative period. Gastroesophageal reflux is another common problem that needs to be medically managed before and during the surgical recovery.