Quality of Life after Scoliosis Surgery in Cerebral Palsy

Abstract

BACKGROUND CONTEXT: 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. PURPOSE: 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. STUDY DESIGN/SETTING: Patients were identified, and after initial contact the parent completed the modified DuPont questionnaire. This is a retrospective cohort review. PATIENT SAMPLE: Between January 2003 and September 2013, 83 operations were undertaken by four 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). OUTCOME MEASURES: DuPont questionnaire, and Cobb angle and pelvic obliquity from radiographs before and after surgery. METHODS: Questionnaires were completed using a script-guided telephone call. The parents were called in two 5-year blocks. The medical records were reviewed and radiological data collected. RESULTS: 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%). CONCLUSIONS: 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. Parental satisfaction scores were high and similar to currently published literature.