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Can postoperative Cobb and pelvic obliquity corrections be predicted using supine traction X-rays in non-ambulatory patients with cerebral palsy fused to L5? A case series study

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Abstract

Purpose

This study aimed to determine whether Cobb and pelvic obliquity corrections can be predicted using supine traction radiographs in patients with cerebral palsy (CP) who underwent posterior spinal fusion (PSF) from T2/3 to L5.

Methods

From January 2010 to January 2020, 167 non-ambulatory patients with CP scoliosis underwent PSF using pedicle screws in two quaternary centers with a minimum of 2 years follow-up (FU). Radiological measurements and chart reviews were performed.

Results

A total of 106 patients aged 15.6 ± 0.4 years were included. All patients had significant correction of the Cobb angle (MC), pelvic obliquity (PO), thoracic kyphosis (TK), and lumbar lordosis (LL) without loss of correction at the last FU (LFU). Curve flexibility was significantly correlated with Cobb correction (δMC) immediately postoperatively (p < 0.0001, r = 0.8950), followed by the amount of correction in pelvic obliquity under traction (δPOT) (p = 0.0252, r = 0.2174). For correction in PO (δPO), the most significant variable was δPOT (p < 0.0001, r = 0.7553), followed by curve flexibility (p = 0.0059, r = 0.26) and the amount of correction in Cobb under traction (p = 0.0252, r = 0.2174).

Conclusions

Cobb and PO corrections can be predicted using supine traction films for non-ambulatory CP patients treated with PSF from T2/3 to L5. The variables evaluated were interconnected, reinforcing preoperative planning for these patients. Comparative large-scale studies on patient-related clinical outcomes are required to determine whether this predicted correction is associated with improved surgical outcomes and reduced complication rates.

Level of evidence

IV

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Funding

The authors did not received support from any organization for the submitted work.

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Authors and Affiliations

  1. Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK

    Ruben Alejandro Morales Ciancio, Stewart Tucker, Thomas Ember, Mark Harris & Edel Broomfield

  2. Paediatric Spine Department, Evelina London Children Hospital, London, UK

    Jonathan Lucas

Authors
  1. Ruben Alejandro Morales Ciancio
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  2. Jonathan Lucas
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  3. Stewart Tucker
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  4. Thomas Ember
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Contributions

Ruben Alejandro Morales Ciancio: Made substantial contributions to the conception, design, analysis, and interpretation of data. Drafted and critically revised the work, approved the version to be published and agree to be accountable for all aspects of the work. Jonathan Lucas: Made substantial contributions to the analysis and interpretation of data. Drafted and revised the work, approved the version to be published and agree to be accountable for all aspects of the work. Stewart Tucker: Made substantial contributions to the analysis and interpretation of data. Revised the work, approved the version to be published and agree to be accountable for all aspects of the work. Thomas Ember: Made substantial contributions to the analysis and interpretation of data. Revised the work, approved the version to be published and agree to be accountable for all aspects of the work. Mark Harris: Made substantial contributions to the analysis and interpretation of data. Revised the work, approved the version to be published and agree to be accountable for all aspects of the work. Edel Broomfield: Made substantial contributions to the design, analysis, and interpretation of data. Revised the work, approved the version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ruben Alejandro Morales Ciancio.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare relevant to the content of this article.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Great Ormond Street Hospital under the number GOSH3357 in view of the retrospective nature of the study, and all the procedures being performed were part of routine care.

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Morales Ciancio, R.A., Lucas, J., Tucker, S. et al. Can postoperative Cobb and pelvic obliquity corrections be predicted using supine traction X-rays in non-ambulatory patients with cerebral palsy fused to L5? A case series study. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00880-5

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