Is it necessary to fuse to the pelvis when correcting scoliosis in cerebral palsy?

Table 1 Characteristics of patients with cerebral palsy scoliosis

Characteristics	Fusion to pelvis (n = 27)	Fusion to L4/L5 (n = 20)	P value
Demographics
Average age (yr)	14.2	13.4	0.303
Sex, number of males	19	13	0.52
Average weight (kg)	34.2	35.6	0.66
Average follow-up (mo)	41.7	31.0	0.11
Gastrostomy (n)	15	6	0.061
VP shunt (n)	4	3	0.95
Seizures (n)	10a	14a	0.050
Operative details
Average operative duration (min)	341	334	0.72
Average blood loss (mL)	989	1049	0.74

^aP ≤ 0.05, between the groups.

VP shunt: Ventriculoperitoneal shunt.

Table 2 Radiographic parameters

	Pre-operative values, mean (Range)	Final values, mean (Range)
Fusion to pelvis
Thoracic curve (degrees)	30 (0–64)	14 (0-38)
Lumbar curve (degrees)	56 (4–106)	32 (0-68)
L5 tilt (degrees)	10 (0-41)	4 (0-16)
Pelvic obliquity (degrees)	21 (1-59)	12 (0-34)
Fusion to L4/L5
Thoracic curve (degrees)	42 (2-109)	24 (1-88)
Lumbar curve (degrees)	39 (5-75)	14 (1-47)
L5 tilt (degrees)	6 (0-13)	2 (0-8)
Pelvic obliquity (degrees)	11 (1-30)	7 (2-20)

Table 3 Preoperative and final pelvic obliquity of patients

	Pelvic obliquity
	< 10˚	10˚-15˚	> 15˚
Fusion to pelvis
Preoperative	6	6	15
Final	12	6	9
Fusion to L4/L5
Preoperative	10	5	5
Final	15	1	4

Table 4 Complications encountered in both groups, n (%)

Complications	Fusion to pelvis (n = 27)	Fusion to L4/L5 (n = 20)	Total (n = 47)
Pulmonary complications
Respiratory failure1	1 (3.7)	1 (5)	2 (4.2)
Atelectasis	3 (11.1)	1 (5)	4 (8.5)
Pneumonia1	0	1(5)	1 (2.1)
Pressure ulcer	5 (18.5)	1 (5)	6 (12.8)
Instrumentation
Hardware break or prominence	3 (11.1)	0	3 (6.4)
PJK1	1 (3.7)	0	1 (2.1)
Superficial SSI	0	2 (10)	2 (4.2)
Deep SSI1	1 (3.7)	0	1 (2.1)
Wound dehiscence	1 (3.7)	0	1 (2.1)
SIRS1	1 (3.7)	0	1 (2.1)
Durotomy	1 (3.7)	0	1 (2.1)
Total	17 (63)	6 (30)	23 (49.9)

¹Major complications.

SIRS: Systemic inflammatory response syndrome; SSI: Surgical site infection; PJK: Proximal junctional kyphosis.