Spinal Fusion in Patients with GMFCS IV or V Cerebral Palsy: Durable Correction and Lasting Quality of Life Improvements
Bibliographic record
Abstract
BACKGROUND: Understanding outcomes of spinal fusion (SF) in children with cerebral palsy (CP) beyond the short term is important to determine efficacy and durability. This study examined complications, unplanned returns to the operating room (UPROR), and radiographic and clinical outcomes after SF in children with CP. METHODS: Patients with GMFCS IV or V CP who had been followed for a minimum of 5 years after SF were identified in a prospective multicenter database and analyzed. The major Cobb angle and pelvic obliquity (PO) were recorded. Data regarding complications and any UPROR were collected prospectively. The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire was completed preoperatively and at 2 and 5 years postoperatively. Data were analyzed using a generalized estimating equation (GEE), repeated-measures analysis of variance (RM-ANOVA), and the Kaplan-Meier method. RESULTS: One hundred and eighty-nine patients (mean age, 13.4 ± 2.7 years; 94 male and 95 female; 45% White, 24% Hispanic, 16% Black, and 4% Asian as self-reported) were included in the study. The preoperative Cobb angle (82.8° ± 23.0°) was improved at 2 years (29.9° ± 16.2°; p < 0.001), and the improvement was maintained at 5 years (30.2° ± 17.0°; p = 0.284). The preoperative PO (27.4° ± 15.6°) was improved at 2 years (9.7° ± 9.1°; p < 0.001), and the improvement was maintained at 5 years (9.9° ± 9.8°; p = 0.997). There were 46 patients (24.3%) with major complications and 25 patients (13.2%) who required UPROR, mostly within the first year. The probability of remaining free of major complications and of having no UPROR at 5 years was >75% and >87%, respectively. Improvements in CPCHILD scores were observed at 2 years and remained improved at 5 years compared with baseline. RM-ANOVA demonstrated no significant differences in the change in scores over time in patients with complications or UPROR compared with those who did not. Those with complications or UPROR showed no evidence of a major decline in CPCHILD scores. CONCLUSIONS: SF resulted in durable radiographic correction and sustained improvements in caregiver-reported quality of life over a minimum of 5 years. Patients with major complications or UPROR showed no deterioration in CPCHILD scores. These findings support SF as an effective treatment option for appropriately selected patients with GMFCSIV or V CP. LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".