Does an intrathecal baclofen pump impact scoliosis progression and complicate posterior spine fusion in patients with cerebral palsy?

STUDY DESIGN: Retrospective comparative study. OBJECTIVES: In patients with cerebral palsy (CP), we determine the impact of intrathecal baclofen pumps (ITBPs) on scoliosis curve progression before posterior spine fusion (PSF) and its effects on surgical outcome. BACKGROUND: Children with CP can have rapid scoliosis progression, and high rates of surgical complications can be encountered. It is unknown whether the presence of pre-existing ITBP results in more difficult surgery and higher complication rates in similarly affected children. METHODS: This is a single-center retrospective study of CP patients undergoing PSF over a 15-year period. Demographics, comorbidities, curve magnitudes, and surgical methods were compared between patients with ITBP and those without. Postoperative complications, length of intensive care unit/hospital stay, drain use and output volume, and need for further surgery were also compared. Curve progression analysis after ITBP placement was performed on a subgroup of patients with high-quality consistent radiographs. RESULTS: Nineteen patients with ITBP and 49 patients without ITBP met inclusion criteria. Age, comorbidities, number of levels fused, and fixation techniques during PSF were not significantly different between cohorts. ITBP patients were more likely to have PSF with osteotomy (p = 0.022). Increased intraoperative neurosurgical consultations were found for patients with ITBP (42.1% vs. 4.0%; p < 0.001). Median surgical time was 1.2 h greater in patients with ITBP (6.7 vs. 5.5 h, p = 0.039). There was no difference in hospital course and complications in patients with ITBP and those without ITBP. Thirty-one patients without ITB were compared with 15 ITBP patients for curve progression before PSF, demonstrating a mean rate of scoliosis progression of 9.6° ± 6.7°/year and 14.8° ± 9.1°/year (p = 0.0346), respectively. CONCLUSION: The presence of an ITBP appears to be associated with the increase in scoliosis progression; and these patients will likely have a more challenging spine fusion. Fortunately, the final outcome is not affected by ITBP. LEVEL OF EVIDENCE: Level III.

Assessment of Acetabular Morphology Using the Acetabular Anterior Center-Edge Angle on Modified False-Profile Radiographs.

PURPOSE: To compare radiographic parameters of acetabular morphology between standard and modified false-profile (FP) radiographs. METHODS: Standard and modified FP radiographs were obtained in 225 hips in 200 consecutive patients evaluated for hip pain and suspected femoroacetabular impingement. Radiographs were retrospectively reviewed by 2 readers to determine the anterior center-edge angle (ACEA), as assessed to the sourcil and to the bone edge. Inter-rater reliability of radiographic measurements was assessed using the intraclass correlation coefficient. Measurements were evaluated for normality with the Shapiro-Wilk test, averaged between the 2 readers, and compared between views using the paired Wilcoxon test. RESULTS: The intraclass correlation coefficient values for standard and modified FP views were 0.923 and 0.932, respectively, measuring to the sourcil and 0.867 and 0.896, respectively, measuring to the lateral bone edge. The median difference in ACEA measurements to the sourcil was 1° between the standard and modified FP view (45° vs 44°, P < .001). The median difference in ACEA measurements to the bone edge was 2° (34° vs 32°, P < .001). CONCLUSIONS: Thirty-five degrees of femoral internal rotation for a modified FP hip radiographic view provides similar clinical information regarding acetabular morphology to that of the standard FP view. Given that the modified FP view also provides better visualization of the anterosuperior head-neck junction cam lesion, the modified FP view may be preferred over the standard FP view in evaluation of hip pain in the young patient. LEVEL OF EVIDENCE: Level III, retrospective comparative study.