1. Surgical correction and fusion using posterior-only pedicle screw in patients with cerebral palsy Seung Woo Suh, Jae Young Hong Scoliosis Research Institute, Korea University Guro Hospital

2. Introduction Many reports support the use of pedicle screw-only constructs for the correction of AIS, similar studies have not been reported in patients with CP Galveston techniqueUnit Rod fixIliac screw

3. Aims of Study To determine the effectiveness of correction using posterior-only pedicle screw construct in cerebral palsy.

5. Material and Methods 52 CP patients M : F = 28 : 24 Mean FU 36.1 Month (24-65 M) Mean age 22 Y (8-34 Y) Spastic CP and scoliosis >40  (average 76.8  )

6. Operative technique Post only pedicle screw fix - no ant procedure Pelvic fixation if pelvic obliquity >15  (10 pt) Free hand pedicle screw insertion Correction by rod derotation & in situ contouring 15 

7. Operative technique Free hand pedicle screw insertion

8. Patient Analysis Cobb angle / Pelvic obliquity / Thoracic kyphosis / Lumbar lordosis – Pre, Post, and Final FU Functional Status (modified Rancho classification) - class 1 (independent ambulatory) - class 2 (ambulation with support) - class 3 (sitting without support).

9. Mean op time323 min(120-600) Mean Blood loss3,091ml(500-8,000) Hospital stay22.1 Day(11-47) Fixation levels Pelvic fixation10pt Results

10. Pre opPost opFinal FU Cobb angle76.8±28 30.2±18.5 (62.9%) 31.6±18.4 Pelvic obliquity9.2±8.4 4±3.9 (59.3%) 5.2±6.4 Thoracic kyphosis 38±22.926.8±13.729.2±18 Lumbar lordosis 35.1±28.333.7±1432.3±15.1

11. Results Functional Status Pre opPost op Class 1 (independent ambulator) 6명6명 11 명 Class 2 (ambulation with support) 22 명 18 명 Class 3 (sitting without support) 3명3명 8명8명 Class 4 (sitting with support) 6명6명 8명8명 Class 5 (confined to bed) 15 명 5명5명

12. Complications 17 complications(15pt) - 32.7% Pleural effusion2Screw impingement1 Hemothorax2Death2 Pulm edema2Arrythmia1 UTI2Bronchitis1 Sup infection2 Gastroenteritis1 Drug Fever1

13. Case 1 M / 32 120 

14. 68 

15. Case 2 M / 34 110 

16. 47 

17. Case 3 M / 27 127  150 

18. 62  127  150  62  3 level vertebrotomy

19. 42% (21 patients)- improved functional ability by grade one with two patients by grade two. Overall 32.7% complication -not higher than others. No deep wound infections. No implant related complications. Discussion

20. Conclusion Pedicle screws with posterior-only correction can bear good results in cerebral palsy.

21. Thank You