From the Helsinki University Hospital (M.A.); Department of Orthopaedics and Traumatology (I.H.), University of Helsinki and Helsinki University Hospital; THL Finnish Institute for Health and Welfare (M.G.); and Department of Health and Welfare (I.J.-K.), Arcada University of Applied Sciences, Helsinki, Finland.
Neurology. 2023 Oct 31;101(18):e1787-e1792. doi: 10.1212/WNL.0000000000207796. Epub 2023 Sep 7.
To compare mortality and causes of death in scoliotic children with cerebral palsy (CP) with and without scoliosis surgery.
National population-based registries were searched for children with CP and scoliosis with and without surgery for scoliosis and were analyzed for comorbidities, mortality, and causes of death.
Two hundred thirty-six had not been operated and 238 had been operated on for scoliosis during the median follow-up of 17.8 (interquartile range [IQR] 11.7-25.7) and 23.0 (IQR 18.4-28.2) years, respectively. Both groups had similar comorbidities. During the follow-up, mortality was higher in the nonsurgically treated group than in the surgically treated group (n = 38/236, 16% and 8.7 per 1,000 follow-up years vs n = 29/238, 12% and 5.3 per 1,000 follow-up years, = 0.047). In patients with nonsurgical treatment, the cause of death was respiratory in 76.3% (29/38) and 37.9% (11/29) in patients with surgical treatment of scoliosis (6.6 and 2.0 per 1,000 follow-up years, = 0.002). Neurologic causes of death were more common in surgically treated patients than in nonsurgically treated patients, 44.8% (13/29) and 15.8% (6/38), respectively (3.0 and 1.1 per 1,000 follow-up years, = 0.009).
Surgical treatment of scoliosis associates to reduced mortality because of respiratory causes in children with CP and scoliosis.
This study provides Class IV evidence of the effects of spinal fusion on mortality of children with severe scoliosis due to CP.
比较脑瘫（CP）合并脊柱侧凸和不合并脊柱侧凸的患儿的死亡率和死亡原因。
检索全国人群为基础的 CP 伴脊柱侧凸登记处，包括未手术和已手术治疗脊柱侧凸的患儿，并对其合并症、死亡率和死亡原因进行分析。
236 例患儿未行手术，238 例患儿行手术治疗脊柱侧凸，平均随访时间分别为 17.8（IQR 11.7-25.7）和 23.0（IQR 18.4-28.2）年。两组患儿均有相似的合并症。随访期间，未手术治疗组死亡率高于手术治疗组（n = 38/236，16%和 1,000 随访年 8.7 例 vs n = 29/238，12%和 5.3 例， = 0.047）。未手术治疗组中，38 例死亡患儿中，76.3%（29/38）因呼吸系统疾病死亡，而行手术治疗组中，29 例死亡患儿中，37.9%（11/29）因呼吸系统疾病死亡（6.6 和 2.0 例/1,000 随访年， = 0.002）。手术治疗组中，44.8%（13/29）的死亡患儿死于神经系统疾病，而未手术治疗组中，6 例（6/38）患儿因神经系统疾病死亡（3.0 和 1.1 例/1,000 随访年， = 0.009）。
对于 CP 合并脊柱侧凸的患儿，行脊柱侧凸手术治疗可降低因呼吸系统疾病导致的死亡率。
本研究为 IV 级证据，表明脊柱融合术可降低 CP 患儿重度脊柱侧凸的死亡率。
