Bipolar spinal correction reduces transfusion rate and hospital stay compared with traditional posterior spinal fusion in children with scoliosis secondary to cerebral palsy.

PURPOSE

Patients with neuromuscular scoliosis due to Cerebral Palsy (CP) are complex due to their curve severity and associated medical comorbidities. Spinal fusion is associated with high risk of peri-operative complications and large blood loss requiring allogenic red blood cell (RBC) transfusion. In June 2017, our tertiary paediatric institution implemented a new minimally-invasive approach for the treatment of neuromuscular scoliosis, Bipolar Spinal Correction (Bipolar), a technique first published by Miladi et al. in 2018. This study represents an analysis of the initial experience of this technique to see if it achieves the goal of minimally invasive surgery by decreasing surgical stress in this high-risk population.

METHODS

We identified patients with an underlying diagnosis of CP who underwent primary single-day surgical correction for their scoliosis between 2010 and 2024 at a single paediatric institution. Patients either underwent a primary posterior spinal fusion (PSF) or Bipolar surgeries. Revision procedures and patients undergoing anterior spinal surgery were excluded. Patient charts and x-rays were reviewed to collect data on demographics, pre-operative curve severity and peri-operative details.

RESULTS

PSF cohort included 46 patients and Bipolar included 78 patients. Demographic and curve severity data were similar between the groups. Bipolar surgery resulted in shorter operative times than PSF (228 min vs. 270 min) and reduced blood loss based on cell-saver return (113 mL vs. 382 mL) and lowest post-operative Hgb level (99.8 g/L vs. 89.6 g/L). Allogenic RBC transfusion rate was markedly reduced in the Bipolar cohort compared to the PSF cohort both intra-operatively (2.6% vs. 23.9%) and post-operatively (14.1% vs. 23.9%). No patient in the Bipolar cohort required mass transfusion protocol, defined as needing more than 3 units of allogenic RBC, compared with 2 patients in the PSF cohort. Post-operative hospital length-of-stay was reduced in the Bipolar cohort compared to PSF (6.5 days vs. 8 days).

CONCLUSIONS

When compared with traditional posterior spinal fusion, Bipolar Spinal Correction resulted in decreased operative times, less surgical blood loss, decreased allogenic transfusion rate, and reduced post-operative hospital length of stay in the treatment of children with CP and scoliosis.

LEVEL OF EVIDENCE

Level III, Retrospective Comparative Cohort.