312. Residual lumbar hyperlordosis is associated with worsened hip status 5 years after cerebral palsy scoliosis correction

Abstract

BACKGROUND CONTEXT Cerebral palsy (CP) can be described as a “static encephalopathy with progressive musculoskeletal pathology.” Nonambulant children (GMFCS IVV however, the role of spinal alignment on hip status in CP remains unknown. PURPOSE To identify surgical factors and postoperative spinal alignment parameters that are associated with worsening postoperative hip status (WHS) (ie, subluxation, dislocation or resection) after spinal fusion. STUDY DESIGN/SETTING Prospective multicenter outcomes study of nonambulant CP patients (GMFCS IVV or if a subluxated hip at BL became dislocated or resected at postop intervals. Hip status up to 5Y postop was analyzed according to age, sex, coronal spinal alignment (major curve Cobb, pelvic obliquity), sagittal spinal alignment (thoracic kyphosis, T12-S1 lumbar lordosis, C7-S1 sagittal vertical axis), Risser score, hip position at rest, upper and lower- instrumented vertebrae (UIVL p=.284) were not associated with WHS. Reoperation was not associated with WHS (p=.304). CONCLUSIONS Postoperative hyperlordosis (>60°) is the only determined risk for WHS at 5Y after spinal fusion in nonambulant patients with cerebral palsy (GMFCS IV&V). WHS likely relates to anterior pelvic tilt and functional acetabular retroversion due to hyperlordosis, as well as loss of protective lumbo-pelvic motion causing anterior femoracetabular impingement. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.