Dysfunction of a ventriculoperitoneal shunt after posterior spinal fusion in children with cerebral palsy: a report of two cases.

Abstract

Posterior spinal fusion with the use of unit rod instrumentation has been successful in the treatment of neuromuscular scoliosis 1-3. The reported complications of this procedure include wound infection, pulmonary embolism, pneumonia, skin ulceration, excessive blood loss, pneumothorax, latex anaphylaxis, superior mesenteric artery syndrome, pancreatitis, instrumentation failure, pseudarthrosis, and spinal cord injury 1-11. We report on two children with cerebral palsy who sustained life-threatening hydrocephalus due to dysfunction of a ventriculoperitoneal shunt after posterior spinal fusion. To our knowledge, this unusual complication has not been reported previously. Both of our patients had severe scoliosis secondary to spastic quadriplegic cerebral palsy, and both had a history of hydrocephalus treated with a shunt. In both patients, the correction of the spinal curve at surgery was marked. In one of the two patients (Case 1), fracture of the shunt tubing in the cervical region was noted in the immediate postoperative period, but a computed tomographic scan of the head demonstrated no ventricular dilation at that time. Profound symptoms occurred approximately four weeks after the procedure, requiring emergent decompression of a hydrocephalus and revision of the ventriculoperitoneal shunt. In the other patient (Case 2), fracture of the shunt tubing in the cervical region had been recognized two years prior to the spinal fusion. Computed tomographic evaluation of the shunt at that time demonstrated no ventricular dilation, and the hydrocephalus was thought to have arrested. On correction of the scoliosis, the distance between the two ends of the fractured tubing in the cervical region increased, resulting in profound hydrocephalus within eight weeks after the spinal procedure. Case 1. A ten-year-old boy with severe spastic quadriplegic cerebral palsy and a history of hydrocephalus treated with a shunt was evaluated because of increasing difficulties with sitting in a wheelchair as a …