Surgical Techniques   |    
Correction of Sagittal Plane Spinal Deformities with Unit Rod Instrumentation in Children with Cerebral Palsy
Kirk W. Dabney, MD1; Freeman Miller, MD1; Glenn E. Lipton, MD2; Eric J. Letonoff, DO3; H. Catherine McCarthy, BA, MS1
1 Division of Orthopaedics, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19899. E-mail address for K.W. Dabney: kdabney@nemours.org
2 Department of Orthopaedic Surgery, Drexel University College of Medicine, Broad and Vine Streets, Mail Stop 420, Philadelphia, PA 19102
3 Department of Orthopaedic Surgery, St. John Oakland Hospital, 27351 Dequindre Road, Madison Heights, MI 48071
View Disclosures and Other Information
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 85-A, pp. 2349-2357, December 2003
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The line drawings in this article are the work of Jennifer Fairman of Fairman Studios (jfairman@fairmanstudios.com).
Investigation performed at the Alfred I. duPont Hospital for Children, Wilmington, Delaware

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Sep 01;86(1 suppl 2):156-168
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



To our knowledge, there have been no previous studies addressing the indications for and the results of treatment of patients with cerebral palsy and concomitant kyphosis or lordosis without scoliosis. The purpose of the present study was to identify the indications for and the results of treatment of patients with cerebral palsy who have a spinal curve deformity solely in the sagittal plane.


We conducted a retrospective review of the data on all patients with cerebral palsy who had a sagittal plane spinal deformity but no coronal plane deformity, had undergone posterior spinal fusion with unit rod instrumentation at our institution, and had been followed for at least two years. Medical records and radiographs were reviewed for symptoms, type and magnitude of deformity, age at surgery, duration of surgery, nutritional status, complications, and concomitant medical problems.


Twenty-four patients-—ten boys and fourteen girls-—were identified. Eight patients had a hyperlordotic deformity, fourteen had a hyperkyphotic deformity, and two exhibited both. Surgical indications included severe seating problems that could not be rectified with wheelchair modifications (eighteen patients), severe back pain (four patients), superior mesenteric artery syndrome that was refractory to conservative treatment (two patients), and a hyperlordotic deformity with a loss of bowel and bladder control (one patient).

It was found that specific technical concerns had to be addressed when the unit rod instrumentation was used. The mean preoperative hyperkyphotic curve of 93.8° was corrected to a mean of 35.8° postoperatively and was a mean of 34.8° at the last visit. The mean preoperative hyperlordotic curve of 91.8° was corrected to a mean of 43.6° postoperatively and was a mean of 48.6° at the last visit. All patients with seating problems and back pain had improvement or resolution of the problem after the surgery. The superior mesenteric artery syndromes, losses of bowel and bladder function, and malnutrition all resolved completely after the surgery.


Patients with cerebral palsy and a severe sagittal plane deformity (=70°) can be treated successfully with posterior spinal fusion with use of unit rod instrumentation. Indications for treatment include loss of sitting ability or balance, back pain, loss of bowel or bladder function, and superior mesenteric artery syndrome that is unresponsive to medical management.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    District of Columbia (DC) - Children's National Medical Center
    W. Virginia - Charleston Area Medical Center
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    New York - Icahn School of Medicine at Mount Sinai