Infections and Late Complications of Spine Surgery in Cerebral Palsy

Children with cerebral palsy at the GMFCS IVand V levels often develop spinal deformity requiring surgical correction. A very common concern of parents is to understand the expected complications. The most common significant postoperative complication is a deep wound infection which usually requires a prolonged period of wound care and intravenous antibiotics. However, with proper management seldom do the rods need to be removed, and as a consequence, the benefit of the surgery will almost always be maintained. In the long term, there is a small chance of a late infection in the spine around the instrumentation. When a late infection occurs, almost always removal of all the hardware is required. Another problem which may occur is pseudarthrosis, with the two most common sites being the thoracolumbar junction and lumbosacral junction. The most common presenting sign of a pseudarthrosis is fracture of the spine rod. If there is pain or progressive deformity at the site of the pseudarthrosis, a localized repair is required. When patients report back pain 6 months after spine fusion, chronic low-grade infection or pseudarthrosis should be considered. Workup is performed with CT scan, technetium bone scan, and testing for inflammatory markers. Long-term mortality is another concern that is not well defined; however, children with the most severe neurologic impairments develop spinal deformities and do have a reduced life expectancy compared to age-matched peers. There is not good data to show that correcting the spinal deformity increases life expectancy.