Mortality and Causes of Death in Children With Cerebral Palsy With Scoliosis Treated With and Without Surgery.

BACKGROUND AND OBJECTIVES:To compare mortality and causes of death in scoliotic children with cerebral palsy (CP) with and without scoliosis surgery. METHODS:National population-based registries were searched for children with CP and scoliosis with and without surgery for scoliosis and were analyzed for comorbidities, mortality, and causes of death. RESULTS:Two hundred thirty-six had not been operated and 238 had been operated on for scoliosis during the median follow-up of 17.8 (interquartile range [IQR] 11.7-25.7) and 23.0 (IQR 18.4-28.2) years, respectively. Both groups had similar comorbidities. During the follow-up, mortality was higher in the nonsurgically treated group than in the surgically treated group (n = 38/236, 16% and 8.7 per 1,000 follow-up years vs n = 29/238, 12% and 5.3 per 1,000 follow-up years, p = 0.047). In patients with nonsurgical treatment, the cause of death was respiratory in 76.3% (29/38) and 37.9% (11/29) in patients with surgical treatment of scoliosis (6.6 and 2.0 per 1,000 follow-up years, p = 0.002). Neurologic causes of death were more common in surgically treated patients than in nonsurgically treated patients, 44.8% (13/29) and 15.8% (6/38), respectively (3.0 and 1.1 per 1,000 follow-up years, p = 0.009). DISCUSSION:Surgical treatment of scoliosis associates to reduced mortality because of respiratory causes in children with CP and scoliosis. CLASSIFICATION OF EVIDENCE:This study provides Class IV evidence of the effects of spinal fusion on mortality of children with severe scoliosis due to CP.