LAUSR

STUDY DESIGN Retrospective review of a prospectively collected multicenter database. OBJECTIVE To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis versus hyperlordosis. SUMMARY OF BACKGROUND DATA Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood. METHODS A multicenter database was queried for CP patients who underwent surgery from 2008-2017. Minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° (HL). Perioperative, radiographic, and outcomes were compared. RESULTS 275 patients were studied: 236 NL and 39 HL (-75 to -125°). Mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P=0.008) and higher CPCHILD scores (59.4 vs. 51.0, P=0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. -31.5°, P<0.001) and smaller sagittal vertical axis (SVA) (-4.0 vs. 2.6 cm, P<0.001). Patients with hyperlordosis had greater estimated blood loss (EBL) (2222.0 vs. 1460.7 mL, P<0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P=0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and SVA of -1.0 cm. At 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P=0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in reoperation rate between the groups. CONCLUSION Surgical correction of scoliosis with hyperlordosis is associated with greater EBL but similar radiographic results, perioperative morbidity, and reoperation rate. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory. LEVEL OF EVIDENCE Level III.