Abstract
Scoliosis is a common deformity in children and adolescents with cerebral palsy. This is usually associated with pelvic obliquity due to extension of the curve to the sacrum. Sagittal plane deformity is less common and often develops along with scoliosis. Spinal deformity in patients with severe neurological handicaps can affect their ability to sit and cause significant back pain or pain due to rib impingement against the elevated side of the pelvis on the concavity of the curvature. Surgical correction followed by spinal arthrodesis is indicated in patients with progressive deformities which interfere with their level of function and quality of life. Spinal deformity correction is a major task in children with multiple medical co-morbidities and can be associated with a high risk of complications including death. A well-coordinated multidisciplinary approach is required in the assessment and treatment of this group of patients with the aim to minimize the complication rate and secure a satisfactory surgical outcome. Good knowledge of the surgical and instrumentation techniques, as well as the principles of management is needed to achieve optimum correction of the deformity and balancing of the spine and pelvis. Spinal fusion has a well-documented positive impact even in children with quadriplegia or total body involvement and is the only surgical procedure which has such a high satisfaction rate among parents and caregivers.
Highlights
Scoliosis is a common deformity in children and adolescents with cerebral palsy
Spinal deformity in growing patients with Cerebral palsy (CP) develops due to the combination of spasticity, muscle weakness, as well as incompetent muscle control; this can result in poor trunk balance and significantly limits the patient’s ability to function
The purpose of this review is to present the characteristics and specific considerations of spinal deformity in children and adolescents with CP, as well as provide guidelines for treatment of these complex deformities in the presence of severe associated medical co-morbidities, which can significantly compromise the surgical outcome
Summary
Scoliosis often associated with increased thoracic or thoracolumbar kyphosis is the most commonly encountered deformity in patients with CP.[12]. Two scoliotic patterns have been described in patients with CP.[5] Group 1 curves develop in patients with good ambulatory function and less severe neurological deficit such as patients with monoplegia or hemiplegia. They resemble idiopathic scoliosis and involve single thoracic or thoracic and lumbar curves with level pelvis.[5] Their treatment follows similar criteria to those applied in the management of idiopathic scoliosis and requires a spinal arthrodesis short of the sacrum. In the presence of a collapsing scoliosis with significant pelvic obliquity, as well as associated hip subluxation or dislocation, it is usually best to treat the spinal deformity first with the aim to stabilize the spine, level the pelvis and facilitate relocation of the hips once the pelvic deformity is been corrected
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