Scoliosis in the child with cerebral palsy

Area of Science:

• Pediatric Orthopedics
• Neurology
• Rehabilitation Medicine

Background:

• Scoliosis is a frequent complication in children with cerebral palsy.
• The severity of neurologic impairment influences scoliosis incidence and curve patterns.
• Associated medical comorbidities increase complication risks in these patients.

Purpose of the Study:

• To outline the necessary preoperative evaluations for children with cerebral palsy and scoliosis.
• To define surgical candidacy criteria for spinal fusion in this population.
• To review surgical goals and current techniques for scoliosis correction in cerebral palsy.

Main Methods:

• Comprehensive preoperative assessment including pulmonary, nutritional, gastrointestinal, neurologic, and musculoskeletal evaluations.
• Consideration of spinal fusion for progressive curves (>40-50 degrees) impacting function or unresponsive to bracing.
• Surgical techniques discussed include posterior spinal fusion with multisegmental fixation, anterior release/fusion, and combined procedures, with pelvic extension for specific cases.

Main Results:

• Preoperative evaluation is crucial due to high-risk comorbidities.
• Spinal fusion is indicated for significant progressive curves impacting sitting ability or bracing outcomes.
• Surgical goals focus on achieving a stable, balanced, and pain-free spinal fusion.

Conclusions:

• Children with cerebral palsy require thorough preoperative assessment for scoliosis surgery.
• Spinal fusion is an effective treatment for progressive scoliosis in this population.
• Surgical techniques should be tailored to individual patient needs, including pelvic fixation when necessary.