Pediatric spinal deformity correction in children with cerebral palsy: natural history and correction techniques

Abstract

Introduction Spinal deformity is one of major orthopaedic manifestations of cerebral palsy (CP). Despite the prevalence of the nosologic condition there is a deficiency in the availability of criteria for screening and management of the spinal pathology in CP patients, difficulties in interdisciplinary logistics, lack of registry and restraints in the continuity of the rehabilitation system. The purpose of the work was to focus the attention of mainstream audience of dedicated experts on the aspects of the course and correction techniques of spinal deformities in CP patients. Evidence level 5 (UK Oxford, version 2011). Results The type of spinal deformity depends on the functional level classified with the GMFCS. Vertebral evaluation included identification of the leading component of the deformity, apex location, mobility, trunk balance, chest deformity, type of pelvic obliquity, the way contractures and dislocation of the femoral heads affected the lumbar spine mobility. The goal of spinal deformity correction in CP patients is to maintain or improve the functionality of the patients, improve the quality of life for the patient and the family. The use of transpedicular multi-support fixation systems and bone allografts can be recommended for bone fusion in the patients. Spinal fixation can be extended from the upper thoracic vertebrae down to the pelvis. Dynamic fixation systems, multilevel or multi-rod fixation can be an option depending on the age, extent of the maturity of the axial skeleton and size of the curve. Conclusion The severity of manifestations of spinal deformity increases in CP patients with greater level of global motor functions and does not depend on the skeletal maturity. Conservative treatment is ineffective at a long term. Correction and instrumentation transpedicular fixation allows for threedimensional correction without the need for anterior fusion. Surgical treatment significantly improves body balance, functional level and quality of life.

Keywords

• cerebral palsy
• cerebral palsy in children
• spinal pathology
• spinal deformity
• scoliosis
• bracing
• posterior spinal fusion
• pelvis fixation
• complications