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Scoliosis in the Child With Cerebral Palsy

Dr. McCarthy is Assistant Chief of Staff, Shriners Hospitals for Children, and Assistant Professor, Department of Orthopaedics, Temple University, Philadelphia, PA. Dr. D’Andrea is Staff Orthopaedic Surgeon, Shriners Hospitals for Children, and Assistant Professor, Department of Orthopaedics, Temple University. Dr. Betz is Chief of Staff, Shriners Hospitals for Children, and Professor, Department of Orthopaedics, Temple University. Dr. Clements is Director of Spine Surgery, Cooper Bone & Joint Institute, Camden, NJ.

Dr. McCarthy has received nothing of value from, nor does he own stock in a commercial company or institution related directly or indirectly to the subject of this article. Dr. D’Andrea serves as a consultant to or is an employee of DePuy. Dr. Betz serves as a consultant to or is an employee of DePuy, Medtronic, Synthes, Osteotech, Nuvasive, and Spinevision. Dr. Clements or the department with which he is affiliated has received research or institutional support from DePuy Spine.

Reprint requests: Dr. McCarthy, Shriners Hospital, 3551 N Broad Street, Philadelphia, PA 19140.

Scoliosis is common in children with cerebral palsy. The incidence and curve pattern depend on the degree of neurologic involvement. These children carry a higher risk of complications because of the increased presence of associated medical comorbidities. Accordingly, a careful preoperative evaluation is required that should involve assessment of the patient’s pulmonary, nutritional, gastrointestinal, and neurologic systems as well as a thorough evaluation of the spine and musculoskeletal system. Children with progressive curves >40° to 50° are candidates for spinal fusion, especially when the deformity interferes with sitting or is unresponsive to bracing. The goal of surgery is to obtain a stable, balanced, and painless spinal fusion. Although posterior spinal fusion with multisegmental fixation is the most common technique, others, such as anterior release and/or fusion or combined procedures, are now considered. In patients with significant pelvic obliquity or who are at risk of developing pelvic obliquity, instrumentation should extend to the pelvis, particularly in the nonambulatory child.