Skip to main content
SpringerLink
Log in

Surgical Treatment of Scoliosis Due to Cerebral Palsy

  • Living reference work entry
  • First Online:
Cerebral Palsy

Abstract

Scoliosis is the most common spinal deformity in cerebral palsy (CP) and is most common in children with greater motor involvement. Most patients present with an unbalanced thoracolumbar or lumbar curvature and pelvic obliquity making it very difficult for the non-ambulatory child to sit in a wheelchair and for the ambulatory child to maintain the head centered over the center of the sacrum for standing balance. Scoliosis may also cause pain, further motor dysfunction, pulmonary compromise, and overall decrease in quality of life. While nonoperative treatment may be temporarily helpful in some children, surgery is the only definitive treatment. The indications for spinal fusion must consider the child’s age, medical condition, scoliosis magnitude, scoliosis flexibility, and the desires of families and caretakers. Posterior spinal fusion with instrumentation is effective in most children with CP with scoliosis; however, very rigid curvatures may require anterior release and/or posterior osteotomy or complete vertebral resection. A multidisciplinary approach to the preoperative and postoperative assessment and medical management is critical to achieve optimum postoperative outcomes. The preoperative management should include preparation for intraoperative bleeding including the use of tranexamic acid, prophylaxis to prevent deep wound infection, maintaining spinal cord integrity, nutritional optimization, and when necessary the management of osteopenic bone. Surgical, functional, and more recent quality of life outcomes have been shown to be favorable in the child with CP undergoing scoliosis surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Abousamra O, Nishnianidze T, Rogers KJ, Bayhan IA, Yorgova P, Shah SA (2016) Correction of pelvic obliquity after spinopelvic fixation in children with cerebral palsy: a comparison study with minimum two-year follow-up. Spine Deformity 4(3):217–224

    Article  Google Scholar 

  • Abousamra O, Sullivan BT, Samdani AF, Yaszay B, Cahill PJ, Newton PO, Sponseller PD (2018) Three methods of pelvic fixation for scoliosis in children with cerebral palsy: differences at 5-year follow-up. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000002761. [Epub ahead of print

    Article  Google Scholar 

  • Auerbach JD, Spiegel DA, Zgonis MH, Reddy SC, Drummond DS, Dormans JP, Flynn JM (2009) The correction of pelvic obliquity in patients with cerebral palsy and neuromuscular scoliosis: is there a benefit of anterior release prior to posterior spinal arthrodesis? Spine (Phila Pa 1976) 34(21):E766–E774

    Article  Google Scholar 

  • Bell DF, Moseley CF, Koreska J (1989) Unit rod segmental spinal instrumentation in the management of patients with progressive neuromuscular spinal deformity. Spine (Phila Pa 1976) 14(12):1301–1307

    Article  CAS  Google Scholar 

  • Boachie-Adjei O, Lonstein JE, Winter RB, Koop S, vanden Brink K, Denis F Management of neuromuscular spinal deformities with Luque segmental instrumentation

    Google Scholar 

  • Bonnett C, Brown JC, Grow T (1976) Thoracolumbar scoliosis in cerebral palsy. Results of surgical treatment. J Bone Joint Surg Am 58:328–336

    Article  CAS  Google Scholar 

  • Bowen RE, Abel MF, Arlet V et al (2012) Outcome assessment in neuromuscular spinal deformity. J Pediatr Orthop 32:792–798

    Article  Google Scholar 

  • Brenn BR, Theroux MC, Dabney KW, Miller F (2004) Clotting parameters and thromboelastography in children with neuromuscular and idiopathic scoliosis undergoing posterior spinal fusion. Spine (Phila Pa 1976) 29(15):E310–E314

    Article  Google Scholar 

  • Brown JC, Swank S, Specht I (1982) Combined anterior and posterior spine fusion in cerebral palsy. Spine 7:570–573

    Article  CAS  Google Scholar 

  • Cognetti D, Keeny HM, Samdani AF, Pahys JM, Hanson DS, Blanke K, Hwang SW (2017) Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society morbidity and mortality database. Neurosurg Focus 43(4):E10

    Article  Google Scholar 

  • Comstock CP, Leach J, Wenger DR (1998) Scoliosis in total-body involvement cerebral palsy. Analysis of surgical treatment and patient and caregiver satisfaction. Spine 23:1412–1424

    Article  CAS  Google Scholar 

  • Dhawale AA, Shah SA, Sponseller PD, Bastrom T, Neiss G, Yorgova P, Newton PO, Yaszay B, Abel MF, Shufflebarger H, Gabos PG, Dabney KW, Miller F (2012) Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis? Spine (Phila Pa 1976) 37(9):E549–E555

    Article  Google Scholar 

  • Dias RC, Miller F, Dabney K, Lipton G, Temple T (1996) Surgical correction of spinal deformity using a unit rod in children with cerebral palsy. J Pediatr Orthop 16(6):734–740

    Article  CAS  Google Scholar 

  • DiCindio S, Theroux M, Shah S, Miller F, Dabney K, Brislin RP, Schwartz D (2003) Multimodality monitoring of transcranial electric motor and somatosensory-evoked potentials during surgical correction of spinal deformity in patients with cerebral palsy and other neuromuscular disorders. Spine (Phila Pa 1976) 28(16):1851–1855

    Article  Google Scholar 

  • DiCindio S, Arai L, McCulloch M, Sadacharam K, Shah SA, Gabos P, Dabney K, Theroux MC (2015) Clinical relevance of echocardiogram in patients with cerebral palsy undergoing posterior spinal fusion. Paediatr Anaesth 25(8):840–845

    Article  Google Scholar 

  • DiFazio RL, Miller PE, Vessey JA, Snyder BD (2017) Health-related quality of life and care giver burden following spinal fusion in children with cerebral palsy. Spine (Phila Pa 1976) 42(12):E733–E739

    Article  Google Scholar 

  • Edebol, Tysk K (1989) Epidemiology of spastic tetraplegic cerebral palsy in Sweden. I. I. Impairments and disabilities. Neuropediatrics 20:41–45

    Article  Google Scholar 

  • Erickson MA, Oliver T, Baldini T et al (2004) Biomechanical assessment of conventional unit rod xation versus a unit rod pedicle screw construct: a human cadaver study. Spine (Phila Pa 1976) 29:1314–1319

    Article  Google Scholar 

  • Ferguson RL, Allen BL Jr (1988) Considerations in the treatment of cerebral palsy patients with spinal deformities. Orthop Clin North Am 19(2):419–425

    PubMed  CAS  Google Scholar 

  • Fuhrhop SK, Keeler KA, Oto M, Miller F, Dabney KW, Bridwell KH, Lenke LG, Luhmann SJ (2013) Surgical treatment of scoliosis in non-ambulatory spastic quadriplegic cerebral palsy patients: a matched cohort comparison of unit rod technique and all-pedicle screw constructs. Spine Deformity 1(5):389–394

    Article  Google Scholar 

  • Gau YL, Lonstein JE, Winter RB, Koop S, Denis F (1991) Luque-Galveston procedure for correction and stabilization of neuromuscular scoliosis and pelvic obliquity: a review of 68 patients. J Spinal Disord 4(4):399–410. J Bone Joint Surg Am. 1989;71(4):548–62

    Article  CAS  Google Scholar 

  • Hagglund G, Pettersson K, Czuba T, Persson-Bunke M, Rodby-Bunke M (2018) Incidence of scoliosis in cerebral palsy: a population-based study of 962 young individuals. Acta Orthop 89(4):443–447

    Article  Google Scholar 

  • Jackson TJ, Yaszay B, Pahys JM, Singla A, Miyanji F, Shah SA, Sponseller PD, Newton PO, Flynn JM, Cahill PJ, Harms Study Group (2018) Intraoperative traction may be a viable alternative to anterior surgery in cerebral palsy scoliosis ≥100 degrees. J Pediatr Orthop 38(5):e278–e284

    Article  Google Scholar 

  • Jain A, Njoku DB, Sponseller PD (2012) Does patient diagnosis predict blood loss during posterior spinal fusion in children? Spine (Phila Pa 1976) 37(19):1683–1687

    Article  Google Scholar 

  • Jain A, Kebaish KM, Sponseller PD (2016a) Sacral-alar-iliac fixation in pediatric deformity: radiographic outcomes and complications. Spine Deform 4(3):225–229

    Article  Google Scholar 

  • Jain A, Sponseller PD, Shah SA, Samdani A, Cahill PJ, Yaszay B, Njoku DB, Abel MF, Newton PO, Marks MC, Narayanan UG, Harms Study Group (2016b) Subclassification of GMFCS Level-5 cerebral palsy as a predictor of complications and health-related quality of life after spinal arthrodesis. J Bone Joint Surg Am 98(21):1821–1828

    Article  Google Scholar 

  • Jain A, Sponseller PD, Shah SA, Yaszay B, Njoku DB, Miyanji F, Newton PO, Bastrom TP, Marks MC, Harms Study Group (2017a) Incidence of and risk factors for loss of 1 blood volume during spinal fusion surgery in patients with cerebral palsy. J Pediatr Orthop 37(8):e484–e487

    Article  Google Scholar 

  • Jain A, Sullivan BT, Kuwabara A, Kebaish KM, Sponseller PD (2017b) Sacral-alar-iliac fixation in children with neuromuscular scoliosis: minimum 5-year follow-up. World Neurosurg 108:474–478

    Article  Google Scholar 

  • Jain A, Sullivan BT, Shah SA, Samdani AF, Yaszay B, Marks MC, Sponseller PD (2018) Caregiver perceptions and health-related quality-of-life changes in cerebral palsy patients after spinal arthrodesis. Spine (Phila Pa 1976) 43(15):1052–1056

    Google Scholar 

  • Jones KB, Sponseller PD, Shindle MK et al (2003) Longitudinal parental perceptions of spinal fusion for neuromuscular spine deformity in patients with totally involved cerebral palsy. JPO 23:143–114

    Google Scholar 

  • Karatas AF, Miller EG, Miller F, Dabney KW, Bachrach S, Connor J, Rogers K, Holmes L Jr (2013) Cerebral palsy patients discovered dead during sleep: experience from a comprehensive tertiary pediatric center. J Pediatr Rehabil Med 6(4):225–231

    PubMed  Google Scholar 

  • Ko PS, Jameson PG 2nd, Chang TL, Sponseller PD (2011) Transverse-plane pelvic asymmetry in patients with cerebral palsy and scoliosis. J Pediatr Orthop 31(3):277–283

    Article  Google Scholar 

  • Koop SE (2009) Scoliosis in cerebral palsy. Dev Med Child Neurol 4(Suppl):92–98

    Article  Google Scholar 

  • Kuklo TR, Bridwell KH, Lewis SJ et al (2001) Minimum 2-year analysis of sacro-pelvic xation and L5–S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 26:1976–1983

    Article  CAS  Google Scholar 

  • Larsson EL, Aaro SI, Normelli HC et al (2005) Long-term follow-up of functioning after spinal surgery in patients with neuromuscular scoliosis. Spine (Phila Pa 1976) 30:2145–2152

    Article  Google Scholar 

  • Lipton GE, Miller F, Dabney KW, Altiok H, Bachrach SJ (1999) Factors predicting postoperative complications following spinal fusions in children with cerebral palsy. J Spinal Disord 12(3):197–205

    PubMed  CAS  Google Scholar 

  • Lonstein JE, Koop SE, Novachek TF et al (2012) Results and complications after spinal fusion for neuromuscular scoliosis in cerebral palsy and static encephalopathy using Luque-Galveston instrumentation. Spine (Phila Pa 1976) 37:583–591

    Article  Google Scholar 

  • Madigan RR, Wallace SL (1981) Scoliosis in the institutionalized cerebral palsy population. Spine 6:583–590

    Article  CAS  Google Scholar 

  • Majd ME, Muldowny DS, Holt RT (1997) Natural history of scoliosis in the institutionalized adult cerebral palsy population. Spine 22:1461–1466

    Article  CAS  Google Scholar 

  • Mercado E, Alman B, Wright JG (2007) Does spinal fusion influence quality of life in neuromuscular scoliosis? Spine (Phila Pa 1976) 32:S120–S125

    Article  Google Scholar 

  • Miyanji F, Nasto LA, Sponseller PD, Shah SA, Samdani AF, Lonner B, Yaszay B, Clements DH, Narayanan U, Newton PO (2018) Assessing the risk-benefit ratio of scoliosis surgery in cerebral palsy: surgery is worth it? J Bone Joint Surg Am 100(7):556–563

    Article  Google Scholar 

  • Modi HN, Hong JY, Mehta SS et al (2009) Surgical correction and fusion using posterior-only pedicle screw construct for neuropathic scoliosis in patients with cerebral palsy: a three year follow up study. Spine (Phila Pa 1976) 34:1167–1175

    Article  Google Scholar 

  • Nishnianidze T, Bayhan IA, Abousamra O, Sees J, Rogers KJ, Dabney KW, Miller F (2016) Factors predicting postoperative complications following spinal fusions in children with cerebral palsy scoliosis. Eur Spine J 25(2):627–634

    Article  Google Scholar 

  • Peelle MW, Lenke LG, Bridwell KH et al (2006) Comparison of pelvic xation techniques in neuromuscular spinal deformity correction: Galveston rod versus iliac and lumbosacral screws. Spine (Phila Pa 1976) 31:2392–2398

    Article  Google Scholar 

  • Rappaport DI, Pressel DM (2008) Pediatric hospitalist comanagement of surgical patients: challenges and opportunities. Clin Pediatr (Phila) 47(2):114–121

    Article  Google Scholar 

  • Rappaport DI, Cerra S, Hossain J, Sharif I, Pressel DM (2013a) Pediatric hospitalist preoperative evaluation of children with neuromuscular scoliosis. J Hosp Med 8(12):684–688

    Article  Google Scholar 

  • Rappaport DI, Adelizzi-Delany J, Rogers KJ, Jones CE, Petrini ME, Chaplinski K, Ostasewski P, Sharif I, Pressel DM (2013b) Outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery. Hosp Pediatr 3(3):233–241

    Article  Google Scholar 

  • Reames DL, Smith JS, Fu KM et al (2011) Scoliosis Research Society morbidity and mortality committee. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society morbidity and mortality database. Spine (Phila Pa 1976) 36:1484–1491

    Article  Google Scholar 

  • Rinsky LA (1990) Surgery of spinal deformity in cerebral palsy. Twelve years in the evolution of scoliosis management. Clin Orthop Relat Res 253:100–109

    Google Scholar 

  • Saito N, Ebar S, Ohotsuka K, Kumeta H, Takaoka K (1998) Natural history of scoliosis in spastic cerebral palsy. Lancet 351:1687–1692

    Article  CAS  Google Scholar 

  • Samdani AF, Belin EJ, Bennett JT, Miyanji F, Pahys JM, Shah SA, Newton PO, Betz RR, Cahill PJ, Sponseller PD (2016) Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors. Eur Spine J 25(3):795–800

    Article  Google Scholar 

  • Sees JP, Sitoula P, Dabney K, Holmes L Jr, Rogers KJ, Kecskemethy HH, Bachrach S, Miller F (2016) Pamidronate treatment to prevent reoccurring fractures in children with cerebral palsy. J Pediatr Orthop 36(2):193–197

    Article  Google Scholar 

  • Sponseller PD, Shah SA, Abel MF et al (2009) Scoliosis surgery in cerebral palsy: differences between unit rod and custom rods. Spine (Phila Pa 1976) 34:840–844

    Article  Google Scholar 

  • Sponseller PD, Shah SA, Abel MF, Newton PO, Letko L, Marks M (2010) Infection rate after spine surgery in cerebral palsy is high and impairs results: multicenter analysis of risk factors and treatment. Clin Orthop Relat Res 468(3):711–716

    Article  Google Scholar 

  • Sponseller PD, Jain A, Lenke LG, Shah SA, Sucato DJ, Emans JB, Newton PO (2012) Vertebral column resection in children with neuromuscular spine deformity. Spine (Phila Pa 1976) 37(11):E655–E661

    Article  Google Scholar 

  • Strauss D, Brooks J, Rosenbloom L, Shavelle R (2008) Life expectancy in cerebral palsy: an update. Dev Med Child Neurol 50:487–493

    Article  Google Scholar 

  • Sussman MD, Little D, Alley RM, McCoig JA (1996) Posterior instrumentation and fusion of the thoracolumbar spine for treatment of neuromuscular scoliosis. J Pediatr Orthop 16:304–313

    Article  CAS  Google Scholar 

  • Takeshita K, Lenke LG, Bridwell KH, Kim YJ, Sides B, Hensley M (2006) Analysis of patients with nonambulatory neuromuscular scoliosis surgically treated to the pelvis with intraoperative halo-femoral traction. Spine (Phila Pa 1976) 31(20):2381–2385

    Article  Google Scholar 

  • Thometz JG, Simon SR (1988) Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy. J Bone Joint Surg Am 70(9):1290–1296

    Article  CAS  Google Scholar 

  • Tsirikos AI, Mains E (2012) Surgical correction of spinal deformity in patients with cerebral palsy using pedicle screw instrumentation. J Spinal Disord Tech 25(7):401–408

    Article  Google Scholar 

  • Tsirikos AI, Chang WN, Shah SA, Dabney KW, Miller F (2003) Preserving ambulatory potential in pediatric patients with cerebral palsy who undergo spinal fusion using unit rod instrumentation. Spine (Phila Pa 1976) 28(5):480–483

    Google Scholar 

  • Tsirikos AI, Chang WN, Dabney KW, Miller F (2004) Comparison of parents’ and caregivers’ satisfaction after spinal fusion in children with cerebral palsy. J Pediatr Orthop 24(1):54–58

    Article  Google Scholar 

  • Tsirikos AI, Lipton G, Chang WN, Dabney KW, Miller F (2008) Surgical correction of scoliosis in pediatric patients with cerebral palsy using the unit rod instrumentation. Spine (Phila Pa 1976) 33(10):1133–1140

    Article  Google Scholar 

  • Vitale MG, Riedel MD, Glotzbecker MP, Matsumoto H, Roye DP, Akbarnia BA, Anderson RC, Brockmeyer DL, Emans JB, Erickson M, Flynn JM, Lenke LG, Lewis SJ, Luhmann SJ, LM ML, Newton PO, Nyquist AC, Richards BS 3rd, Shah SA, Skaggs DL, Smith JT, Sponseller PD, Sucato DJ, Zeller RD, Saiman L (2013) Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop 33(5):471–478

    Article  Google Scholar 

  • Watanabe K, Lenke LG, Daubs MD et al (2009) Is spine deformity surgery in patients with spastic cerebral palsy truly beneficial? A patient/parent evaluations. Spine (Phila Pa 1976) 34:2222–2232

    Article  Google Scholar 

  • Yoshido K, Kajiura I, Suzuki T, Kawabata H (2018) Natural history of scoliosis in cerebral palsy and risk factors for progression of scoliosis. J Orthop Sci 23(4):649–652

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nemours/AI duPont Hospital For Children, Willmington, DE, USA

    Kirk Dabney & Wade Shrader

Authors
  1. Kirk Dabney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wade Shrader
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kirk Dabney .

Editor information

Editors and Affiliations

  1. Alfred I. duPont Institute, Wilmington, DE, USA

    Freeman Miller

  2. Cerebral Palsy Program, AI DuPont Hospital for Children , Wilmington, DE, USA

    Steven Bachrach

  3. AI DuPont Hospital for Children , Wilmington, DE, USA

    Nancy Lennon

  4. Drexel University, PHILADELPHIA, PA, USA

    Margaret O'Neil

Section Editor information

  1. Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, USA

    Freeman Miller

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Dabney, K., Shrader, W. (2019). Surgical Treatment of Scoliosis Due to Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-50592-3_115-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-50592-3_115-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50592-3

  • Online ISBN: 978-3-319-50592-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation