Cerebral Palsy Spinal Deformity: Etiology, Natural History, and Nonoperative Management

Children with cerebral palsy (CP) develop scoliosis as they go through adolescent growth. The most common group of children are those who are not able to walk and are labeled Gross Motor Function Classification System (GMFCS) IV–V. The scoliosis develops between the ages of 8 and 12 years old with progression during the adolescent growth. As the scoliosis curves become more severe, the deformity starts to cause problems with seating. Also as the curve continues to become more severe, it impacts pulmonary function and gastrointestinal motility and often causes pain. The pain develops mostly as the deformity becomes even more severe and the pelvis impinges on the inferior chest wall. Nonoperative treatment options are very limited as there is no evidence that the use of body bracing or orthotics makes an impact on either the magnitude of the scoliosis or the rate of progression of the scoliosis. These body braces or thoracolumbar spinal orthosis (TLSO) can be helpful to improve sitting posture and sitting balance. They should be used for the immediate functional benefit they provide. There is no indication for nighttime bracing, and the complications of the braces have to also be considered which include respiratory restrictions and abdominal restriction which may impact feeding tolerance and pulmonary clearance. Other nonoperative treatments such as physical therapy, postural support, electrical stimulation, and botulinum toxin type A have not demonstrated any benefit to prevent the progression of the deformity.