Cervical Spine in Children with Cerebral Palsy

Cervical spine problems in children with cerebral palsy are uncommon. Some children with severe movement disorder and those with extensor posturing, however, may develop occipital cervical instability. Atlantoaxial instability can also occur in patients with torsional dystonia. Cervical extensor contractures occur in those children with severe extensor posturing. Symptoms of cervical problems are usually pain or occasionally related to spinal cord compression. Spinal cord compression symptoms cause either increase spasticity in the legs or sudden loss of spasticity and decreased movement in the lower extremities. Mid-cervical spinal stenosis and degenerative arthritis occur in adults with movement disorders especially those with athetosis. Lower cervical spine problems occur primarily as a residual of high kyphosis. The treatment for this drop off kyphosis requires surgical correction if it is symptomatic. Other spinal problems that occur after posterior spinal fusion are relatively uncommon although on rare occasions children will develop pseudarthrosis which become symptomatic and require repair. When the spinal instrumentation is not strong enough or solidly connected, deformities may occur around the instrumentation. Treatments of these complex problems are discussed in this chapter.