Surgical Treatment of Scoliosis Due to Cerebral Palsy

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.