Management of spinal deformity in cerebral palsy: conservative treatment

Abstract

Introduction: The incidence of scoliosis in Cerebral Palsy (CP) is directly related to the Gross Motor Function Classification System (GMFCS) level. The natural history of untreated scoliosis in patients with CP is one of progression and factors implicated in deterioration include type of involvement (quadriplegia), poor functional status (nonambulatory, GMFCS levels IV and V), and curve location (thoracolumbar). The generally accepted incidence in the overall CP population is 20-25 %.

Materials and methods: We recently published our short term results for 31 children treated with a short lumbar brace. In cases of a "positive hands up test" we recommend a short lumbar brace, and in patients with scoliosis with a Cobb angle >20° a double shelled brace.

Results: In our study, there was a correction of 37 % for the lumbar Cobb angle and 39 % for the thoracic Cobb angle at a mean follow-up of 28 months.

Conclusion: The incidence of scoliosis in the overall CP population is 20-25 % and is directly related to the GMFCS level. Therefore, we recommend early treatment and prescribe a short lumbar brace in patients with dynamic instability of the trunk, and in scoliosis with a Cobb angle >20° a double shelled brace.

Keywords: Cerebral palsy; Conservative treatment; Double shelled brace; Scoliosis; Short lumbar brace; Spinal deformity.

Fig. 1

Short lumbar brace

Fig. 2

Double shelled brace

Fig. 3

Sufficiant correction of a neuromuscular scoliosis in a 12 years old girl with spastic quadriplegia. a the Cobb angles were 35° (lumbar) and 25° (thoracic). b the angles were 12° (lumbar) and 4° (thoracic)