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Review
. 2020 Feb 1;14(1):17-23.
doi: 10.1302/1863-2548.14.190160.

Spinal sagittal alignment and head control in patients with cerebral palsy

Brice Ilharreborde  1 , Adrien de Saint Etienne  1 , Ana Presedo  1 , Anne-Laure Simon  1
Affiliations
Review

Spinal sagittal alignment and head control in patients with cerebral palsy

Brice Ilharreborde et al. J Child Orthop. .

Abstract

Purpose: Spinal sagittal alignment restoration has been associated with improved functional outcomes and with reduced complications rates. Several limitations exist for radiological analysis in cerebral palsy (CP) patients. The goal of this study was to summarize the existing literature and report the important considerations to evaluate in a CP patient undergoing spinal surgery.

Methods: A retrospective radiological analysis was performed, including non-ambulant CP children with progressive scoliosis. Full-spine sitting radiographs performed pre-and postoperatively were required to measure spino-pelvic sagittal parameters.

Result: A total of 23 non-ambulating CP patients were included, mean age 16.0 years (standard error of the mean 0.5). Two distinct groups of patients were identified. Group 1 (61%) were patients with less trunk control (lumbar lordosis (LL) < 50°), retroverted and vertical pelvis (mean sacral slope (SS) 11.4° and pelvic tilt (PT) 38.1°) and anterior imbalance (mean sagittal vertical axis (SVA) 5.9 cm) and Group 2 (39%) were patients with better trunk control (LL > 60°, anteverted and horizontal pelvis (mean SS 49.3°, PT 9.7°) and posterior imbalance (mean SVA 5.8 cm). Postoperative measures showed significant impact of surgery with a PT reduction of 19° (p = 0.007), a mean SS increase of 15° (p = 0.04) and a LL gained of 10° (p = 0.2).

Conclusion: Sagittal spino-pelvic alignment in non-ambulating CP patients remains difficult to assess. The current literature is poor but our radiological study was able to define two distinct groups among Gross Motor Function Classification System (GMFCS) level V patients, based on the quality of their trunk control. All possible factors that may influence head and trunk posture should be systematically considered and optimized.

Level of evidence: Level IV.

Keywords: cerebral palsy; children; non-ambulant; sagittal spinal alignment.

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Figures

Fig. 1
Fig. 1
Photographs of two patients with major anterior and posterior imbalance. Radiographs showed poor visibility of pelvic landmarks and osteopenia, making pelvic parameters not measurable.
Fig. 2
Fig. 2
Patients’ distribution according to maximal lumbar lordosis and the number of lordotic levels.
Fig. 3
Fig. 3
Illustration of sagittal alignment of the two distinct groups of patients. Group 1 were patients with poor trunk control and anterior imbalance. Group 2 were patients with better trunk control and posterior imbalance.
Fig. 4
Fig. 4
Postoperative result in a 16-year-old girl. The patient was initially with anterior imbalance and low lumbar lordosis (Group 1). Postoperatively, there was a posterior imbalance (sagittal vertical axis 63 mm) but spinal harmony was restored.
See this image and copyright information in PMC

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