Surgical Correction of Spinal Deformity in Cerebral Palsy

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Abstract
Spinal deformity from neuromuscular imbalance in the patient with an immature nervous system may progress to cause compromise of sitting/standing balance, pain, or both. To assess the achievement of treatment goals, a retrospective analysis of 13 patients over a six and one-half year period with a diagnosis of spinal deformity and cerebral palsy was done. Treatment goals were; (1) prevention of curve progression; (2) relief of back pain; and (3) improved sitting balance, Age at surgery ranged from 9.5 to 32 years (average 17 years). The cerebral palsy was primarily the spastic type. In general, an inverse relationship existed between the amount of deformity and the immaturity of the central nervous system. Six patients underwent Harrington rod instrumentation and posterior fusion, and five patients had combined anterior fusion with Dwyer instrumentation and posterior fusion with Harrington instrumentation. Two patients had in situ fusions. All patients had located hips. Curves ranged from 28° to 120° (average 55°) preoperatively. Follow-up ranged from six to 72 months (average 22.1 months). In all cases, arthrodesis of the spine was achieved. Curve correction averaged 41% overall, with 62% correction in patients after combined anterior and posterior procedures. Postoperative complications were minimal. All patients with back pain had their pain eliminated following fusion. Curve progression was arrested in all patients, and the objective of improved sitting balance was achieved in all sitting patients. To reduce the potential for pseudarthrosis in this group of patients, both anterior and posterior instrumentation and fusion are recommended for those whose curves are progressive and disabling.

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