Cerebral palsy

The management of early onset scoliosis (EOS) associated with cerebral palsy (CP) is challenging. Children with CP who develop EOS generally have significant medical comorbidities and functional impairments and, therefore, require coordinated, multidisciplinary care in order to optimize outcome. The treatment for mild-to-moderate, flexible curves is generally supportive with adequate seating support and possibly soft orthosis (thoracolumbosacral orthosis (TLSO)) bracing to facilitate transfers. Strict indications for surgery for EOS in CP are not available in the literature; however, the data suggest that a curve approaching 90°, particularly one that is becoming stiff, should be treated with surgery. The literature also only offers limited recommendations for surgical constructs. Definitive spinal fusion is described in this cohort. Certainly, the concern for thoracic insufficiency syndrome (TIS) exists with definitive spinal fusion, but the impact of definitive fusion on pulmonary function is difficult to assess in this patient population as patients have profound intellectual disability and limited ability to participate in pulmonary function tests. Growth friendly techniques continue to evolve. The vertically expandable prosthetic titanium rib (VEPTR) was thought to be an effective tool in managing these complex conditions but may be falling out of favor due to a high complication profile. Traditional growing rods (TGR) and, more recently, magnetically controlled growing rods (MCGR), and growth guidance implants - such as the Shilla™ and modern Luque trolley - are other constructs available for these patients, but the literature supporting their use is at an early stage. While the burden of surgery on the patient and their family is significant, emerging data suggest that the benefit of surgery on health-related quality of life (HRQoL) appears to justify the treatment of EOS in children with CP, but the choice of surgical approach is less clear. More study is required to delineate the optimal surgical approach in this vulnerable group of patients.