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Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment

  • Review Article
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Abstract

Study design

Literature Review.

Objective

Review the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in cerebral palsy patients with neuromuscular scoliosis.

Summary of background data

Neuromuscular scoliosis (NMS) in cerebral palsy (CP) patients is rapidly progressive and often leads to an imbalance in musculoskeletal mechanics that extends to the pelvis. A horizontal misalignment of the pelvis in the frontal plane known as pelvic obliquity (PO) is a common finding in this population. When untreated, PO can exacerbate the back pain, postural strain, and walking difficulties experienced by these patients. Establishing the manifestation and treatment plan for PO in the setting of NMS can provide valuable insight for diagnosis and management.

Methods

A comprehensive literature review was performed on the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in the setting of NMS in CP. The advantages and limitations of measurement and treatment options were evaluated.

Results

PO is categorized into suprapelvic, infrapelvic, and intrapelvic causes, each presenting with a unique pattern of pathology. NMS in CP with hip contractures and structural deformities fall into these categories. The Maloney and O’Brien methods of pelvic measurement have demonstrated superior utility and are recommended for clinical diagnosis. The management of PO in NMS patients is focused on the cause of malalignment, with posterior fusion, contracture release, and osteotomy encompassing the mainstay of treatment.

Conclusion

PO is commonly found in patients with NMS in cerebral palsy. There is currently no standard method for determining the PO angle. Interventions designed to reduce scoliotic curves and release tissue contractures can level the pelvis and restore proper alignment of the spine and sacrum in the coronal plane in these patients. Further understanding of the causes of PO in NMS, as well as the establishment of a standardized measuring technique and diagnostic parameters will allow for more effective treatment options and improve outcomes in patients with CP.

Level of evidence

N/A.

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Acknowledgement

We would like to extend our appreciation to Sophia Seik-Ismail for her assistance with the illustrations included in this review.

Funding

None.

Author information

Authors and Affiliations

  1. Touro College of Osteopathic Medicine, Middletown, NY, USA

    Winston Yen

  2. Department of Orthopedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, 3400 Bainbridge Ave, 6th Floor, Bronx, NY, 10461, USA

    Ariella Gartenberg & Woojin Cho

Authors
  1. Winston Yen
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  2. Ariella Gartenberg
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  3. Woojin Cho
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Contributions

WY: Acquisition, analysis, and interpretation of data for the work; review of various articles and drafting of the work; final approval of version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AG: Acquisition, analysis, and interpretation of data for the work; drafting of the work; final approval of the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. WC: Chief PI for the study; substantial contributions to the conception of the work; revision of paper for critically important content; final approval of the version to be submitted; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Woojin Cho.

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Yen, W., Gartenberg, A. & Cho, W. Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment. Spine Deform 9, 1259–1265 (2021). https://doi.org/10.1007/s43390-021-00346-y

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  • DOI: https://doi.org/10.1007/s43390-021-00346-y

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