Incidence of spinal deformities and the relationship with physical status and back pain in ambulant adults with cerebral palsy and spastic diplegia

  • Nelleke G. Langerak
  • Elsabe Britz
  • Stewart Dix-Peek
  • Jacques du Toit
  • A. Graham Fieggen
  • Robert P. LambertsEmail author
Original Article



The purpose of this study was to determine the incidence of spinal deformities in ambulant adults with cerebral palsy (CP) and spastic diplegia, more than 15 years after orthopaedic interval surgery approach (ISA) treatment, and its relationship to contextual factors, level of pain and physical status.


Spinal X-rays, pain (Oswestry Disability Index (ODI) and location/frequency) questionnaires and physical examination assessing lower extremity muscle strength (Medical Research Council scale), motor control (selectivity scale) and muscle tone (Ashworth score) were conducted in 30 adults with spastic diplegic CP.


Mild scoliosis (curve 12–22°) was determined in eight (28%) participants. Hyperkyphosis (> 50°) was reported in two (7%) and lumbar hyperlordosis (> 60°) in five (17%) participants. Pain was most commonly reported at cervical (n = 19, 63%) and lumbosacral (n = 18, 60%) area, resulting in ‘moderate disability’ for six (20%) and ‘severe disability’ for one (3%) participant. Most apparent physical abnormalities determined were hip abduction weakness and increased rectus femoris muscle tone. Regarding correlations, no relations were found for scoliosis curvature, but kyphosis curvature was related to females, ODI scores (lifting and sitting) and increased muscle tone of ankle plantar flexor muscles, lordosis curvature to passive hip extension mobility, and hip flexors and ankle plantar flexors muscle tone.


Adults with spastic diplegic CP who received their first orthopaedic intervention more than 15 years ago (based on ISA) showed similar incidence of spinal deformities as reported in the younger CP population, suggesting stability of spinal curvature into adulthood.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Spinal deformities Cerebral Palsy Physical status Back pain ISA Orthopaedic surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6235_MOESM1_ESM.pptx (2.5 mb)
Supplementary material 1 (PPTX 2533 kb)


  1. 1.
    Hemming K, Hutton JL, Pharoah POD (2006) Long-term survival for a cohort of adults with cerebral palsy. Dev Med Child Neurol 48:90–95. CrossRefPubMedGoogle Scholar
  2. 2.
    Strauss D, Brooks J, Rosenbloom L, Shavelle R (2008) Life expectancy in cerebral palsy: an update. Dev Med Child Neurol 50:487–493CrossRefGoogle Scholar
  3. 3.
    Kembhavi G, Darrah J, Payne K, Plesuk D (2011) Adults with a diagnosis of cerebral palsy: a mapping review of long-term outcomes. Dev Med Child Neurol 53:610–614. CrossRefPubMedGoogle Scholar
  4. 4.
    Tosi LL, Maher N, Moore DW, Goldstein M, Aisen ML (2009) Adults with cerebral palsy: a workshop to define the challenges of treating and preventing secondary musculoskeletal and neuromuscular complications in this rapidly growing population. Dev Med Child Neurol 51:2–11. CrossRefPubMedGoogle Scholar
  5. 5.
    Roebroeck ME, Jahnsen R, Carona C, Kent RM, Chamberlain MA (2009) Adult outcomes and lifespan issues for people with childhood-onset physical disability. Dev Med Child Neurol 51:670–678. CrossRefGoogle Scholar
  6. 6.
    Koop SE (2009) Scoliosis in cerebral palsy. Dev Med Child Neurol 51:92–98. CrossRefPubMedGoogle Scholar
  7. 7.
    Majd ME, Muldowny DS, Holt RT (1997) Natural history of scoliosis in the institutionalized adult cerebral palsy population. Spine (Phila Pa 1976) 22:1461–1466CrossRefGoogle Scholar
  8. 8.
    Spiegel DA, Loder RT, Alley KA, Rowley S, Gutknecht S, Smith-Wright DL, Dunn ME (2004) Spinal deformity following selective dorsal rhizotomy. J Pediatr Orthop 24:30–36CrossRefGoogle Scholar
  9. 9.
    McGinley JL, Dobson F, Ganeshalingam R, Shore BJ, Rutz E, Graham HK (2012) Single-event multilevel surgery for children with cerebral palsy: a systematic review. Dev Med Child Neurol 54:117–128. CrossRefPubMedGoogle Scholar
  10. 10.
    Lamberts RP, Burger M, Du Toit J, Langerak NG (2016) A systematic review of the effects of single-event multilevel surgery on gait parameters in children with spastic cerebral palsy. PLoS ONE 11:e0164686. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Langerak NG, Tam N, Du Toit J, Lambets RP (2019) Gait pattern of adults with cerebral palsy and spastic diplegia more than 15 years after being treated with an interval surgery approach; implications for low resource settings. Indian J Orthop 53:655–661. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    McDowell B (2008) The gross motor function classification system expanded and revised. Dev Med Child Neurol 50:725. CrossRefPubMedGoogle Scholar
  13. 13.
    Jahnsen R, Aamodt G, Rosenbaum P (2006) Gross motor function classification system used in adults with cerebral palsy: agreement of self-reported versus professional rating. Dev Med Child Neurol 48:734–738. CrossRefPubMedGoogle Scholar
  14. 14.
    Micklesfield LK, Levitt NS, Carstens MT, Dhansav MA, Norris SA, Lambert EV (2007) Early life and current determinants of bone in South African children of mixed ancestral origin. Ann Hum Biol 34:647–655. CrossRefPubMedGoogle Scholar
  15. 15.
    Fairbank JCT, Pynsent PB (2000) The Oswestry disability index. Spine (Phila Pa 1976) 25:2940–2953CrossRefGoogle Scholar
  16. 16.
    Fisher K, Johnston M (1997) Validation of the oswestry low back pain disability questionnaire, its sensitivity as a measure of change following treatment and its relationship with other aspects of the chronic pain experience. Physiother Theory Pract 13:67–80. CrossRefGoogle Scholar
  17. 17.
    Langerak NG, Vaughan CL, Hoffman EB, Figaji AA, Fieggen AG, Peter CJ (2009) Incidence of spinal abnormalities in patients with spastic diplegia 17 to 26 years after selective dorsal rhizotomy. Childs Nerv Syst 25:1593–1603CrossRefGoogle Scholar
  18. 18.
    Langerak NG, Hillier SL, Verkoeijen PP, Peter CJ, Fieggen AG, Vaughan CL (2011) Level of activity and participation in adults with spastic diplegia 17–26 years after selective dorsal rhizotomy. J Rehabil Med 43:330–337CrossRefGoogle Scholar
  19. 19.
    Bertoncelli C, Solla F, Loughenbury PR, Tsirikos AJ, Bertoncelli D, Rampal V (2017) Risk factors for developing scoliosis in cerebral palsy: a cross-sectional descriptive study. J Child Neurol 32:657–663. CrossRefGoogle Scholar
  20. 20.
    Bernhardt M, Bridwell K (1989) Semental analysis of the sagital plane alignmnet of the normal thoracic and lumbar spines and thoracolumbar junction. Spine (Phila Pa 1976) 14:717–721CrossRefGoogle Scholar
  21. 21.
    Lipton GE, Letenhoff EJ, Darbey KW, McCarthy HC (2003) Correction of sagittal plane spinal deformities with unit rod instrumentation in children with Cerebral palsy. J Bone Joint Surg Am 85:2349–2358CrossRefGoogle Scholar
  22. 22.
    Vogtle LK (2009) Pain in adults with cerebral palsy: impact and solutions. Dev Med Child Neurol 51:113–121. CrossRefPubMedGoogle Scholar
  23. 23.
    Schwartz L, Engel JM, Jensen MP (1999) Pain in persons with cerebral palsy. Arch Phys Med Rehabil 80:1243–1246. CrossRefPubMedGoogle Scholar
  24. 24.
    Jahnsen R, Villien L, Aamodt G, Stanghelle JK, Holm I (2004) Musculoskeletal pain in adults with cerebral palsy compared with the general population. J Rehabil Med 36:78–84. CrossRefPubMedGoogle Scholar
  25. 25.
    Yoshida K, Kajiura I, Suzuki T, Kawabata H (2018) Natural history of scoliosis in cerebral palsy and risk factors for progression of scoliosis. J Orthop Sci 23:649–652. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
  2. 2.Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
  3. 3.Division of Orthopaedic Surgery, Department of Surgery, Faculty Health SciencesUniversity of Cape TownCape TownSouth Africa

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