Spinal Procedure Atlas for Cerebral Palsy Deformities
Scoliosis is a common deformity in nonambulatory children with cerebral palsy, and most of the children require surgical correction. The surgical correction of scoliosis in children with cerebral palsy has to involve considerations that are not common for children with idiopathic scoliosis. It is especially important to consider the amount of the spine to fuse since it is very common for deformities to occur at the ends of the fusion area if it is not extensive enough. Therefore, almost all children with nonambulatory cerebral palsy (GMFCS IV and V) who have scoliosis should have a fusion from T1–T2 to the pelvis. This corrects the deformity and also assures that the deformity will remain corrected long term with maximum benefit to the patient. The technique of using cantilever correction has been used extensively to make sure that the pelvis will align with the spine. This has been the best documented and most accurate way to get a pelvic alignment corrected. The description of this procedure requires that the rod systems be fixed in the pelvis first and then sequentially the correction is made so that the spine is brought to normal alignment with the pelvis. This technique is not well recognized by spine surgeons who do not have familiarity with treating children with cerebral palsy. The goal of this chapter is to describe the technique for using cantilever deformity correction to align the trunk and pelvis.