Spinal Procedure Atlas for Cerebral Palsy Deformities

  • Freeman Miller
  • Kirk Dabney
Living reference work entry


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.


Cerebral palsy Posterior spinal fusion Anterior spinal release Unit rod Modular unit rod Sublaminar wires Pedicle screws Cantilever correction 


  1. Borkhuu B, Borowski A, Shah SA, Littleton AG, Dabney KW, Miller F (2008) Antibiotic-loaded allograft decreases the rate of acute deep wound infection after spinal fusion in cerebral palsy. Spine (Phila Pa 1976) 33:2300–2304CrossRefGoogle Scholar
  2. Dias RC, Miller F, Dabney K, Lipton G, Temple T (1996) Surgical correction of spinal deformity using a unit rod in children with cerebral palsy. J Pediatr Orthop 16:734–740CrossRefGoogle Scholar
  3. Smucker JD, Miller F (2001) Crankshaft effect after posterior spinal fusion and unit rod instrumentation in children with cerebral palsy. J Pediatr Orthop 21:108–112CrossRefGoogle Scholar
  4. Tsirikos AI, Chang WN, Dabney KW, Miller F (2004) Comparison of parents’ and caregivers’ satisfaction after spinal fusion in children with cerebral palsy. J Pediatr Orthop 24:54–58CrossRefGoogle Scholar
  5. Tsirikos AI, Lipton G, Chang WN, Dabney KW, Miller F (2008) Surgical correction of scoliosis in pediatric patients with cerebral palsy using the unit rod instrumentation. Spine (Phila Pa 1976) 33:1133–1140CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OrthopedicsNemours/AI DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations