Cerebral Palsy: Classification, Etiology and Evolution of Spine Deformity in Children and Adolescents

Cerebral palsy (CP) is a static encephalopathy affecting the immature brain and leading into a permanent motor disability. There is a spectrum of causative factors, which may be congenital in origin, or can be related to incidences occurring in the perinatal or postnatal period. The development of spine deformity constitutes a common orthopaedic problem with an increased incidence in children with spasticity. The prevalence of spine deformity is directly proportionate to the degree of neurological impairment, and inversely proportionate to the ambulatory capacity. Scoliosis in this group of severely disabled children decreases their sitting tolerance, causes pain from impingement of their pelvis against the rib cage on the concavity of scoliosis, and creates cardiopulmonary complications. Patients with walking function gradually lose their ability to ambulate and become wheelchair-dependent. Spinal arthrodesis is indicated in children with progressive curve size and rigidity, which interferes with their level of function. Spine surgery in patients with severe neurological compromise and complex medical problems is associated with technical difficulties and an increased risk of life-threatening complications. However, there is a documented positive impact on these children by correcting the deformity and maintaining a good coronal and sagittal spinal balance. Spinal fusion is the only surgical procedure that has such a high satisfaction rate among parents and caregivers, especially for quadriplegics. With improved medical management, life expectancy for this group is higher than previously reported and operative procedures to correct the spine have a definitive effect in improving the patients` quality of life. The author did not receive grants or outside funding in support of his research or preparation of this manuscript. He did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.