Scoliosis and Severe Pelvic Obliquity in a Patient With Cerebral Palsy

Abstract

It is concluded that scoliosis with associated severe pelvic obliquity deformities can be treated with anterior and posterior spinal fusion and instrumentation with intraoperative halo-femoral traction in the properly selected and prepared patient with cerebral palsy.

Selective Anterior Fusion and Instrumentation for the Treatment of Neuromuscular Scoliosis

“…Although patients treated with both anterior and posterior instrumentation showed greater correction of scoliotic curvatures and improved sitting balance in comparison with anterior or posterior fixation alone, [2][3][4][5]20 our study showed that ASF and AI alone is comparable to the combined approach. In our study, the primary curve correction of 68% was achieved with only a slight deterioration at follow-up (at a mean of 4 years 11 months).…”

“…[2][3][4]9,12,20 In the nonambulatory patient, it has been well documented that an increase in these deformities is directly related to a decrease in function because of the inability to have a stable seating base that requires the use of the upper extremities to stabilize the seating posture. Loss of seating height is also noted with this situation.…”

The Effect of Intraoperative Traction During Posterior Spinal Instrumentation and Fusion for Adolescent Idiopathic Scoliosis

“…14,15 This study was the first to specifically document the effect of intraoperative traction on the correction of AIS using modern posterior segmental instrumentation systems.…”

A New Halo-Pelvic Apparatus

“…2,3,7,8,10,12,15,[17][18][19][20]30 Its use has declined in the past decade, probably because of an improvement in health and awareness of spinal problems such that patients tend to present with less severe deformities, and also because of improvements in surgical techniques, implants, and perioperative management such that more aggressive corrective procedures with internal fixation are now performed. 9 A decline in the use of the halo-pelvic apparatus likely means that few spinal units still keep stock of the old apparatus. Even when available, the apparatus is difficult to apply and prone to complications, as previously described.…”