Cerebral Palsy

The management of cerebral palsy and spinal deformity can be challenging for the spine surgeon. The presence of large, structural deformities oftentimes detracts from the subtle changes in neurological status and necessitates a thorough neurologic examination. Scoliosis is the most common spinal deformity associated with cerebral palsy, but the development of thoracic lordoscoliosis is rare. Cervical kyphosis has been noted to occur in cerebral palsy patients, but primarily is associated with the athetoid variant of the disorder. We present a case report of a 17 year-old male, spastic quadriplegic cerebral palsy patient with progressive myelopathy and concurrent cervical kyphosis and thoracic lordoscoliosis. The patient’s condition and symptoms were managed via two-stages. The cervical spine was managed by a sequential, circumferential one-stage procedure, which entailed a two-level cervical corpectomy of C5 and C6 with multi-level laminectomies, lateral mass plating, and wire fixation. Approximately 3 months following cervical spine surgery, a simultaneous, anteroposterior approach was used to correct the thoracic deformity and entailed a combined anterior spinal release of the thoracic spine with posterior spinal segmental instrumentation and sublaminar wiring. No complications were noted. The patient was successfully returned to independent ambulation. On follow-up, the spinal correction and instrumentation was maintained. The occurrence of concurrent cervical kyphosis and thoracic lordoscoliosis in patients with cerebral palsy is rare, but can be managed successfully with combined anteroposterior approaches.

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