Scoliosis in the Pediatric Cerebral Palsy Population
MARIE LABERGE, M.D. AND MORRIS DUHAIME, M.D.
Ten years after the development of specialized seating teams, it is important to review the evolution of scoliosis in the cerebral palsy population, aged 0-18 years. The goal is to ascertain the effects of our seating approach and to evaluate if corrective surgery improves the quality of life. Six hundred and eighty-six (686) cases from Marie Enfant Hospital's seating program were studied.
One hundred and thirty-six (136) patients or 19.8% presented a scoliosis. They were evenly divided between home and institutional dwellers. Most often (65%) the scoliosis was thoraco-lumbar. There was no sex preference. Twenty-nine percent (29%) presented with a scoliosis of greater than 40°.
Those with scoliosis greater than 46° were studied more in-depth. In this group, there was a higher frequency of institutionalized patients. Seventy-nine percent (79%) presented a scoliosis before their first seating device. These were always progressive, in spite of bracing and/or positioning, reaching curves of greater than 55°. This was also the case for those with a scoliosis of 30° at the time of their first positioning module. The onset of the scoliosis was before 10 years of age in half the cases. Only fifty-four percent had an associated hip dysplasia.
Twelve patients had corrective surgery. Radiological follow-up initially showed good correction, but progressive loss of correction was often noted after 5 years. However, after 7 years, patients and parents answered that there were few medical complications, improved comfort and ease of seating as well as easier hygiene care and no pain.
Seating does not seem to be effective in preventing curve progression, however, it does delay its evolution. Are seating teams merely succeeding in retarding scoliosis progression until the age when patients are transferred to adult facilities? Perhaps we should attend to this problem with more frequent surgical intervention in the pediatric population.
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