Surgical Management of Kyphosis and Hyperlordosis in Children with Cerebral Palsy

Abstract

Sagittal plane spinal deformities, excessive kyphosis or lordosis may occur in the child with cerebral palsy (CP) and may be seen either with or without scoliosis. These spinal deformities may cause difficulty with seating and/or pain, especially when the deformity is greater than 70 degrees. And hyperlordosis has also been reported to cause superior mesenteric artery syndrome. Pain and difficulty with seating are the most common indications for correcting sagittal plane spinal deformities in the child with CP.Mild and some moderate sagittal plane deformities can be treated by wheelchair modifications and bracing. Symptomatic moderate and severe deformity may require surgical treatment. More flexible kyphosis and hyperlordosis can be corrected by posterior spinal fusion and segmental instrumentation alone while rigid deformity may require posterior osteotomies (for kyphosis) or anterior discectomies (for hyperlordosis). Instrumentation and correction techniques vary from screw/rod constructs using distraction/ compression correction to wire or screw/rod constructs using cantilever correction. Overall, natural history and surgical outcome studies focused solely on sagittal plane spinal deformities in the patientwithCP are limited. Those authors that do measure functions report improvements in pain, sitting balance, head and neck control, breathing, and hand use. Patients with kyphosis undergoing spinal fusion with instrumentation are at risk for loss of proximal and/or distal fixation. Patients with hyperlordosis appear to be at greatest risk for postoperative complications.