Pelvic Alignment and Spondylolisthesis in Children with Cerebral Palsy

Abstract

Children with cerebral palsy may have malalignments related to their lumbar spine and pelvis. Pelvic obliquity is a common problem having two primary causes. Suprapelvic pelvic obliquity occurs due to scoliosis, and infrapelvic pelvic obliquity is due to asymmetric contractures of the hips. The treatment of pelvic obliquity requires first to define the etiology; if it is suprapelvic, correct the scoliosis, and if it is infrapelvic, correct the hip contractures. Anterior pelvic tilt is due to hyperlordosis or hip flexion contracture. Posterior pelvic tilt is due to lumbar kyphosis or contractures of the hip extensors. Abnormal pelvic rotation maybe due to asymmetric rotation at the hips or to abnormal fixed rotation through spine. Treatment to correct abnormal pelvic alignment requires identifying the etiology and then treating the primary cause. Lumbar spondylolysis and spondylolisthesis also occur in children with cerebral palsy who are ambulatory. The highest incidence is in ambulatory children who have had dorsal rhizotomy. The primary initial treatment for painful defects is immobilization, and if this is not successful, surgical stabilization is required.