Early-Onset Scoliosis in Cerebral Palsy
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There is a group of children with cerebral palsy who developed very-early-onset scoliosis before the age of 7. This scoliosis may be associated with hip dislocation or asymmetric hip contractures as the primary driving force of the scoliosis. In children with hip dislocation or asymmetric contractures and scoliosis under the age of 7 years, first the hip problems should be addressed. If the hip problems are corrected and the patient has been monitored with increasing scoliosis curve size and stiffness, then surgery should be considered. The surgical options to consider include short apical fusion, a growing rod construct using either MAGEC rod or a classic growing rod construct. Growing rods have reported very high complication rates; however, there are no reports at this time of the MAGEC rod use in children with spasticity. Children between the ages of 7 and 9 years whose scoliosis becomes large and stiff can be monitored with radiographs every 6 months. When the scoliosis curve reaches 90° or becomes very stiff, complete spine (T1 to pelvis) fusion is recommended. Children who develop early-onset scoliosis tend to have severe medical problems and generally are fragile with most of them having seizures and requiring gastrostomy tubes for feeding. Approximately a quarter of the children require tracheostomies. The mortality in this group of patients is approximately 25% 10 years after the spine fusion. This mortality is not related to the spinal fusion or surgery but due to the many underlying medical problems.