Progressive Bone and Joint Abnormalities of the Spine and Lower Extremities in Cerebral Palsy

Abstract

Bone and joint changes in cerebral palsy result from muscle spasticity and contracture. The spine and the joints of the lower extremity are most commonly affected. Scoliosis may progress rapidly and may continue after skeletal maturity. Increased thoracic kyphosis and lumbar lordosis, spondylolisthesis, spondylolysis, and pelvic obliquity may accompany the scoliosis. Progressive hip flexion and adduction lead to windswept deformity, increased femoral anteversion, apparent coxa valga, subluxation, deformity of the femoral head, hip dislocation, and formation of a pseudoacetabulum. In the knee, flexion contracture, patella alta, and patellar fragmentation are the most commonly seen abnormalities. Recurvatum deformity can also develop in the knee secondary to contracture of the rectus femoris muscle. Progressive equinovalgus and equinovarus of the foot and ankle are associated with rocker-bottom deformity and subluxation of the talonavicular joint. Early recognition of progressive deformity in patients with cerebral palsy allows timely treatment and prevention of irreversible change.

Progression and Direction of Contractures of Knee Joints Following Spinal Cord Injury in the Rat

“…Flexion contractures are the most common knee abnormalities related to CNS disorders (Banks 1972;Morrell et al 2002;Kagaya et al 2003). Knee flexion contractures occur in animals with SCI as well as in humans.…”

Bilateral hip reconstruction improve hip stability, pelvic balance and mobility function in children with cerebral palsy

“…Progressive deformity of hip, pelvis and trunk may develop continuously and contribute to difficulty in seating ,ambulation and handling [20][21][22][23]. One of common question which parent ask a treatment team is how much mobility function of the patients would be improved after surgery?…”

Comparison of mid-term efficacy of spastic flatfoot in ambulant children with cerebral palsy by 2 different methods

“…Upon further progression, secondary skeletal developmental malformation occurs complicated with osteoarthritis of the talocalcaneal joint, the talonavicular joint, and the metatarsophalangeal joint, thereby completely losing the potential of spontaneous relief. [5] With time this deformity becomes more rigid and the talus head is excessively protruded inducing pain and restricting shoe wear, and painful plantar corpus callosum changes occur, restricting independent walking distance or even completely losing walking ability. [6] Treatments of the spastic flatfoot include conservative or surgical management.…”