Surgical Strategies and Perioperative Considerations for Cervical Deformity With Cerebral Palsy: A Comprehensive Review of the Literature

Abstract

The complex nature of the cervical spine makes surgical intervention challenging when treating cervical deformity in patients with cerebral palsy (CDCP). However, few studies have investigated the unique characteristics of cerebral palsy that create the need for surgery, the most effective surgical strategies, and the possible perioperative complications. The intended benefit and the potential risk of postoperative complications must be considered when deciding to operate for CDCP. Because the approach and correction strategy depend on the type of cervical deformity, as well as the patient’s comorbidities and functional status, a customized strategy is needed. Perioperatively, botulinum toxin injections and muscle division techniques can help control excessive involuntary movements and improve the spinal fusion success rate. Surgical intervention for CDCP requires a multidisciplinary approach, and the information presented in this article is intended to help in the perioperative management and surgical treatment of CDCP.

Management and treatment of musculoskeletal problems in adults with cerebral palsy: Experience gained from two lifespan clinics

“…Harada et al reported an eight-fold increase in cervical disc degeneration and midcervical instability, predisposing to stenosis and neurologic deterioration [28]. Cervical myelopathy occurs in the 40 s, earlier than the general population [29,30]. Poor head control, increased muscle tone, and abnormal gait predispose to cervical degeneration [29].…”

“…Cervical myelopathy occurs in the 40 s, earlier than the general population [29,30]. Poor head control, increased muscle tone, and abnormal gait predispose to cervical degeneration [29]. Athetoid CP, in particular, is a predisposing risk factor to cervical instability, myelopathy, and functional deterioration [9,29,31].…”

“…Poor head control, increased muscle tone, and abnormal gait predispose to cervical degeneration [29]. Athetoid CP, in particular, is a predisposing risk factor to cervical instability, myelopathy, and functional deterioration [9,29,31]. One study reported a rate of cervical myelopathy or degeneration of 36% in athetotic patients versus 7.5% in spastic CP patients [32].…”