Epidemiology
- Scoliosis in 25% of children with cerebral palsy
- Up to 75% in spastic quadriplegia
- Risk rises with GMFCS level IV and V
Pathology
- Severe curves more common than in idiopathic scoliosis
- Long C shaped thoracolumbar curves with pelvic obliquity in non ambulators
- Curves over 40 degrees continue progressing after skeletal maturity
- Associated hip subluxation and windswept deformity
Clinical Features
- Sitting imbalance and need for upper limb support
- Pressure areas and pain
- Feeding and respiratory difficulties
- Assess pelvic obliquity, flexibility and hip status
Investigations
- Sitting radiographs for non ambulators including pelvis
- Hip surveillance radiographs
- Nutritional status and respiratory assessment before surgery
Management
- Under 30 degrees observe
- Bracing and seating adaptations improve sitting but do not halt progression
- Ambulators treated like idiopathic scoliosis
- Non ambulators with progressive curves need fusion to the pelvis
- Posterior fusion from upper thoracic spine to pelvis
- Pelvic fixation with iliac or sacral alar iliac screws
- Correct spinal deformity before hip reconstruction when both are required
- Optimise nutrition and respiratory care before surgery
- Gastrostomy may be needed before spinal surgery
- Families report improved sitting, comfort and care after fusion
- Growing rods for young children with severe progressive curves
Complications
- High rates of wound infection
- Pneumonia and respiratory failure
- Blood loss
- Pseudarthrosis and implant failure
- Gastrointestinal complications including ileus and SMA syndrome
- Mortality higher than idiopathic scoliosis surgery
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.