Treatment of Neuromuscular Scoliosis in Young Children With Severe Spastic Cerebral Palsy: A Systematic Review of the Literature
Abstract
Introduction: Children with GMFCS IV and V spastic cerebral palsy (CP) are at risk of developing early-onset scoliosis (EOS). There is no agreement about treatment for very young children (less than 5 or 6 years old). This systematic review focuses on this problem. Materials and Methods: We conducted a search in the PubMed, Scholar Google, Cochrane Library, BVS/BIREME, LILACS, and SCIELO databases from 1/2009 to 11/2020, using the following keywords: “cerebral palsy”, “scoliosis”, “early-onset”, “treatment”. We eliminated duplicated articles, those with unrelated research, without complete text, with very few spastic CP patients or patients aged over 6, and without clear etiology or results. The variables evaluated in the selected articles were: level of evidence, average age, GMFCS level, deformity types, treatments, follow-up, outcomes, and complications. Results: From the 6770 articles retrieved, only 10 were included: 8/10 with evidence level IV, average ages 3.2 to 10 years old, scoliosis as prevalent deformity, average follow-up 1.5 to 9.8 years. Treatment: traditional growing rods (3), magnetic growing rods (1), early instrumented fusion (2), casting (1), orthotics (2), and VEPTR (1). Early instrumented fusion provides >/= 75% of Cobb correction; growing rods, orthotics, and VEPTR, between 25 and 50%, and plaster casts only prevent progression. Non-surgical treatments have a lower rate of complications (5.8%-36%) than surgical ones (21.5% - 73.1%). Surgical complications and postoperative mortality are higher in spastic than in hypotonic patients. Conclusions: Surgery is not a good initial option in very young children with spastic, GMFCS IV-V CP.Downloads
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