Serebral Palsi ve Skolyoza Yaklaşım
Synopsis
Serebral palsi (SP); matürasyonunu tamamlamamış beyinde, bir takım etiyolojik faktörlere bağlı olarak ortaya çıkan, progresif olmayan hareket, motor işlev ve kalıcı postürdeki bozukluğu olarak tanımlanmaktadır. Serebral palsili çocuklarda ortalama %21-64 oranında skolyoz görülmektedir. Serebral palsi tiplerinden ise skolyoz en fazla spastik quadroplejiklerde (%75) görülmektedir. Serebral palsili hastalarda amaç hastanın omurga eğriliğinin ilerlemesini önlemek ve düzeltmek, hastanın ambulasyonunu ve oturma düzenini korumak, fonksiyonel yaşam kalitesini artırmak olmalıdır. Bu yazıda serebral palsi tanılı çocuk hastalarda skolyoz yönetimini güncel tedavi seçenekleri doğrultusunda değerlendirmeyi ve bu konu hakkında farkındalığı arttırmayı amaçladık.
References
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007 Feb;109:8-14. Erratum in: Dev Med Child Neurol. 2007 Jun;49(6):480.
Stanley FJ., Blair E., Alberman E. Cerebral palsies: epidemiology and causal pathways. 1st ed.Cambridge University Press.2000; p. 251
Blair E, Watson L. Epidemiology of cerebral palsy. Semin Fetal Neonatal Med. 2006 Apr;11(2):117-25. doi: 10.1016/j.siny.2005.10.010.
Maenner MJ, Blumberg SJ, Kogan MD, et al. Prevalence of cerebral palsy and intellectual disability among children identified in two U.S. National Surveys, 2011-2013. Ann Epidemiol. 2016 Mar;26(3):222-6. doi: 10.1016/j.annepidem.2016.01.001.
Gulati S, Sondhi V. Cerebral Palsy: An Overview. Indian J Pediatr. 2018 Nov 20;85(11):1006-1016.
Erdem Sultanoğlu T. , Ünlü Akyüz E. , Çevikol A. , Sultanoğlu H. Serebral palsili hastaların demografik ve klinik özellikleri. Ege Tıp Dergisi. 2019; 58(3): 265-273.
Serdaroğlu A, Cansu A, Ozkan S, Tezcan S. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol. 2006 Jun;48(6):413-6. doi: 10.1017/S0012162206000910.
Graham HK, Rosenbaum P, Paneth N, Dan B, Lin JP, Damiano DıL, et al. Cerebral palsy. Nat Rev Dis Primers. 2016 Jan 7; 2: 15082.
Koman LA, Smith BP, Shilt JS. Cerebral Palsy. Lancet. 2004;363:1619-1631.
Wood E. The Child with Cerebral Palsy: Diagnosis and Beyond. Semin Pediatr Neurol. 2006;13:286-296.
Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options. Neuropsychiatr Dis Treat. 2020 Jun; 16:1505-18.
Surveillance of Cerebral Palsy in Europe. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol. 2000;42(12):816-824.
Arnaud C, Ehlinger V, Delobel-Ayoub M, et al. Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study. Front Neurol. 2021;12:624884.
Özel S, Çulha C, Ünsal-Delialioğlu S, Sarı ĠF, Köklü K. Serebral palsili çocuklarda Kaba Motor Fonksiyon Sınıflama Sistemi düzeyleri ve tedavi yöntemleri arasındaki ilişki. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi. 2016;62 (2):116-22.
Lovell, W. W., Winter, R. B., Morrissy, R. T., & Weinstein, S. L. (Eds.). (2006). Lovell and Winter's pediatric orthopaedics. Lippincott Williams & Wilkins. 2006 Vol:1; p.1-42
Balmer GA, MacEwen GD. The incidence and treatment of scoliosis in cerebral palsy. J Bone Joint Surg Br. 1970 Feb;52(1):134-7.
Rosenthal T. Scoliosis: causes, treatments and preventive measures for curvature of the spine. J Pract Nurs. 1986 Mar;36(1):48-50.
Madigan RR, Wallace SL. Scoliosis in the institutionalized cerebral palsy population. Spine (Phila Pa 1976). 1981 Nov-Dec;6(6):583-590. doi: 10.1097/00007632-198111000-00009.
Persson-Bunke M, Hägglund G, Lauge-Pedersen H, et al. Scoliosis in a total population of children with cerebral palsy. Spine (Phila Pa 1976). 2012 May 20;37(12):E708-713. doi: 10.1097/BRS.0b013e318246a962.
Saito N, Ebara S, Ohotsuka K, et al. Natural history of scoliosis in spastic cerebral palsy. Lancet. 1998 Jun 6;351(9117):1687-92. doi: 10.1016/S0140-6736(98)01302-6.
Allam AM, Schwabe AL. Neuromuscular scoliosis. PM R. 2013 Nov;5(11):957-63. doi: 10.1016/j.pmrj.2013.05.015.
Loeters MJ, Maathuis CG, Hadders-Algra M. Risk factors for emergence and progression of scoliosis in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol. 2010 Jul;52(7):605-611. doi: 10.1111/j.1469-8749.2010.03617.x.
Koop SE. Scoliosis in cerebral palsy. Dev Med Child Neurol. 2009 Oct;51 Suppl 4:92-8. doi: 10.1111/j.1469-8749.2009.03461.x.
Terjesen T, Lange JE, Steen H. Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy. Dev Med Child Neurol. 2000 Jul;42(7):448-454. doi: 10.1017/s0012162200000840.
Holmes KJ, Michael SM, Thorpe SL, et al. Management of scoliosis with special seating for the non-ambulant spastic cerebral palsy population--a biomechanical study. Clin Biomech (Bristol, Avon). 2003 Jul;18(6):480-487. doi: 10.1016/s0268-0033(03)00075-5.
Nuzzo RM, Walsh S, Boucherit T, et al. Counterparalysis for treatment of paralytic scoliosis with botulinum toxin type A. Am J Orthop (Belle Mead NJ). 1997 Mar;26(3):201-207.
Albright AL, Cervi A, Singletary J. Intrathecal baclofen for spasticity in cerebral palsy. JAMA. 1991 Mar 20;265(11):1418-1422.
Sansone JM, Mann D, Noonan K, et al. Rapid progression of scoliosis following insertion of intrathecal baclofen pump. J Pediatr Orthop. 2006 Jan-Feb;26(1):125-128. doi: 10.1097/01.bpo.0000191555.11326.bd.
Hägglund G, Pettersson K, Czuba T, et al. Incidence of scoliosis in cerebral palsy. Acta Orthop. 2018 Aug;89(4):443-447. doi: 10.1080/17453674.2018.1450091.
Yoshida K, Kajiura I, Suzuki T, et al. Natural history of scoliosis in cerebral palsy and risk factors for progression of scoliosis. J Orthop Sci. 2018 Jul;23(4):649-652. doi: 10.1016/j.jos.2018.03.009.
Pettersson K, Wagner P, Rodby-Bousquet E. Development of a risk score for scoliosis in children with cerebral palsy. Acta Orthop. 2020 Apr;91(2):203-208. doi: 10.1080/17453674.2020.1711621.
Murphy RF, Mooney JF 3rd. The Crankshaft Phenomenon. J Am Acad Orthop Surg. 2017 Sep;25(9):e185-e193. doi: 10.5435/JAAOS-D-16-00584.
McElroy MJ, Sponseller PD, Dattilo JR, et al; Growing Spine Study Group. Growing rods for the treatment of scoliosis in children with cerebral palsy: a critical assessment. Spine (Phila Pa 1976). 2012 Nov 15;37(24):E1504-1510. doi: 10.1097/BRS.0b013e31826fabd3.
McCarthy JJ, D'Andrea LP, Betz RR, et al. Scoliosis in the child with cerebral palsy. J Am Acad Orthop Surg. 2006 Jun;14(6):367-375. doi: 10.5435/00124635-200606000-00006.
Ágústsson A, Sveinsson Þ, Rodby-Bousquet E. The effect of asymmetrical limited hip flexion on seating posture, scoliosis and windswept hip distortion. Res Dev Disabil. 2017 Dec;71:18-23. doi: 10.1016/j.ridd.2017.09.019.
Hägglund G, Lauge-Pedersen H, Persson Bunke M, et al. Windswept hip deformity in children with cerebral palsy: a population-based prospective follow-up. J Child Orthop. 2016 Aug;10(4):275-279. doi: 10.1007/s11832-016-0749-1.
Sarwark J, Sarwahi V. New strategies and decision making in the management of neuromuscular scoliosis. Orthop Clin North Am. 2007 Oct;38(4):485-96, v. doi: 10.1016/j.ocl.2007.07.001.
Cloake T, Gardner A. The management of scoliosis in children with cerebral palsy: a review. J Spine Surg. 2016 Dec;2(4):299-309. doi: 10.21037/jss.2016.09.05.
Miyanji F, Nasto LA, Sponseller PD, et al. Assessing the Risk-Benefit Ratio of Scoliosis Surgery in Cerebral Palsy: Surgery Is Worth It. J Bone Joint Surg Am. 2018 Apr 4;100(7):556-563. doi: 10.2106/JBJS.17.00621.
Canaz H, Alatas I, Canaz G, et al. Surgical treatment of patients with myelomeningocele-related spine deformities: study of 26 cases. Childs Nerv Syst. 2018 Jul;34(7):1367-1374. doi: 10.1007/s00381-018-3731-z.
Farhat G, Yamout B, Mikati MA, et al. Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology. 2002 May 14;58(9):1348-1353. doi: 10.1212/wnl.58.9.1348.
Oskoui M, Shevell MI, Swaiman KF. Cerebral palsy. In:Swaimann KF, Ashwal S, Ferriero DM, Schor NF, FinkelRS, Gropman AL, Pearl PL, Shevell MI, editors. Pediatricneurology principles and practice. 6th ed. Philadelphia: Mosby Elsevier; 2017. p. 734-4.
Mohamad F, Parent S, Pawelek J, et al. Perioperative complications after surgical correction in neuromuscular scoliosis. J Pediatr Orthop. 2007 Jun;27(4):392-397. doi: 10.1097/01.bpb.0000271321.10869.98.
Khirani S, Bersanini C, Aubertin G, et al. Non-invasive positive pressure ventilation to facilitate the post-operative respiratory outcome of spine surgery in neuromuscular children. Eur Spine J. 2014 Jul;23 Suppl 4:S406-411. doi: 10.1007/s00586-014-3335-6.
Brown JC, Swank S, Specht L. Combined anterior and posterior spine fusion in cerebral palsy. Spine (Phila Pa 1976). 1982 Nov-Dec;7(6):570-3. doi: 10.1097/00007632-198211000-00010.
Reyes AL, Cash AJ, Green SH, et al. Gastrooesophageal reflux in children with cerebral palsy. Child Care Health Dev. 1993 Mar-Apr;19(2):109-18. doi: 10.1111/j.1365-2214.1993.tb00718.x.
Vande Velde S, Van Biervliet S, De Bruyne R, Van Renterghem K, Plasschaert F, Van Winckel M. Gastric dysmotility following orthopaedic scoliosis surgery in patients with cerebral palsy: a case series. Neuropediatrics. 2010 Aug;41(4):182-185. doi: 10.1055/s-0030-1265227.
Stanley FJ., Blair E., Alberman E. Cerebral palsies: epidemiology and causal pathways. 1st ed.Cambridge University Press.2000; p. 251
Blair E, Watson L. Epidemiology of cerebral palsy. Semin Fetal Neonatal Med. 2006 Apr;11(2):117-25. doi: 10.1016/j.siny.2005.10.010.
Maenner MJ, Blumberg SJ, Kogan MD, et al. Prevalence of cerebral palsy and intellectual disability among children identified in two U.S. National Surveys, 2011-2013. Ann Epidemiol. 2016 Mar;26(3):222-6. doi: 10.1016/j.annepidem.2016.01.001.
Gulati S, Sondhi V. Cerebral Palsy: An Overview. Indian J Pediatr. 2018 Nov 20;85(11):1006-1016.
Erdem Sultanoğlu T. , Ünlü Akyüz E. , Çevikol A. , Sultanoğlu H. Serebral palsili hastaların demografik ve klinik özellikleri. Ege Tıp Dergisi. 2019; 58(3): 265-273.
Serdaroğlu A, Cansu A, Ozkan S, Tezcan S. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol. 2006 Jun;48(6):413-6. doi: 10.1017/S0012162206000910.
Graham HK, Rosenbaum P, Paneth N, Dan B, Lin JP, Damiano DıL, et al. Cerebral palsy. Nat Rev Dis Primers. 2016 Jan 7; 2: 15082.
Koman LA, Smith BP, Shilt JS. Cerebral Palsy. Lancet. 2004;363:1619-1631.
Wood E. The Child with Cerebral Palsy: Diagnosis and Beyond. Semin Pediatr Neurol. 2006;13:286-296.
Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options. Neuropsychiatr Dis Treat. 2020 Jun; 16:1505-18.
Surveillance of Cerebral Palsy in Europe. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol. 2000;42(12):816-824.
Arnaud C, Ehlinger V, Delobel-Ayoub M, et al. Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study. Front Neurol. 2021;12:624884.
Özel S, Çulha C, Ünsal-Delialioğlu S, Sarı ĠF, Köklü K. Serebral palsili çocuklarda Kaba Motor Fonksiyon Sınıflama Sistemi düzeyleri ve tedavi yöntemleri arasındaki ilişki. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi. 2016;62 (2):116-22.
Lovell, W. W., Winter, R. B., Morrissy, R. T., & Weinstein, S. L. (Eds.). (2006). Lovell and Winter's pediatric orthopaedics. Lippincott Williams & Wilkins. 2006 Vol:1; p.1-42
Balmer GA, MacEwen GD. The incidence and treatment of scoliosis in cerebral palsy. J Bone Joint Surg Br. 1970 Feb;52(1):134-7.
Rosenthal T. Scoliosis: causes, treatments and preventive measures for curvature of the spine. J Pract Nurs. 1986 Mar;36(1):48-50.
Madigan RR, Wallace SL. Scoliosis in the institutionalized cerebral palsy population. Spine (Phila Pa 1976). 1981 Nov-Dec;6(6):583-590. doi: 10.1097/00007632-198111000-00009.
Persson-Bunke M, Hägglund G, Lauge-Pedersen H, et al. Scoliosis in a total population of children with cerebral palsy. Spine (Phila Pa 1976). 2012 May 20;37(12):E708-713. doi: 10.1097/BRS.0b013e318246a962.
Saito N, Ebara S, Ohotsuka K, et al. Natural history of scoliosis in spastic cerebral palsy. Lancet. 1998 Jun 6;351(9117):1687-92. doi: 10.1016/S0140-6736(98)01302-6.
Allam AM, Schwabe AL. Neuromuscular scoliosis. PM R. 2013 Nov;5(11):957-63. doi: 10.1016/j.pmrj.2013.05.015.
Loeters MJ, Maathuis CG, Hadders-Algra M. Risk factors for emergence and progression of scoliosis in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol. 2010 Jul;52(7):605-611. doi: 10.1111/j.1469-8749.2010.03617.x.
Koop SE. Scoliosis in cerebral palsy. Dev Med Child Neurol. 2009 Oct;51 Suppl 4:92-8. doi: 10.1111/j.1469-8749.2009.03461.x.
Terjesen T, Lange JE, Steen H. Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy. Dev Med Child Neurol. 2000 Jul;42(7):448-454. doi: 10.1017/s0012162200000840.
Holmes KJ, Michael SM, Thorpe SL, et al. Management of scoliosis with special seating for the non-ambulant spastic cerebral palsy population--a biomechanical study. Clin Biomech (Bristol, Avon). 2003 Jul;18(6):480-487. doi: 10.1016/s0268-0033(03)00075-5.
Nuzzo RM, Walsh S, Boucherit T, et al. Counterparalysis for treatment of paralytic scoliosis with botulinum toxin type A. Am J Orthop (Belle Mead NJ). 1997 Mar;26(3):201-207.
Albright AL, Cervi A, Singletary J. Intrathecal baclofen for spasticity in cerebral palsy. JAMA. 1991 Mar 20;265(11):1418-1422.
Sansone JM, Mann D, Noonan K, et al. Rapid progression of scoliosis following insertion of intrathecal baclofen pump. J Pediatr Orthop. 2006 Jan-Feb;26(1):125-128. doi: 10.1097/01.bpo.0000191555.11326.bd.
Hägglund G, Pettersson K, Czuba T, et al. Incidence of scoliosis in cerebral palsy. Acta Orthop. 2018 Aug;89(4):443-447. doi: 10.1080/17453674.2018.1450091.
Yoshida K, Kajiura I, Suzuki T, et al. Natural history of scoliosis in cerebral palsy and risk factors for progression of scoliosis. J Orthop Sci. 2018 Jul;23(4):649-652. doi: 10.1016/j.jos.2018.03.009.
Pettersson K, Wagner P, Rodby-Bousquet E. Development of a risk score for scoliosis in children with cerebral palsy. Acta Orthop. 2020 Apr;91(2):203-208. doi: 10.1080/17453674.2020.1711621.
Murphy RF, Mooney JF 3rd. The Crankshaft Phenomenon. J Am Acad Orthop Surg. 2017 Sep;25(9):e185-e193. doi: 10.5435/JAAOS-D-16-00584.
McElroy MJ, Sponseller PD, Dattilo JR, et al; Growing Spine Study Group. Growing rods for the treatment of scoliosis in children with cerebral palsy: a critical assessment. Spine (Phila Pa 1976). 2012 Nov 15;37(24):E1504-1510. doi: 10.1097/BRS.0b013e31826fabd3.
McCarthy JJ, D'Andrea LP, Betz RR, et al. Scoliosis in the child with cerebral palsy. J Am Acad Orthop Surg. 2006 Jun;14(6):367-375. doi: 10.5435/00124635-200606000-00006.
Ágústsson A, Sveinsson Þ, Rodby-Bousquet E. The effect of asymmetrical limited hip flexion on seating posture, scoliosis and windswept hip distortion. Res Dev Disabil. 2017 Dec;71:18-23. doi: 10.1016/j.ridd.2017.09.019.
Hägglund G, Lauge-Pedersen H, Persson Bunke M, et al. Windswept hip deformity in children with cerebral palsy: a population-based prospective follow-up. J Child Orthop. 2016 Aug;10(4):275-279. doi: 10.1007/s11832-016-0749-1.
Sarwark J, Sarwahi V. New strategies and decision making in the management of neuromuscular scoliosis. Orthop Clin North Am. 2007 Oct;38(4):485-96, v. doi: 10.1016/j.ocl.2007.07.001.
Cloake T, Gardner A. The management of scoliosis in children with cerebral palsy: a review. J Spine Surg. 2016 Dec;2(4):299-309. doi: 10.21037/jss.2016.09.05.
Miyanji F, Nasto LA, Sponseller PD, et al. Assessing the Risk-Benefit Ratio of Scoliosis Surgery in Cerebral Palsy: Surgery Is Worth It. J Bone Joint Surg Am. 2018 Apr 4;100(7):556-563. doi: 10.2106/JBJS.17.00621.
Canaz H, Alatas I, Canaz G, et al. Surgical treatment of patients with myelomeningocele-related spine deformities: study of 26 cases. Childs Nerv Syst. 2018 Jul;34(7):1367-1374. doi: 10.1007/s00381-018-3731-z.
Farhat G, Yamout B, Mikati MA, et al. Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology. 2002 May 14;58(9):1348-1353. doi: 10.1212/wnl.58.9.1348.
Oskoui M, Shevell MI, Swaiman KF. Cerebral palsy. In:Swaimann KF, Ashwal S, Ferriero DM, Schor NF, FinkelRS, Gropman AL, Pearl PL, Shevell MI, editors. Pediatricneurology principles and practice. 6th ed. Philadelphia: Mosby Elsevier; 2017. p. 734-4.
Mohamad F, Parent S, Pawelek J, et al. Perioperative complications after surgical correction in neuromuscular scoliosis. J Pediatr Orthop. 2007 Jun;27(4):392-397. doi: 10.1097/01.bpb.0000271321.10869.98.
Khirani S, Bersanini C, Aubertin G, et al. Non-invasive positive pressure ventilation to facilitate the post-operative respiratory outcome of spine surgery in neuromuscular children. Eur Spine J. 2014 Jul;23 Suppl 4:S406-411. doi: 10.1007/s00586-014-3335-6.
Brown JC, Swank S, Specht L. Combined anterior and posterior spine fusion in cerebral palsy. Spine (Phila Pa 1976). 1982 Nov-Dec;7(6):570-3. doi: 10.1097/00007632-198211000-00010.
Reyes AL, Cash AJ, Green SH, et al. Gastrooesophageal reflux in children with cerebral palsy. Child Care Health Dev. 1993 Mar-Apr;19(2):109-18. doi: 10.1111/j.1365-2214.1993.tb00718.x.
Vande Velde S, Van Biervliet S, De Bruyne R, Van Renterghem K, Plasschaert F, Van Winckel M. Gastric dysmotility following orthopaedic scoliosis surgery in patients with cerebral palsy: a case series. Neuropediatrics. 2010 Aug;41(4):182-185. doi: 10.1055/s-0030-1265227.
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23-34
Published
April 17, 2023
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Kaya O. Serebral Palsi ve Skolyoza Yaklaşım. In: Alabaz D, editor. Güncel Çocuk Sağlığı ve Hastalıkları V [Internet]. Türkiye: Academician Publishing Book DOI Portal; 2023 [cited 2026 Jul. 15]. pp. 23-34. Available from: https://omp35.books.akademisyen.net/index.php/akya/catalog/book/2565/chapter/13175
