title: Management of spinal deformity in cerebral palsy: conservative treatment.
abstract: BACKGROUND
  The incidence of scoliosis in Cerebral Palsy (CP) is directly related to the Gross Motor Function Classification System (GMFCS) level. The natural history of untreated scoliosis in patients with CP is one of progression and factors implicated in deterioration include type of involvement (quadriplegia), poor functional status (nonambulatory, GMFCS levels IV and V), and curve location (thoracolumbar). The generally accepted incidence in the overall CP population is 20-25 %.
  
  
  METHODS
  We recently published our short term results for 31 children treated with a short lumbar brace. In cases of a "positive hands up test" we recommend a short lumbar brace, and in patients with scoliosis with a Cobb angle >20° a double shelled brace.
  
  
  RESULTS
  In our study, there was a correction of 37 % for the lumbar Cobb angle and 39 % for the thoracic Cobb angle at a mean follow-up of 28 months.
  
  
  CONCLUSIONS
  The incidence of scoliosis in the overall CP population is 20-25 % and is directly related to the GMFCS level. Therefore, we recommend early treatment and prescribe a short lumbar brace in patients with dynamic instability of the trunk, and in scoliosis with a Cobb angle >20° a double shelled brace.
authors.affiliation: Pediatric Orthopaedic Department, University Children's Hospital Basel, UKBB, Basel, 4031 Switzerland.
authors.forename: Erich
authors.initials: E
authors.lastname: Rutz
authors.affiliation: Pediatric Orthopaedic Department, University Children's Hospital Basel, UKBB, Basel, 4031 Switzerland.
authors.forename: Reinald
authors.initials: R
authors.lastname: Brunner
keywords: Cerebral palsy; Conservative treatment; Double shelled brace; Scoliosis; Short lumbar brace; Spinal deformity