Operative Principles of Scoliosis in Patients with Cerebral Palsy

Neuromuscular scoliosis (NMS) is a progressive spinal deformity commonly seen in children with cerebral palsy (CP), particularly in those with severe functional impairment. Operative treatment is indicated for progressive deformity, functional decline, and impaired quality of life, with curve magnitude and pelvic obliquity remaining important decision-making factors. Careful preoperative multidisciplinary assessment is essential given the high burden of pulmonary, nutritional, and medical comorbidities in this population. The risk of major complications after surgery is as high as 39%, which underlines the importance of multidisciplinary management and good preoperative optimization. Although complication rates remain high, recent literature demonstrates durable radiographic correction and meaningful improvements in health-related quality of life. Continued advances in surgical techniques and perioperative optimization remain essential to further improve outcomes in this high-risk patient population.