Scoliosis in children with cerebral palsy: what parents need to know

​Scoliosis is one of the most common secondary musculoskeletal complications of cerebral palsy — yet many families are not prepared for it, and some children go undetected until the curve has progressed significantly. If your child has cerebral palsy (CP), understanding why scoliosis develops, when to start screening, and what management options are available can make a meaningful difference to the outcome.
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This article explains the relationship between CP and scoliosis, how neuromuscular scoliosis differs from the more commonly known idiopathic scoliosis, and what bracing and orthotic management at Gibson Orthotics in Johannesburg can offer.

Why does scoliosis develop in children with cerebral palsy?

​Cerebral palsy affects muscle tone, posture, and movement in ways that place the developing spine under asymmetric forces over time. The underlying mechanisms vary by CP subtype, but the common contributors include:

• Muscle tone imbalance — spastic or hypotonic muscle groups on one side create unequal forces across the spinal segments
• Asymmetric posture — habitual positioning of the head, trunk, and pelvis reinforces lateral deviation of the spine
• Hip displacement or subluxation — pelvic obliquity caused by hip problems transmits directly to the lower spine, creating or exacerbating curvature
• Prolonged seated positioning — children who use wheelchairs or supportive seating spend extended time in postures that can drive spinal deviation if not properly managed
• Limited trunk muscle control — inability to actively self-correct posture means the spine is not counteracting lateral forces throughout the day

 
The prevalence of scoliosis in cerebral palsy is directly related to functional level. Research consistently shows that children with higher GMFCS levels — those with more significant motor impairment — carry a substantially greater risk. Published estimates suggest scoliosis affects up to 25% of children with CP at GMFCS levels I–II, rising to over 60–70% in children at GMFCS level V. Scoliosis in this group is not inevitable, but for children with moderate to severe CP, it is a known and predictable risk that warrants proactive monitoring.

​How is neuromuscular scoliosis different from idiopathic scoliosis?

When most people hear the word "scoliosis", they are thinking of adolescent idiopathic scoliosis (AIS) — the type that develops in otherwise healthy teenagers, typically as an S-shaped double curve that is discovered at a routine check. Neuromuscular scoliosis, which develops in children with CP and similar conditions, is a fundamentally different problem in several key ways:
Idiopathic scoliosis
Curve shape
S-curve (double) or C-curve
Pelvis involvement
Typically not involved
Progression rate
Slower; often stabilises at skeletal maturity
Primary goal of bracing
Halt curve progression, achieve correction
Age of onset
Adolescence (10–16 years typically)
 
Neuromuscular scoliosis (CP)
Curve shape
Long C-curve, often pelvis to thorax
Pelvis involvement
Pelvic obliquity common and significant
Progression rate
Faster; may continue into adulthood
Primary goal of bracing
Postural support, function, slowing progression
Age of onset
Childhood; can develop early and progress rapidly

These differences matter for management. Bracing protocols designed for idiopathic scoliosis cannot simply be applied to a child with CP.

The brace design, wearing schedule, goals, and follow-up protocol all need to be adapted to the individual — their GMFCS level, seating needs, respiratory status, communication abilities, and sensory profile.
At higher Cobb angles: typically above 50–60°, neuromuscular scoliosis can begin to compromise respiratory mechanics.

This is one of the reasons early identification and proactive management are clinically important.

​When should a child with cerebral palsy be screened for scoliosis?

The most effective approach to scoliosis in CP is proactive screening and identifying early-stage curves before they progress to the point where conservative management becomes difficult or impossible.
We recommend that children with cerebral palsy be assessed for scoliosis annually from around age four to five, and earlier if there is visible trunk asymmetry, rapid postural change, or hip displacement.

For children at GMFCS IV–V, where risk is highest and self-correction is not possible, earlier and more frequent screening is warranted.
 
Screening referral checklist
Consider requesting an orthotist assessment if your child's treating team notes any of the following:

• Visible lean or tilt in the trunk when sitting or standing
• One shoulder noticeably higher than the other
• Pelvic obliquity (one hip higher than the other in seating)
• Progressive difficulty maintaining sitting balance previously achieved
• Visible rib prominence or back asymmetry
• GMFCS IV–V with no previous scoliosis assessment

You do not need a specialist referral to book a scoliosis assessment at Gibson Orthotics.
Contact us directly or ask your physiotherapist or paediatrician to refer.
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About the author:

Kirsten Gibson is a Clinical Orthotist Prosthetist (CPO), founder and director of Gibson Orthotics in Kyalami, Johannesburg. She holds Level 2 certification in the Rigo Concept for scoliosis bracing, is an authorized Orthomerica STARband provider, and serves as Chair of the South African Orthotic & Prosthetic Association (SAOPA) and Executive Board Member of ISPO. She has a clinical focus in pediatric orthotics, neuromuscular conditions, scoliosis management, and lymphoedema compression therapy.