Treating Cervical Spondylosis in Cerebral Palsy: A Pain Management Puzzle

Authors: Shreya N. Patel, DO (Presenting Author); James C. Pendleton, MD

INTRODUCTION

• Cervical spondylosis can cause significant pain and disability, especially in patients with pre-existing conditions like Cerebral Palsy (CP)

• Managing cervical spondylosis in spastic quadriplegic CP patients is challenging, due to increased muscle tone, positioning difficulties, and altered anatomy. 

• This case demonstrates the importance of physician adaptability and anatomical knowledge in performing pain management procedures tailored to complex patients

METHODS

• Patient: 53 year old Female with spastic quadriplegic CP and prior C5-7 anterior cervical discectomy and fusion (ACDF) presenting with worsening right sided cervical pain

• Procedure Adjustments: Performed right C3-6 medial branch blocks (MBB) and radiofrequency ablation (RFA) in left lateral decubitus position due to patient’s inability to lie prone

• Pre-Treatment with Diazepam 5mg to minimize spasticity and gentle traction to RUE 

• Imaging Modifications: Adjusted radiographic views to accommodate ACDF hardware and limited neck extension

RESULTS

• Two MBB followed by RFA provided > 80% pain relief, lasting 8 months 

• Patient experienced improved head and neck control for her powered wheelchair 

• Enhanced overall mobility, independence, and quality of life

• Successful outcomes highlight the significance of a flexible, patient-centered approach in managing cervical spondylosis in complex CP cases