Spastic Diplegia in Children — Presentation and Management
DNB Orthopaedics • May 2024 • Paper IV • 10 Marks
Introduction
Spastic diplegia is a clinical pattern of cerebral palsy in which both lower limbs are predominantly affected by spasticity, while the upper limbs are relatively less involved. It classically occurs following injury to the periventricular white matter, particularly in premature infants.
The disorder is non-progressive at the level of the brain lesion, but its musculoskeletal manifestations are dynamic and may progressively worsen during growth because persistent spasticity and muscle imbalance lead to contractures, torsional abnormalities, hip displacement and gait deterioration.
Central principle: Management is not simply treatment of spasticity. The goal is to preserve function, prevent fixed deformity, maintain hip stability and optimize efficient gait throughout growth.
Definition
Spastic diplegia is a form of cerebral palsy characterized by bilateral motor involvement, with lower-limb spasticity significantly greater than upper-limb involvement. Intelligence may be normal, and many children are ambulant with or without assistive devices.
Etiopathogenesis
The characteristic neurological lesion is often periventricular leukomalacia involving descending corticospinal fibres supplying the lower limbs.
Common associations include:
- Prematurity
- Low birth weight
- Perinatal hypoxia–ischemia
- Periventricular hemorrhage
- Neonatal sepsis or other complications of…