Michael G. Vitale, MD, MPH

Children with cerebral palsy have a high chance of developing scoliosis during their early years and adolescence. Spasticity, muscle weakness, and poor muscle control can contribute to spinal deformity. Individuals who are non-ambulatory are at higher risk.

Michael G. Vitale, MD MPH, is an internationally renowned expert in pediatric spine deformity, specializing in complex pediatric scoliosis. He is an innovator in many pediatric spine deformity techniques and has developed spine safety program that has reached the entire nation. Dr. Vitale also leads the Conservative Treatment of Scoliosis Center, teaching the profession on how effective conservative care can be. We caught up with Dr. Vitale about his work with the WFCPC’s multidisciplinary team in treating people with cerebral palsy.

1) As one of the country's leading pediatric spine deformity experts, how do you change your treatment protocols or approach to the cerebral palsy child with scoliosis that needs surgery?

Taking care of scoliosis in children with cerebral palsy requires a team approach. We utilize formal risk severity scores to estimate the perioperative risk of problems like infection. That allows us to optimize the patient preoperatively with the help of our care team. Also, we will sometimes have a second spine surgeon involved when the nature of the surgery and patient suggests that this is helpful. We always use a plastic surgeon to do the closure.

2) Your conservative treatment of scoliosis program has been an amazing success and has taught the profession about how effective conservative care can be. Do you see applications for these principles to the treatment of spine deformity in cerebral palsy or other neuromotor disabilities?  

Thank you. We use many of the concepts of conservative scoliosis care for patients with adolescent idiopathic scoliosis in our patients who have cerebral palsy. In fact, for patients who can comply with treatment we will often recommend scoliosis specific physical therapy and use of a Rigo Cheneau brace. For more involved children, we sometimes opt for a semirigid TLSO to improve trunk control and sitting balance.

3) You developed a spine safety program that has reached the entire nation. Can you identify some special aspects of that program that have enhanced the care of spine deformity and cerebral palsy patients? 

We have developed risk severity scores which are used nationally to try to help predict the chances of a perioperative problem. We also share information regarding the postoperative care pathways that we have developed. Over the years, there have been many talks about making care better for children with cerebral palsy and scoliosis and many are available online at www.safetyinspinesurgery.com. 

4) You are an innovator in many pediatric spine deformity techniques including the magnetic growing rods. Can these techniques be applied for young children with cerebral palsy and other neurodevelopmental problems? 

We definitely use magnetically controlled growing rods in patients with cerebral palsy although the protocols for management are a bit different.                        

5) You have an amazing career that has included leadership of major pediatric orthopedic organizations. How have you been able to use your leadership to enhance the care of cerebral palsy patients?

Yes, we started a POSNA Safe Surgery Program (PSSP) to help POSNA members share best practices in the care of children with neuromuscular diseases.                  

Learn more about Dr. Vitale and the treatment options for scoliosis.