The natural history and risk factors for progressive severe scoliosis were evaluated in 37 institutionalized spastic cerebral palsy patients followed at the Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, and at Centers in Nagano, Japan. Scoliosis started before age 10 yrs and progressed rapidly during the growth period, reaching a 60° magnitude by 17 yrs. Those with scoliosis >60° were bedridden and had thoracolumbar curves. Risk factors for progression of scoliosis in spastic cerebral palsy are: a spinal curve of 40° before age 15 yrs; total body involvement; being bedridden; a thoracolumbar curve. Early surgical intervention to prevent progression is recommended in patients with these risk factors. 
COMMENT. Reports indicate that bracing is frequently ineffective for scoliosis with cerebral palsy and surgery is advocated in severe cases. Fusion is intended to facilitate sitting and standing, improve pulmonary and upper limb function, and benefit nursing procedures. The above study provides guidelines for early surgical intervention.