Prevalence of Early Spinal Deformity in Children With GMFCS v Cerebral Palsy

Abstract

Objective: Spastic cerebral palsy (sCP) is a cause of early onset scoliosis, although there are no data on its prevalence. Our objective was to determine the prevalence of early onset neuromuscular spinal deformities (SD) in severely compromised children with sCP. Methods: Cross-sectional quantitative, observational, exploratory, and descriptive study. Review of clinical records. Inclusion criteria: age 2 to 5 years, sCP, level V of the GMFCS, residents in our province. X-ray blind reading by 2 observers. The Student t test was used for parametric data and the chi-square test for non-parametric data. Level of statistical significance: p < 0.05. Results: Thirty-eight cases of 158 registered were included. Average age: 3 years 7 months (2 years – 5 years 2 months). Sex: 21 male/17 female. The predominant etiologies were perinatal: 21 (55.3%), and the prevalent nutritional status was eutrophic: 28 cases (73.7%). SD was very frequent: 32 patients (84.2%) without statistical differences between sexes; there were 20 kyphoscoliosis, 1 lordoscoliosis, 6 scoliosis, 5 hyperkyphosis. Mean angular values: 23.9° (10°- 50°) for the frontal plane deformities and 58° (9°- 92º) for the sagittal deformities. Seventeen patients (44.7%) had average pelvic obliquity of 15° (2°- 30°) without differences in patients with and without SD. There was no association between SD and etiology, digestive disorders, seizures, nutritional status, hip excentration, or limb deformities. Conclusions: The prevalence of SD in children up to 5 years old with severe sCP is high: 84.2% (32/38 cases). The orthopedic profile is children with sCP of any etiology at GMFCS level V, with multiple disabilities and independently of associated limb deformities. Level of evidence I; Diagnostic Studies - Investigating a Diagnostic Test: Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

Epidemiological and Diagnostic Characteristics of Scoliosis in Children in a Single Tertiary Centre in Abidjan

“…[ 41 42 ] Considering this neuromuscular scoliosis, the predominance of thoracolumbar curvature observed in our study is similar to that of Manzone et al . [ 39 ] Apart from CP, the rarity of other aetiologies is consistent with the data in the literature. In our practice, genetic and neuromuscular abnormalities are clearly underdiagnosed due to the technical platform and the high cost of laboratory examinations.…”

“…This CP is mainly due to cerebral damage from hypoxia. [ 39 40 ] In our context, the poor monitoring of pregnancies, home deliveries and the under-equipment of our first-level health centres could explain the perinatal cerebral suffering. This neuromuscular scoliosis had the most severe curvatures.…”

Tratamiento de la escoliosis neuromuscular en niños pequeños con parálisis cerebral espástica grave: revisión sistemática de la bibliografía

“…La prevalencia mundial de la PC es de alrededor de 2,11 por 1000 nacidos vivos y se ha mantenido constante a pesar de los cambios sanitarios. 2 La escoliosis neuromuscular en pacientes con PC es una de las deformidades que puede aparecer en una etapa temprana de la vida, [3][4][5][6] y está englobada dentro de las "escoliosis de comienzo temprano" (ECT), 4 la edad fue extendida por la Scoliosis Research Society para incluir a todas las curvas aparecidas antes de los 10 años. 7 La aparición precoz de escoliosis en un paciente con PC es, como se sabe, uno de los grandes factores de riesgo para su progresión.…”

“…8 Pero el factor de riesgo aislado más importante es el grado de compromiso neurológico, 9,10 es tanto más prevalente cuanto más alto es el nivel del Gross Motor Function Classification System (GMFCS), 3 y es máximo en el nivel V del GMFCS con severo compromiso general. 5,6 La evolución natural de las ECT depende de la etiología de la deformidad, pero no es buena, independientemente de ella. 11 A su vez, la evolución natural de las escoliosis neuromusculares muestra que la edad es un factor de riesgo importante para la progresión: 12 cuanto más precoz es el inicio, mayores son los riesgos de agravamiento y de llevar a una deformidad muy grave durante el crecimiento.…”