Sagittal X-ray parameters in walking or ambulating children with cerebral palsy

Abstract

Adolescents with cerebral palsy (CP) who walk or ambulate often have an abnormal clinical and radiological spinal profile during pubertal growth compared with adolescents of the same age without neuromotor impairments. Therefore, in the following study, we aimed to conduct a radiological assessment of static data on the lumbar-pelvic-femoral complex in ambulatory children with CP to compare these data with those of an asymptomatic population. The CP population was comprised of 119 children and the asymptomatic population was comprised of 652 children. The large format (30×90cm) sagittal X-rays were taken while subjects were in a comfortable position in which knees and hips were in maximal extension. Analyses were performed using Optispine(®) software to measure the parameters of an X-ray of the profile of the spine, pelvis and femurs. Comparing, the two populations, we found no difference in the shape parameter (pelvic incidence) but we did find significant differences in the positional parameters (pelvic tilt and sacral slope) of the pelvis. We found a difference in the curvature and orientation of lumbar lordosis as well as in the number of vertebrae involved in the kyphosis and its orientation. There was also a significant difference in the C7 plumb line. We can say that the CP population is not structurally different from the control population, but that parameters become disturbed during growth. These disturbances should be identified and monitored so that changes can be detected early and progression can be prevented.

Pelvic-Spinal Analysis and the Impact of Onabotulinum toxin A Injections on Spinal Balance in one Child With Cerebral Palsy

“…The authors found only 1 study in the literature that used these parameters to compare the pelvic-spinal balance of children with cerebral palsy (hemiplegic and diplegic) with healthy children. 9 Similar to the results for L., they found that the pelvic incidence of the children with cerebral palsy was normal (46° vs 44.8° in healthy children), however, the pelvic positional parameters (pelvic tilt and sacral slope), spinal curvatures, and balance were significantly different compared to the healthy children. This suggests that the changes in spinal alignment that occur during adolescence in cerebral palsy are the result of impaired muscle tone and strength (eg, hypertonia of muscles above and below the pelvis, weakness in the posterior muscles), tendon and muscle contractures, and compensations of the skeletal system.…”

“…9 Equally, few objective measures exist to evaluate the baseline state and to determine changes following treatment.…”

“…Botulinum toxin injections in the lower limb muscles could change the global pelvis-spine balance; however, there are currently no published guidelines for this treatment since few studies have specifically considered the consequences of cerebral palsy on pelvis-spine balance. 9 Equally, few objective measures exist to evaluate the baseline state and to determine changes following treatment.…”

Spinal sagittal alignment and head control in patients with cerebral palsy

“…10 Patients with walking abilities are classified from GMFCS I to GMFCS IV level, while non-ambulant patients are GMFCS V. Three studies have explored and described the spino-pelvic sagittal alignment of walking CP patients, who often present retraction of hip flexors (right anterior, iliopsoas). 3,8,9 Pelvic incidence was found to be similar to that of healthy controls, indicating that the shape of the pelvis was not affected by the disease. 3 However, the pelvis was anteverted (low pelvic tilt) and sacrum was more horizontal (high sacral slope).…”

“…The literature is, therefore, very poor on the subject, with only six relevant articles available for analysis (only one including GMFCS V patients) and sagittal alignment parameters are currently lacking. [3][4][5][6]8,9…”