The Relationship of Gross Motor Functional Classification Scale Level and Hip Dysplasia on the Pattern and Progression of Scoliosis in Children With Cerebral Palsy

Garg, Sumeet; Engelman, Glenn H.; Yoshihara, Hiroyuki; McNair, Bryan; Chang, Frank M.

doi:10.1016/j.jspd.2013.05.002

Cited by 14 publications

(14 citation statements)

References 21 publications

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“…Although there are controversial findings about the association between the direction of scoliosis and the direction of pelvic obliquity and/or the "windswept" hip deformity [58][59][60] in children above 6 years of age, in this series the laterality of the scoliosis did not seem to influence excentration. (Figures 5 and 6) Establishing a profile of the patient at risk It can be established then that a young child (2 to 5 years of age) severely compromised (quadriplegic with total body involvement) with GMFCS V spastic CP has a high probability of presenting a neuromuscular spinal deformity regardless of the socio-economic status of place where the patient comes from.…”

Section: Factors Associated With the Presence Of Deformitycontrasting

confidence: 54%

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

Manzone¹,

Arce²,

Ávalos³

et al. 2019

Coluna/Columna

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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).

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Section: Factors Associated With the Presence Of Deformitycontrasting

confidence: 54%

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

Manzone¹,

Arce²,

Ávalos³

et al. 2019

Coluna/Columna

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“…The almost invariable early onset and progression of thoracolumbar scoliosis in severely involved neuromuscular patients has been well documented [ 2 , 15 – 17 ]. The scoliosis deformity worsens with the severity of the underlying disorder, as demonstrated in Duchenne muscular dystrophy [ 13 , 18 ], cerebral palsy [ 2 , 19 ], and spinal muscular atrophy [ 17 ]. When patients are non-ambulatory, the severe neuromuscular scoliosis, unlike the patterns seen in ambulatory idiopathic scoliosis patients, almost always extends to involve the lumbosacral region where it contributes to pelvic obliquity [ 1 – 3 , 5 – 8 , 15 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…When patients are non-ambulatory, the severe neuromuscular scoliosis, unlike the patterns seen in ambulatory idiopathic scoliosis patients, almost always extends to involve the lumbosacral region where it contributes to pelvic obliquity [ 1 – 3 , 5 – 8 , 15 – 18 ]. Further evidence of the inter-related nature of the three sites of deformity is provided by specific studies on hip subluxation and dislocation in relation to more proximal scoliosis and pelvic obliquity in cerebral palsy [ 19 – 22 ], spinal muscular atrophy [ 21 , 23 , 24 ], and Duchenne muscular dystrophy [ 3 , 18 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous progression patterns of scoliosis, pelvic obliquity, and hip subluxation/dislocation in non-ambulatory neuromuscular patients: An approach to deformity documentation

Patel

Shapiro

2015

Journal of Children's Orthopaedics

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BackgroundA triad of deformities—thoracolumbar scoliosis, pelvic obliquity, and femoral head (hip) subluxation/dislocation—occurs frequently in non-ambulatory neuromuscular patients, but their close inter-relationship is infrequently appreciated or quantified. We propose a deformity documentation approach to assess each component simultaneously.MethodsThe documentation assesses each component for maximal functional level, deformity, and flexibility/rigidity: deformity from antero-posterior radiographs (scoliosis—maximal functional position, pelvic obliquity—sitting, hip position—supine) and flexibility/rigidity from extent of repositioning on supine (spine, pelvis) and frog lateral (hip) radiographs. The approach was applied in 211 patients: Duchenne muscular dystrophy (110), spinal muscular atrophy (49), cerebral palsy (26), and other neuromuscular disorders (26).ResultsMeasurement of 2124 radiological data points allowed for deformity (mild to moderate to severe) and flexibility/rigidity (fully reducible to partially to non-reducible) gradations for scoliosis, pelvic obliquity, and hip subluxation/dislocation. The charting documented: (1) numerical deformity and flexibility/rigidity changes [x-axis: age; y-axis: angulation (scoliosis and pelvic obliquity) and percent coverage (hip subluxation or dislocation) from 0–120]; and (2) grade deformity and flexibility/rigidity changes [x-axis: age; y-axis: deformity and flexibility/rigidity, following conversion of numerical measurements to a 1–5 grade scale]. In subgroups with the most extensive documentation, thoracolumbar and lumbar scoliosis extended into the sacrum with 98 % (114/116) accompanied by pelvic obliquity; and scoliosis developed more rapidly than hip deformity in 44 % (28/63), scoliosis and hip deformity developed at the same time in 40 % (25/63), and hip deformity developed more rapidly than scoliosis in 16 % (10/63) (Pearson’s chi-squared test p = 0.0501, almost significant).Conclusion and significanceDocumentation of the triad of neuromuscular deformities is applicable to all diagnoses; it outlines maximal functional level, deformity, and flexibility/rigidity at each site; and it shows the relationship between spine, pelvic, and hip deformation. Prospective charting will enhance both clinical management and clinical research into neuromuscular deformity.

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“…Severity of neuropathic onset scoliosis is linked to the Gross Motor Functional Classification Scale with evidence to suggest that children with level five classification will deteriorate at a faster rate than children with level one to four [ 10 ]. The curve presents as one of two variants; an S-shape with balanced, symmetrical thoracic kyphotic and lumbar lordotic curves [ 6 ] accounting for 20 % of spinal curvature, and a single thoracolumbar or lumbar C-shape associated with pelvic obliquity and hip dislocation [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The curve presents as one of two variants; an S-shape with balanced, symmetrical thoracic kyphotic and lumbar lordotic curves [ 6 ] accounting for 20 % of spinal curvature, and a single thoracolumbar or lumbar C-shape associated with pelvic obliquity and hip dislocation [ 9 ]. The latter are experienced in the more severely affected wheelchair based patient (GMFCS level five), and are more likely to experience continuing Cobb angle increase [ 10 ]. Children with Retts Syndrome and scoliosis present with similar C- and S-shaped spinal curves as children with CP, and experience similar hip migration [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes

Matthews¹,

Blandford

Marsden

et al. 2016

Scoliosis

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BackgroundTo date the main treatment approach for neuropathic onset scoliosis has utilised thoracic lumbar sacral orthoses (TLSO) to stabilize the spine and enable stable sitting. Dynamic elastomeric fabric orthoses (DEFOs) may achieve both of these aims if used as an early intervention. Due to a lack of evidence in this area, a retrospective audit of case notes was undertaken to understand current orthotic practice investigating the usage, outcomes and clinical characteristics of treated children with neuropathic onset scoliosis. Clinical notes of 180 children at risk for, or identified with, scoliosis were audited using a search matrix to identify diagnostic group, spinal muscle tone, Gross Motor Functional Classification Scale (GMFCS) level, orthotic treatment modalities, scoliosis specific data, surgical interventions, adaptive technologies used, and outcome measurements reported.ResultsOf the 180 notes examined, 85 were male; mean age nine years one month [SD four years seven months]. Spinal muscle tone was reported in 137 cases: 122/137 presented as low tone, 4/137 high tone, 6/137 fluctuating tone and 5/137 typical tone. Scoliosis was confirmed in (77/180) of whom (39/77) used a DEFO. Another (43/180) had a spinal curve developing, of whom (22/43) used a DEFO. The remaining (60/180) had no report of spinal curvature, but used a DEFO as a preventative measure. GMFCS scores were reported for 49 children of whom 14/49 were graded as level 4 and 17/49 level 5. Of the children with scoliosis who had spinal curve shapes reported, 48/60 had a C-shape presentation and 12/60 had an S-shape.ConclusionsThe findings confirm previously reported papers in children with neuropathic onset scoliosis in relation to curve shape and GMFCS levels. It provides some evidence of the role DEFOs may have in the management of these children, and highlights the need for further research in this area due to the lack of peer-reviewed publications.

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The Relationship of Gross Motor Functional Classification Scale Level and Hip Dysplasia on the Pattern and Progression of Scoliosis in Children With Cerebral Palsy

Abstract: Treatment decisions regarding hip subluxation and scoliosis in patients with cerebral palsy may be made independent of each other.

Cited by 14 publications

References 21 publications

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

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

Simultaneous progression patterns of scoliosis, pelvic obliquity, and hip subluxation/dislocation in non-ambulatory neuromuscular patients: An approach to deformity documentation

The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes

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