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Abstract
Background: Scoliosis is a common musculoskeletal co-morbidity seen in children with cerebral palsy (CP).
Objective: To describe the prevalence of scoliosis and to analyze the relation between scoliosis, gross motor function, and CP subtypes in order to propose a surveillance program for children with CP in Malaysia.
Methods: Cross-sectional study of children with CP between 5 to 18 years old were recruited between July 2017 to March 2018. A clinical examination was done and Cobb’s angle were measured on all spine radiographs. Gross Motor Function Classification System (GMFCS) level, CP subtype, age at clinical diagnosis of scoliosis, and the Cobb angle at the first radiographical examination were registered.
Results: Eighty-one children were recruited. 46/81 (56.8%) had clinical scoliosis and were subjected to spine radiograph. Only 41/81 (50.6%) had scoliosis with Cobb angle >10O, of which 9/81 (11.1%) had a Cobb angle >40O. Risk of scoliosis was directly related to the GMFCS level with 4/81(4.9%) at GMFCS I-III and 37/81(45.7%) in GMFCS IV-V. More than half of the children with bilateral spastic CP (52.3%) and dystonic CP (60%) had scoliosis. Children in GMFCS levels IV-V developed scoliosis by 10 years old.
Conclusion: In our cohort, more than half had scoliosis. The frequency of scoliosis increased with GMFCS level and spastic CP subtypes. The proposed simple spine surveillance based on GMFCS levels will lead to early detection, improve care and allow for timely intervention of the scoliotic deformity in children with CP in Malaysia.
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References
- Johnston MV, Hoon AH Jr. Cerebral palsy. Neuromolecular Med. 2006;8(4):435-50.
- Saito N, Ebara S, Ohotsuka K, et al. Natural history of scoliosis in spastic cerebral palsy. Lancet. 1998;351(9117):1687-92.
- Cloake T, Gardner A. The management of scoliosis in children with cerebral palsy: a review. J Spine Surg. 2016;2(4):299-309.
- Roberts SB, Tsirikos AI. Factors influencing the evaluation and management of neuromuscular scoliosis: A review of the literature. J Back Musculoskelet Rehabil. 2016;29(4):613-623.
- Koop SE. Scoliosis in cerebral palsy. Dev Med Child Neurol. 2009;51(4):92–8.
- Persson-Bunke M, Czuba T, Hägglund G, et al. Psychometric evaluation of spinal assessment methods to screen for scoliosis in children and adolescents with cerebral palsy. BMC Musculoskelet Disord. 2015;16:351.
- Greiner KA. Adolescent idiopathic scoliosis: radiologic decision-making. Am Fam Physician. 2002;65(9):1817-22.
- Allen S, Parent E, Khorasani M, et al. Validity and reliability of active shape models for the estimation of Cobb angle in patients with adolescent idiopathic scoliosis. J Digit Imaging. 2008;21(2):208-18.
- Tsirikos AI, Spielmann P. Spinal deformity in paediatric patient with cerebral palsy. Curr Orthop. 2007;21(2):122–34.
- Grossman TW, Mazur JM, Cummings RJ. An evaluation of the Adams forward bend test and the scoliometer in a scoliosis school screening setting. J Pediatr Orthop. 1995;15(4):535-8.
- Kotwicki T, Chowańska J, Kinel E, et al. Sitting forward bending position versus standing position for studying the back shape in scoliotic children. In: 4th International Conference on Conservative Management of Spinal Deformities. Scoliosis. 2007;2(1):S34.
- Horne JP, Flannery R, Usman S. Adolescent idiopathic scoliosis: diagnosis and management. Am Fam Physician. 2014;89(3):193-98.
- Kim H, Kim HS, Moon ES, et al. Scoliosis imaging: what radiologists should know. Radiographics. 2010;30(7):1823–42.
- Langensiepen S, Semler O, Sobottke R, et al. Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review. Eur Spine J. 2013;22(11):2360-71.
- Zhang J, Lou E, Shi X, et al. A computer-aided Cobb Angle measurement method and its reliability. J Spinal Disord Tech. 2010;23(6):383–87.
- Persson-Bunke M, Hägglund G, Lauge-Pedersen H, et al. Scoliosis in a total population of children with cerebral palsy. Spine. 2012;37(12):708–13.
- Graham HK, Rosenbaum P, Paneth N, et al. Cerebral palsy. Nat Rev Dis Primers. 2016;7(2):15082.
- Johnson A. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002;44(9):633-640.
- Hanna SE, Rosenbaum PL, Bartlett DJ, et al. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol. 2009;51(4):295-302.
- Rutz E, Tirosh O, Thomason P, et al. Stability of the Gross Motor Function Classification System after single-event multilevel surgery in children with cerebral palsy. Dev Med Child Neurol. 2012;54(12):1109-13.
- Tsirikos AI. Development and treatment of spinal deformity in patients with cerebral palsy. Indian J Orthop. 2010;44(2):148-58.
- Jones-Quaidoo SM, Yang S, Arlet V. Surgical management of spinal deformities in cerebral palsy. J Neurosurg Spine. 2010;13(6):672-85.
- Thometz JG, Simon SR. Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy. J Bone Joint Surg Am. 1988;70(9):1290-6.
References
Johnston MV, Hoon AH Jr. Cerebral palsy. Neuromolecular Med. 2006;8(4):435-50.
Saito N, Ebara S, Ohotsuka K, et al. Natural history of scoliosis in spastic cerebral palsy. Lancet. 1998;351(9117):1687-92.
Cloake T, Gardner A. The management of scoliosis in children with cerebral palsy: a review. J Spine Surg. 2016;2(4):299-309.
Roberts SB, Tsirikos AI. Factors influencing the evaluation and management of neuromuscular scoliosis: A review of the literature. J Back Musculoskelet Rehabil. 2016;29(4):613-623.
Koop SE. Scoliosis in cerebral palsy. Dev Med Child Neurol. 2009;51(4):92–8.
Persson-Bunke M, Czuba T, Hägglund G, et al. Psychometric evaluation of spinal assessment methods to screen for scoliosis in children and adolescents with cerebral palsy. BMC Musculoskelet Disord. 2015;16:351.
Greiner KA. Adolescent idiopathic scoliosis: radiologic decision-making. Am Fam Physician. 2002;65(9):1817-22.
Allen S, Parent E, Khorasani M, et al. Validity and reliability of active shape models for the estimation of Cobb angle in patients with adolescent idiopathic scoliosis. J Digit Imaging. 2008;21(2):208-18.
Tsirikos AI, Spielmann P. Spinal deformity in paediatric patient with cerebral palsy. Curr Orthop. 2007;21(2):122–34.
Grossman TW, Mazur JM, Cummings RJ. An evaluation of the Adams forward bend test and the scoliometer in a scoliosis school screening setting. J Pediatr Orthop. 1995;15(4):535-8.
Kotwicki T, Chowańska J, Kinel E, et al. Sitting forward bending position versus standing position for studying the back shape in scoliotic children. In: 4th International Conference on Conservative Management of Spinal Deformities. Scoliosis. 2007;2(1):S34.
Horne JP, Flannery R, Usman S. Adolescent idiopathic scoliosis: diagnosis and management. Am Fam Physician. 2014;89(3):193-98.
Kim H, Kim HS, Moon ES, et al. Scoliosis imaging: what radiologists should know. Radiographics. 2010;30(7):1823–42.
Langensiepen S, Semler O, Sobottke R, et al. Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review. Eur Spine J. 2013;22(11):2360-71.
Zhang J, Lou E, Shi X, et al. A computer-aided Cobb Angle measurement method and its reliability. J Spinal Disord Tech. 2010;23(6):383–87.
Persson-Bunke M, Hägglund G, Lauge-Pedersen H, et al. Scoliosis in a total population of children with cerebral palsy. Spine. 2012;37(12):708–13.
Graham HK, Rosenbaum P, Paneth N, et al. Cerebral palsy. Nat Rev Dis Primers. 2016;7(2):15082.
Johnson A. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002;44(9):633-640.
Hanna SE, Rosenbaum PL, Bartlett DJ, et al. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol. 2009;51(4):295-302.
Rutz E, Tirosh O, Thomason P, et al. Stability of the Gross Motor Function Classification System after single-event multilevel surgery in children with cerebral palsy. Dev Med Child Neurol. 2012;54(12):1109-13.
Tsirikos AI. Development and treatment of spinal deformity in patients with cerebral palsy. Indian J Orthop. 2010;44(2):148-58.
Jones-Quaidoo SM, Yang S, Arlet V. Surgical management of spinal deformities in cerebral palsy. J Neurosurg Spine. 2010;13(6):672-85.
Thometz JG, Simon SR. Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy. J Bone Joint Surg Am. 1988;70(9):1290-6.