Back pain is more frequent in girls and in children with scoliosis in the context of cerebral palsy

Hägglund, Gunnar; Czuba, Tomasz; Alriksson-Schmidt, Ann

doi:10.1111/apa.14909

Cited by 9 publications

(16 citation statements)

References 23 publications

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“…Spinal pain several years after surgical correction of scoliosis, as described in the present study, was found also in a population based study with high number of participants (14). Increased awareness among health professionals of the importance of pain assessments in this population led to extended pain questions in the most recent version of the CPUP PT-form, so more and higher quality data will be available in the future.…”

Section: Limitationssupporting

confidence: 79%

See 1 more Smart Citation

No Increased Risk for Scoliosis After Early Selective Dorsal Rhizotomy - A Longitudinal Population-Based Controlled Registry Study from four to 25 years of Age

Josenby¹,

Westbom²

2020

Preprint

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Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery increases the risk for later spine problems. Using CP-registry data from a geographically defined population with the same health care and habilitation services, the objectives were to compare reported scoliosis and spinal pain up to adult age in all SDR-operated with all non-SDR-operated individuals with same medical history, functional abilities, and level of spasticity at four years of age. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990-2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at four years of age and were included; 36 persons had undergone SDR at a median age of 4.0 years (range 2.5 – 6.6 years), and 113 individuals constituting the control group, had not. Data on scoliosis and spinal pain at 10, 15, 20 and 25 years of age were analyzed using Kaplan-Meier survival curves and Fisher’s exact test. Gross motor function classification (GMFCS) levels at four years of age (or pre-operatively) were used for stratification.Result Presence of scoliosis at 15, 20, and 25 years of age was the same in the SDR group as in the control group (p=0.734, 0.735 and 1.0). In severe functional disability (GMFCS IV), the SDR group had later onset and lower occurrence of scoliosis (p=0.004) than the control group. Frequency of reported spinal pain did not differ between the groups. Conclusion Neither scoliosis, nor spinal pain was more frequent after SDR than expected by natural history. On the contrary, in severe CP (GMFCS level IV), scoliosis was less frequently reported and had a later onset in the SDR group than in the same GMFCS-level control group.

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Section: Limitationssupporting

confidence: 79%

“…In studies excluding persons treated with SDR, incidence of spinal pain in CP was shown to increase with increasing scoliosis severity, and scoliosis incidence consequently increased with severity of gross motor dysfunction (14,15).…”

Section: Introductionmentioning

confidence: 97%

No Increased Risk for Scoliosis After Early Selective Dorsal Rhizotomy - A Longitudinal Population-Based Controlled Registry Study from four to 25 years of Age

Josenby¹,

Westbom²

2020

Preprint

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“…Legend: GMFCS Gross Motor Function Classification System, SDR Selective Dorsal Rhizotomy girls are more affected by scoliosis than boys [16,17]. However, in the present study children with contraindications to SDR, such as ataxic or dyskinetic traits were excluded, obstructing comparisons.…”

Section: Scoliosismentioning

confidence: 90%

“…All 12 in the SDR group GMFCS IV were followed to age 15 years, and 11 were followed to age 20 years; one SDR group participant GMFCS IV had scoliosis at age 14 years, and one at age 23 years. Eight of the 23 control group participants GMFCS IV developed a scoliosis at 12,12,12,13,16,18,18, and 19 years of age respectively. Six of the 14 in the control group followed to at least 15 years of age had scoliosis before end of study, and all five followed to at least their 20th birthday had scoliosis before that age (Fig.…”

Section: Scoliosismentioning

confidence: 99%

No support that early selective dorsal rhizotomy increase frequency of scoliosis and spinal pain – a longitudinal population-based register study from four to 25 years of age

Josenby

Westbom

2020

BMC Musculoskelet Disord

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Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at 4 years of age. Variables associated with scoliosis at 20 years of age were explored. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990–2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at 4 years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5–6.6 years), and 113 had not. Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at 4 years of age were used for stratification. Result Frequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p = 0.004). Frequency of spinal pain did not differ between the groups (p- levels > 0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age. Conclusion Frequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication.

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“…In GMFCS subgroups I-II and III, the differences were not statistically signi cant (p=0.567 and p=0.778 respectively) (Figures 3 a-c) All 12 in the SDR group GMFCS IV were followed to age 15 years, and 11 were followed to age 20 years; one SDR group participant GMFCS IV had scoliosis at age 14 years, and one at age 23 years. Eight of the 23 control group participants GMFCS IV developed a scoliosis at 12,12,12,13,16,18,18, and 19 years of age respectively. Six of the 14 in the control group followed to at least 15 years of age had scoliosis before end of study, and all ve followed to at least their 20 th birthday had scoliosis before that age (Figure 3c).…”

Section: Scoliosismentioning

confidence: 99%

No Support that Early Selective Dorsal Rhizotomy Increase Frequency of Scoliosis and Spinal Pain – a longitudinal population-based register study from four to 25 years of age

Josenby

Westbom

2020

Preprint

View full text Add to dashboard Cite

Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at four years of age. Variables associated with scoliosis at 20 years of age were explored.MethodIn the total population with CP spastic diplegia in Skåne and Blekinge, born 1990-2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at four years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5 – 6.6 years), and 113 had not. Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at four years of age were used for stratification.ResultFrequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p=0.004). Frequency of spinal pain did not differ between the groups (p- levels >0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age.ConclusionFrequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication.

show abstract

Back pain is more frequent in girls and in children with scoliosis in the context of cerebral palsy

Cited by 9 publications

References 23 publications

No Increased Risk for Scoliosis After Early Selective Dorsal Rhizotomy - A Longitudinal Population-Based Controlled Registry Study from four to 25 years of Age

No Increased Risk for Scoliosis After Early Selective Dorsal Rhizotomy - A Longitudinal Population-Based Controlled Registry Study from four to 25 years of Age

No support that early selective dorsal rhizotomy increase frequency of scoliosis and spinal pain – a longitudinal population-based register study from four to 25 years of age

No Support that Early Selective Dorsal Rhizotomy Increase Frequency of Scoliosis and Spinal Pain – a longitudinal population-based register study from four to 25 years of age

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