Natural history of scoliosis in spastic cerebral palsy

Saito, Naoto; Ebara, Sohei; Ohotsuka, Kuniyoshi; Kumeta, Hidemitsu; Takaoka, Kunio

doi:10.1016/s0140-6736(98)01302-6

Cited by 237 publications

(185 citation statements)

References 22 publications

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“…This is in agreement with the rate of 4.7˚ in our patients in the same age group. After 15 years of age, Saito et al (1998) reported decreased rates of progression: 3.5˚ at age 15 to 20 years and 2.5˚ at >20 years of age. In the same age groups, we found somewhat lower rates of progression, 2.1˚ and 0.8˚, respectively.…”

Section: Discussionmentioning

confidence: 97%

“…Sparse data exist, however, on the development of scoliosis in CP. Saito et al (1998) studied the natural history of scoliosis in institutionalized patients with CP <15 years of age at the time of the initial radiographs and found a mean rate of progression of 4.5˚ per year between age 10 and 15 years. This is in agreement with the rate of 4.7˚ in our patients in the same age group.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy

Terjesen¹,

Lange²,

Steen³

2000

Develop Med Child Neuro

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To evaluate the clinical results of the treatment and to assess the factors that influenced the rate of scoliosis progression, a retrospective study of spinal orthosis in 86 patients with spastic quadriplegic cerebral palsy was performed. The mean age of the patients was 13.8 years (range 5 to 33 years). Their scoliotic deformities were treated with custom-moulded, polypropylene thoraco-lumbar-sacral orthoses. Cobb angles were measured on radiographs taken in a sitting position before treatment, in orthosis, and during follow-up. The mean initial Cobb angle was 68.4˚ (range 25 to 131˚). The mean correction in orthosis was 25˚ (range 3 to 60˚). Seventytwo patients had a follow-up period of more than 2 years. At the latest follow-up, average 6.3 years (range 2 to 14 years) after the start of treatment, the mean Cobb angle without orthosis was 93.1˚ (range 40 to 145˚). The mean progression per year was 4.2˚ (range -3 to 21˚). Linear multiple regression revealed that age and initial correction in orthosis were the only variables that significantly influenced the rate of progression. Twenty-two patients had no progression or progression <1.0˚ per year. Correction in orthosis was the only variable that predicted progression <1.0˚ per year in both age groups (<15 years and ≥15 years). Of the 57 patients who were still alive and had not undergone surgical fusion, 72% used their orthoses at a mean age of 22 years. Parents and caregivers expressed satisfaction with the use of orthosis, mainly because of improved sitting stability which gave better overall function.Scoliosis occurs frequently in patients with cerebral palsy (CP), especially in those with spastic quadriplegia (Madigan and Wallace 1981). Although surgical treatment is usually indicated when scoliosis exceeds 45 to 50˚, there are certain risk factors that must be taken into consideration before operation is recommended. Many patients with quadriplegia with large curvatures of the spine have impaired general health, epilepsy, and reduced respiratory capacity, making them poor candidates for major surgery like spine fusion. Moreover, the complication rate after such surgery is substantial (Lonstein and Akbarnia 1983, Boachie-Adjei et al. 1989, Cassidy et al. 1994. Therefore, other treatment alternatives should be available.The role of spinal orthosis in those with quadriplegia with scoliosis has not been frequently studied and reports have rather short follow-up periods (McMaster and Clayton 1980, Letts et al. 1992). We have used this type of treatment for several years, based on clinical evidence that it has a beneficial effect in many patients.This study aimed to evaluate the clinical effects of spinal bracing in quadriplegic patients with scoliosis and to assess the progression of the scoliosis and factors that might influence the rate of progression. MethodDuring the period 1982 to 1996, treatment with spinal orthosis was initiated in 99 patients with CP and scoliosis. To obtain more homogenous material, seven patients with diplegia or hemiplegia were excl...

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy

Terjesen¹,

Lange²,

Steen³

2000

Develop Med Child Neuro

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“…A large study conducted by Persson-Bunke et al (5) highlights the statistically significant relationship between GMFCS level and development of scoliosis with 50% of children GMFCS IV-V developing a severe scoliosis. A Cobb angle of greater than 40 o at an early age has been found to predict significant progression of a CP scoliosis (6,7). Furthermore an inverse relationship between development of scoliosis and ambulation has been suggested, with the least mobile patients at greatest risk (4,6).…”

Section: Risk Factors For Development Of Scoliosismentioning

confidence: 99%

“…It is estimated scoliosis occurs in between 21% and 64% of patients with CP (3)(4)(5). Spinal deformity is thought to occur before 10 years of age (5)(6)(7) and unlike in idiopathic scoliosis, has been shown to progress beyond skeletal maturity (8).…”

Section: Introductionmentioning

confidence: 99%

The management of scoliosis in children with cerebral palsy: a review

Cloake¹,

Gardner²

2016

J. Spine Surg.

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Children who suffer with cerebral palsy (CP) have a significant chance of developing scoliosis during their early years and adolescence. The behavior of this scoliosis is closely associated with the severity of the CP disability and unlike idiopathic scoliosis, it continues to progress beyond skeletal maturity. Conservative measures may slow the progression of the curve, however, surgery remains the only definitive management option. Advances in surgical technique over the last 50 years have provided methods to effectively treat the deformity while also reducing complication rates. The increased risk of surgical complications with these complex patients make decisions about treatment challenging, however with careful pre-operative optimization and post-operative care, surgery can offer a significant improvement in quality of life. This review discusses the development of scoliosis in CP patient, evaluates conservative and surgical treatment options and assesses post-operative outcome.

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“…Diseases that affect the above-mentioned structures, such as spine dysraphia [24,45], muscle dystrophies [29,30,31,42], congenital myopathies [6,16,21,32,36], spine muscle atrophies [5,11], cerebral palsy [34,39], nonprogressive cerebral lesions [13] and spine cerebellar degenerations [22], are well-known causes of scoliosis.…”

Section: Introductionmentioning

confidence: 99%

Muscle study in experimental scoliosis in rabbits with costotransversectomy: evidence of ischemic process

et al. 2008

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Scoliosis involves the central nervous system diseases, ligaments, articulations and skeletal muscles, but there is no consensus on its pathogeny and progression of muscle abnormalities. In this study, we investigate the morphologic changes in the muscle of rabbit submitted to experimental scoliosis, with special emphasis on abnormalities related to blood supply. We studied 26 rabbits subjected to costotransversectomy by pulling out six transverse processes at thoracic level and six rabbits were used as controls. All the animals operated upon developed scoliosis showing an average angle of 29.1°on the 60th day, with its apices located at T4 and T12 when they were subjected to paraspinal muscle biopsy on both sides. The muscle biopsies were subjected to histological stains and histochemical reactions, as well as to a morphometric study. On the concave side, the changes were not statistically significant regarding the control group. On the convex side conjunctive tissue proliferation, infiltration by adipose tissue, central nucleus excess, inflammatory reaction, segmental fibrosis, type 1 fiber hypertrophy, type 2 fiber hypertrophy and atrophic angular dark fibers in the unspecific esterase were statistically significant. The segmental fibrosis reached a circumscribed muscle segment, compatible with an ischemic phenomenon. The histological diagnoses on the concave side of the animals had unspecific alterations (atrophy and hypertrophy) in 13, myopathy in 3, denervation in 3 and normal in 7. The convex side diagnoses were myopathy in 14, denervation in 8, mixed in 3 and normal in 1. The procedure determined morphologic changes on the convex side indicating possible denervation or myopathy of ischemic origin.

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Natural history of scoliosis in spastic cerebral palsy

Cited by 237 publications

References 22 publications

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy

The management of scoliosis in children with cerebral palsy: a review

Muscle study in experimental scoliosis in rabbits with costotransversectomy: evidence of ischemic process

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