Symptomatic cervical spinal stenosis in spastic cerebral palsy

Abstract

Aim To describe the prevalence of symptomatic cervical spinal stenosis (CSS) in spastic cerebral palsy (CP) and associated characteristics. Method This cross‐sectional study of adults (>18y) with CP (2006–2016) at a single institution compared the patient characteristics (demographics, comorbidities, surgical history, medications, Gross Motor Function Classification System [GMFCS] level, and CP type) of patients with and without CSS. Results Of 424 patients (mean age 33y 4mo, SD 13y 6mo, range 18–78y; 225 females, 199 males), 32 patients (7.5%) had symptomatic CSS. GMFCS levels in the study cohort were distributed as follows: level I, 25%; level II, 25%; level III, 22%; level IV, 19%; level V, 9%. Twenty‐five out of 32 (78.1%) patients had spastic CP, two (6.3%) had dystonic CP, and one (3.1%) had mixed characteristics. Individuals with CSS were older (mean age 54y 6mo, SD 10y 5mo vs mean age 31y 7mo, SD 12y 1mo, p<0.05) and had a higher body mass index (26.1, SD 4.8 vs 23.4, SD 6.2, p<0.05) than those without CSS. Presentations included upper‐extremity symptoms (73%), ambulation decline (70%), neck pain (53%), and incontinence (30%). Common stenosis levels were C5–C6 (59%), C4–C5 (56%), and C6–C7 (53%). Interpretation Symptomatic CSS was identified in 7.5% of this adult cohort during the 2006 to 2016 period. Diagnosis in CP is difficult due to impaired communication and pre‐existing gait abnormalities and spasticity. Given the high prevalence of symptomatic CSS in adults, we propose developing screening guidelines. Physicians must maintain a high level of suspicion for CSS if patients present with changes in gait or spasticity.

Adults with Cerebral Palsy Require Ongoing Neurologic Care: A Systematic Review

“…CP is associated with a higher risk of cervical myelopathy than focal cervical dystonia, suggesting that cervical dystonia is not the only risk factor for myelopathy 27 . Supporting this point, a recent study found that 7.5% of adults with spastic CP had symptomatic cervical spinal stenosis 28 . Thus, some orthopedists recommend screening all adults with CP over age 50 years for cervical spinal stenosis with cervical spine X‐rays 29 .…”

“…27 Supporting this point, a recent study found that 7.5% of adults with spastic CP had symptomatic cervical spinal stenosis. 28 Thus, some orthopedists recommend screening all adults with CP over age 50 years for cervical spinal stenosis with cervical spine X-rays. 29 Importantly, neurologic screening recommendations for spondylotic myelopathy in this neurologically complex population are lacking, which is problematic given that spondylotic myelopathy can often yield subtle symptoms even in otherwise healthy individuals.…”

Evaluation of Pain in Adults With Childhood-Onset Disabilities and Communication Difficulties

“…However, there are several diagnoses that are relatively common in adults and uncommon in children. Table 1 illustrates findings in the history and physical examination that could be possible indicators of pain in adults (1,15,(22)(23)(24). The diagnoses associated with these findings should also be considered in the evaluation of behavior change in adults with childhood-onset disabilities and communication impairment.…”

“…Because of advancements in medicine, people with childhood-onset disabilities commonly live into adulthood (1,2). One of the most common childhood-onset disabilities is cerebral palsy (CP), a group of movement disorders caused by a disturbance to the fetal or infant brain (2,3).…”

Cervical myelopathy in cerebral palsy

“…For the patient with cerebral palsy (CP), this challenge is compounded by preexisting abnormal neurological impairments and possibly also by communication impairment. Hung et al 1 found a prevalence of 7.5% of symptomatic CSS in a series of adults with CP. Two issues are critical in this complex topic.…”