Course 449: Pediatrics: Natural History of Scoliosis in Spastic Tetriplegic Cerebral Palsy

Abstract

Objective: To analyze development and progression of scoliosis in children with spastic tetriplegic cerebral palsy. Design: Retrospective review. Setting: Pediatric nursing home. Participants: 113 children, aged less than 18 years with scoliosis. Interventions: Not applicable. Main Outcome Measures: Cobb angle, weight, height, history of hip dislocation, tracheostomy, and osteoporosis. Results: The Cobb angle increased with age, weight, and height in a nonlinear fashion. A square root transformation of Cobb angle was chosen to model the nonlinear relationship between Cobb angle and predictors. Age, height, and weight were significant univariate predictors of the square root of Cobb's angle (slopes .367, .151, .039, respectively). After adjusting for age, we found that height and weight did not remain significant predictors. Age was to be a significant predictor of square root Cobb angle after adjusting, and the effect of age was stronger for those with tracheostomy (age slope=.722 vs .310) than those without. The relationship of age and Cobb angle does not differ significantly between hip dislocated and nondislocated groups, neither among normative bone density, osteopenia, and osteoporosis groups. Conclusions: Age was the most significant predictor of Cobb angle, and effect of age is greater in the tracheostomy group than in the nontracheostomy group. After adjustment of age, the weight and height were not significant predictors of Cobb angle.