Abstract
ABSTRACT Objective: Spastic cerebral palsy (sCP) is a cause of early onset scoliosis, although there are no data on its prevalence. Our objective was to determine the prevalence of early onset neuromuscular spinal deformities (SD) in severely compromised children with sCP. Methods: Cross-sectional quantitative, observational, exploratory, and descriptive study. Review of clinical records. Inclusion criteria: age 2 to 5 years, sCP, level V of the GMFCS, residents in our province. X-ray blind reading by 2 observers. The Student t test was used for parametric data and the chi-square test for non-parametric data. Level of statistical significance: p < 0.05. Results: Thirty-eight cases of 158 registered were included. Average age: 3 years 7 months (2 years – 5 years 2 months). Sex: 21 male/17 female. The predominant etiologies were perinatal: 21 (55.3%), and the prevalent nutritional status was eutrophic: 28 cases (73.7%). SD was very frequent: 32 patients (84.2%) without statistical differences between sexes; there were 20 kyphoscoliosis, 1 lordoscoliosis, 6 scoliosis, 5 hyperkyphosis. Mean angular values: 23.9° (10°- 50°) for the frontal plane deformities and 58° (9°- 92º) for the sagittal deformities. Seventeen patients (44.7%) had average pelvic obliquity of 15° (2°- 30°) without differences in patients with and without SD. There was no association between SD and etiology, digestive disorders, seizures, nutritional status, hip excentration, or limb deformities. Conclusions: The prevalence of SD in children up to 5 years old with severe sCP is high: 84.2% (32/38 cases). The orthopedic profile is children with sCP of any etiology at GMFCS level V, with multiple disabilities and independently of associated limb deformities. Level of evidence I; Diagnostic Studies - Investigating a Diagnostic Test: Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).
Highlights
Neuromuscular spinal deformities appear in the child secondary to various conditions and cause a complex and progressive distortion of the trunk
When we compared the proportion of sample cases from these departments to those from the other departments and, likewise, the total number of spastic quadriplegics we found no statistical differences
It is generally recognized that Cerebral palsy (CP) is more prevalent in the most disadvantaged socio-economic groups,[7] but in the current investigation, we found no relationship between greater socio-economic difficulties and a higher proportion of cases with deformities
Summary
Neuromuscular spinal deformities appear in the child secondary to various conditions and cause a complex and progressive distortion of the trunk. A number of deformities may appear in the spine of the child with spastic CP, but the most frequent is neuromuscular scoliosis (NS),[12,13,14,15] especially in the thoracolumbar region.[12,13,15] It is recognized that children with more profound and severe compromise are at higher risk for its occurrence;[5,12,14,15,16,17,18] and it is not uncommon to have pelvic obliquity associated with the NS, which further aggravates the condition.[5,12,13,15,16,18,19] These deformities increase as long as there is significant growth ahead such that the earlier it begins, the greater the potential to create a severe deformity by the end of that growth. The curves of the spastic CP that begin very early, and are not treated progress, and require much more costly treatments with higher morbidity and mortality,[20] having a greater negative impact on the patient’s quality of life.[21]
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