Spinal Deformity Secondary to Impaired Neurologic Control

Abstract

Spinal deformity occurs in children who have problems with motor control involving the trunk muscles. This lack of control allows the growing spine to collapse. Most commonly, this collapse is due to spasticity in children with the quadriplegic pattern of cerebral palsy. The most typical collapse pattern is scoliosis, although kyphosis or lordosis may also develop. Children who have severe hypotonia may also have development of spinal deformities, often with substantial kyphosis. Individuals with severe extensor posturing may have development of total spinal lordosis. A severe lack of motor control, expressed as a movement disorder such as athetosis or dystonia, is associated with a lower incidence of scoliosis than spasticity is. The incidence of scoliosis in institutionalized individuals, most of whom have a spastic quadriplegic pattern, has been reported to be 64%, with a strong inverse relationship to ambulatory ability1. This means that individuals who are dependent sitters with no head control may have a rate of scoliosis as high as 90%. We are not aware of published data on the incidence of spinal deformity with other movement disorders. Friedreich ataxia is a condition in which the primary neurologic manifestation is also a lack of motor control and in which the development of spinal deformities, primarily scoliosis, is common. Progressive scoliosis requiring surgical stabilization develops in approximately 50% of these individuals2. Individuals with motor-control problems tend to have development of spinal deformity in late childhood. Initially, the child often has very flexible postural curves and tends to lean toward one side. Typically, as the child enters early adolescent growth, the spine develops a structural torsional deformity with increasing stiffness. This structural curve may become so stiff that physical correction, even when the child is in a lying position, is impossible. The stiffness typically increases as the …