Background: The prevalence of neuromuscular scoliosis in children with spinal cord injury (SCI) is high. Published reports suggest that age at time of injury is the most important determinant. No studies have evaluated neurological characteristics using standardized methods to determine if they are strong predictors of scoliosis. Objective: To test the hypothesis that neurological level, motor score, and injury severity are strong predictors of neuromuscular scoliosis. Methods: Two hundred seventeen children were evaluated using the testing guidelines of the International Standards for Neurological Classification of Spinal Cord Injury. Cobb angles were calculated from plain radiographs as a measure of scoliosis. Multivariate analysis with statistical selection was used to determine predictors of worst Cobb angle and spinal fusion. The odds of having a spine fusion for subjects with at least 2-year follow-up and injured prior to (n=16) and after (n=91) 12 years of age were calculated. Results: The hypothesis was not supported. Although there was a very high prevalence (100%) of scoliosis in the study sample, age at time of injury was the only predictor of worst curve (P < .0001) and spine fusion (P < .007). The calculated odds ratio demonstrated that children injured <12 years were 3.7 times more likely to have a spine fusion (95% CI, 0.31-44.64). Conclusion: There is a very high prevalence of neuromuscular scoliosis in pediatric SCI. Neurological level, motor level, and severity of injury are not strong predictors. Age is the only predictor of worst curve and spine fusion.
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Original Article|
April 29 2013
Neuromuscular Scoliosis in Children with Spinal Cord Injury
M.J. Mulcahey;
M.J. Mulcahey
1
Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
2
Shriners Hospitals for Children, Philadelphia, Pennsylvania
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John Gaughan;
John Gaughan
3
Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, Pennsylvania
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Randal Betz;
Randal Betz
2
Shriners Hospitals for Children, Philadelphia, Pennsylvania
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Amer Samdani;
Amer Samdani
2
Shriners Hospitals for Children, Philadelphia, Pennsylvania
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Nadia Barakat;
Nadia Barakat
2
Shriners Hospitals for Children, Philadelphia, Pennsylvania
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Louis Hunter
Louis Hunter
1
Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
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Top Spinal Cord Inj Rehabil (2013) 19 (2): 96–103.
Citation
M.J. Mulcahey, John Gaughan, Randal Betz, Amer Samdani, Nadia Barakat, Louis Hunter; Neuromuscular Scoliosis in Children with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 1 April 2013; 19 (2): 96–103. doi: https://doi.org/10.1310/sci1902-96
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