Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Top Spinal Cord Inj Rehabil. 2022 Winter;28(1):34-41. doi: 10.46292/sci21-00017. Epub 2021 Aug 23.
Acute flaccid myelitis (AFM) is an anterior horn disorder that manifests as rapid onset muscle weakness or paralysis. Development of scoliosis in pediatric AFM patients has been anecdotally reported, but associated risk factors or incidence have yet to be determined.
Pediatric AFM patients treated over a 10-year period at a tertiary care center were identified. Patients were considered to have scoliosis if there was radiographic evidence of coronal curvature ≥15 degrees. Number of limbs affected, independent ambulation and head control, ventilator requirement at initial admission, and long-term ventilatory support (≥1 year) were recorded. Muscle strength and functional status were assessed by manual muscle testing (MMT) and Physical Abilities and Mobility Scale (PAMS), respectively. Areas of spinal cord lesion on initial MRI were recorded. Bivariate analyses were performed, with alpha set to 0.05.
Fifty-six AFM patients (27 scoliosis, 29 no scoliosis) were identified. Mean time from AFM presentation to scoliosis diagnosis was 0.93 years. Mean major Cobb angle at first radiograph was 31.7 ± 14.3 degrees. Lack of independent ambulation, ventilator dependence at time of admission or long term, number of limbs affected, and decreased MMT and PAMS scores were more common in patients who developed scoliosis (all, < .05). Patients who developed scoliosis had more extensive thoracic spinal cord involvement on initial MRI ( = .03).
AFM patients who develop scoliosis are more likely to be ventilator dependent, lack independent ambulation, and have more extensive thoracic SCI.
急性弛缓性脊髓炎（AFM）是一种前角疾病，表现为迅速出现肌肉无力或瘫痪。儿科 AFM 患者发生脊柱侧凸已有报道，但相关的危险因素或发病率尚未确定。
在一家三级医疗中心对 10 年间接受治疗的儿科 AFM 患者进行了识别。如果影像学上有≥15 度的冠状弯曲，则认为存在脊柱侧凸。记录受累肢体的数量、独立行走和头部控制能力、初次入院时的呼吸机需求以及长期呼吸机支持（≥1 年）。通过手动肌肉测试（MMT）和物理能力和移动量表（PAMS）分别评估肌肉力量和功能状态。记录初始 MRI 上脊髓损伤的部位。采用双变量分析，α 值设定为 0.05。
共识别出 56 例 AFM 患者（27 例脊柱侧凸，29 例无脊柱侧凸）。从 AFM 发病到脊柱侧凸诊断的平均时间为 0.93 年。首次放射检查的平均主要 Cobb 角为 31.7±14.3 度。发生脊柱侧凸的患者更常见于不能独立行走、入院时或长期依赖呼吸机、受累肢体数量增加，以及 MMT 和 PAMS 评分降低（均，<.05）。初次 MRI 时发生脊柱侧凸的患者的胸段脊髓受累更为广泛（=.03）。
发生脊柱侧凸的 AFM 患者更有可能依赖呼吸机，不能独立行走，并且胸段 SCI 更为广泛。
