Division of Orthopaedic Surgery, Rikshospitalet, Oslo University Hospital, Postboks 4950 Nydalen, N-0424, Oslo, Norway.
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Eur Spine J. 2023 Nov;32(11):4030-4036. doi: 10.1007/s00586-023-07868-1. Epub 2023 Aug 2.
To evaluate the prevalence of scoliosis and the rate of scoliosis progression in children with severe cerebral palsy (CP) at GMFCS levels III-V.
Two hundred and six children (86 girls, 120 boys), born 2002-2008, were recruited from The Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP). Inclusion criteria were bilateral CP and GMFCS levels III-V. Scoliosis was evaluated annually by examination of the spine by a physiotherapist. Radiographic examination was performed in children with moderate or severe scoliosis at clinical evaluation. The Cobb angle was used as a measure of curve magnitude.
Scoliosis, defined as Cobb angle ≥ 10°, occurred in 121 children (59%). Severe scoliosis (Cobb angle ≥ 40°) developed in 80 of the 206 patients (39%) at a mean age of 10.9 years (range 5-16) and was more prevalent in children at GMFCS level V (62%) than at levels IV (19%) and III (6%). Initial Cobb angle, Cobb angle ≥ 30° at age 10 years, and GMFCS level V were independent risk factors for severe scoliosis. In children at GMFCS level V, the rate of scoliosis progression decreased with age from a mean of 9.7° per year at age 3-5 years to 2-3° per year in children ≥ 11 years.
The prevalence of scoliosis among children with CP increased with decreasing motor functional level. The most important risk factors for progression of scoliosis were high initial Cobb angle, Cobb angle ≥ 30° at age 10 years, and GMFCS level V.
评估 GMFCS 水平 III-V 的重度脑瘫（CP）患儿的脊柱侧弯患病率和进展率。
从挪威脑瘫质量和监测登记处（NorCP）招募了 206 名儿童（86 名女孩，120 名男孩），出生于 2002-2008 年。纳入标准为双侧 CP 和 GMFCS 水平 III-V。由物理治疗师每年对脊柱进行检查来评估脊柱侧弯。在临床评估中发现中度或重度脊柱侧弯的患儿进行放射学检查。Cobb 角用于衡量曲线幅度。
121 名儿童（59%）出现脊柱侧弯，定义为 Cobb 角≥10°。206 例患儿中有 80 例（39%）出现严重脊柱侧弯（Cobb 角≥40°），平均年龄为 10.9 岁（5-16 岁），GMFCS 水平 V 患儿（62%）比水平 IV（19%）和水平 III（6%）更常见。初始 Cobb 角、10 岁时 Cobb 角≥30°和 GMFCS 水平 V 是严重脊柱侧弯的独立危险因素。在 GMFCS 水平 V 的患儿中，随着年龄的增长，脊柱侧弯进展的速度从 3-5 岁时的平均每年 9.7°减慢至≥11 岁时的每年 2-3°。
CP 患儿的脊柱侧弯患病率随着运动功能水平的降低而增加。脊柱侧弯进展的最重要危险因素是初始 Cobb 角高、10 岁时 Cobb 角≥30°和 GMFCS 水平 V。
