Victor Klaas, Moens Pierre
Department of Orthopaedics, University Hospitals Leuven, 3000 Leuven, Belgium.
J Clin Med. 2024 Jul 27;13(15):4402. doi: 10.3390/jcm13154402.
The progression of scoliosis has been observed in skeletally mature patients with cerebral palsy (CP). The aims of this systematic review were to determine the incidence of curve progression of untreated scoliosis after skeletal maturity, to estimate the average annual increase and to identify factors that influence the progression. A systematic literature search was performed in PubMed, Embase and the Cochrane Library for original research articles published between 1968 and May 2024 with a retrospective, prospective or cross-sectional design, investigating CP patients that were followed up beyond the age of 15 years. The search was limited to articles in English, French, German and Dutch. Articles were excluded if the study population concerned neuromuscular diseases other than CP. After an assessment of the methodological quality of each study, estimates of annual curve progression and the effect of the investigated risk factors for progression were recorded systematically and synthetized. Fifteen studies met the inclusion criteria, resulting in a total sample size of 2569 participants. The study populations of the included original research articles were small and heterogeneous in terms of patient age and the type and severity of CP. Curve progression after skeletal maturity occurred in all included studies. A greater curve magnitude at the end of adolescence and a severe motor deficit (an inability to walk or GMFCS IV-V) were identified as significant risk factors for the progression of scoliosis after skeletal maturity. If at least one of these risk factors was present, scoliotic curves progressed after skeletal maturity in up to 74% of patients, with an average annual increase of 1.4 to 3.5 degrees per year. No significant association was found between curve progression and the physiologic type of CP, the type of scoliotic curve, previous hip surgery, positioning and gravity, weight and length, sex, epilepsy, or pelvic obliquity. Findings on the effect of hip instability were inconsistent: a positive correlation was found with the progression of scoliosis overall, but not after skeletal maturity in particular. A significant selection bias should be considered in the calculation of average annual curve progression, as patients that received interventions to halt curve progression were excluded from follow-up. The identification of risk factors in patients with CP and scoliosis can aid in predicting curve progression and managing follow-ups in clinical practice. Based on the findings in this review a radiographic follow-up once every 3 years is recommended for skeletally mature CP patients with at least one risk factor, and once every 5 years if no risk factors are present.
在骨骼成熟的脑瘫（CP）患者中已观察到脊柱侧弯的进展。本系统评价的目的是确定骨骼成熟后未经治疗的脊柱侧弯曲线进展的发生率，估计平均每年的增加幅度，并确定影响进展的因素。在PubMed、Embase和Cochrane图书馆中进行了系统的文献检索，以查找1968年至2024年5月期间发表的具有回顾性、前瞻性或横断面设计的原始研究文章，这些文章对15岁以上接受随访的CP患者进行了调查。检索仅限于英文、法文、德文和荷兰文的文章。如果研究人群涉及除CP以外的神经肌肉疾病，则排除相关文章。在评估每项研究的方法学质量后，系统地记录并综合了年度曲线进展的估计值以及所研究的进展风险因素的影响。15项研究符合纳入标准，总样本量为2569名参与者。纳入的原始研究文章的研究人群在患者年龄以及CP的类型和严重程度方面规模较小且异质性较大。所有纳入研究中均出现了骨骼成熟后的曲线进展。青春期结束时更大的曲线幅度和严重的运动功能障碍（无法行走或GMFCS IV - V级）被确定为骨骼成熟后脊柱侧弯进展的重要风险因素。如果存在至少这些风险因素之一，高达74%的患者在骨骼成熟后脊柱侧弯曲线会进展，平均每年增加1.4至3.5度。未发现曲线进展与CP的生理类型、脊柱侧弯曲线类型、既往髋关节手术、体位和重力、体重和身高、性别、癫痫或骨盆倾斜之间存在显著关联。关于髋关节不稳定影响的研究结果不一致：总体上发现与脊柱侧弯进展呈正相关，但在骨骼成熟后尤其不相关。在计算平均年度曲线进展时应考虑显著选择偏倚，因为接受干预以阻止曲线进展的患者被排除在随访之外。识别CP和脊柱侧弯患者的风险因素有助于预测曲线进展并在临床实践中管理随访。基于本综述的结果，建议对于至少有一个风险因素的骨骼成熟CP患者每3年进行一次影像学随访，若无风险因素则每5年进行一次。
