Rajendra Ravi, Bratton Matthew B, Leonardi Claudia, Clement R Carter
Department of Orthopaedic Surgery, LSUHSC, 1542 Tulane Avenue, Box T6-7, New Orleans, LA, 70112, USA.
School of Medicine, LSUHSC, New Orleans, LA, USA.
J Orthop Surg Res. 2025 Jun 9;20(1):577. doi: 10.1186/s13018-025-05816-x.
Minimal data exists on whether adolescents with both autism spectrum disorder (ASD) and scoliosis exhibit distinct curve types or require varying surgical management compared to neurotypical adolescents. Our study at a high-volume scoliosis center compares patterns of scoliosis in ASD patients with those of neurotypical patients. We hypothesized adolescents with ASD would present with atypical scoliosis curve characteristics compared to neurotypical adolescents.
Using ICD-10 codes, we constructed an electronic database of adolescents aged 10 to 18 with diagnoses of both scoliosis and ASD. To avoid confounding with syndromic conditions, adolescents with a syndrome independently associated with scoliosis were excluded. Additionally, a 1:2 matched cohort analysis was performed to compare adolescents with ASD and scoliosis (ASD-S) to neurotypical individuals diagnosed with adolescent idiopathic scoliosis (AIS).
In our study, we describe demographics, radiographic characteristics, and complications experienced by 37 patients with both scoliosis and ASD. Almost half of ASD-S patients (18/37 patients; 48.6%) exhibited sagittal plane abnormalities. In comparison to the matched cohort of neurotypical patients, ASD-S patients had increased T5-12 thoracic kyphosis (31.6 vs. 24.4 degrees, p = 0.005), maximum thoracic kyphosis (36.8 vs. 30.9 degrees, p = 0.040) and lumbar lordosis (50.9 vs. 46.1 degrees, p = 0.043). Sagittal vertical axis ≥ 5 cm was more prevalent in ASD-S patients than patients with AIS (p = 0.015). Furthermore, ASD-S patients were more likely to demonstrate an abnormal trunk shift (46% versus 19%) compared to the neurotypical cohort. Social and behavioral barriers prevented three ASD-S patients (8%) and no patients with AIS who were indicated for posterior spinal fusion from undergoing the procedure.
ASD-S patients had increased thoracic kyphosis compared to both controls and published AIS norms, suggesting scoliosis in ASD could potentially be considered a form of syndromic scoliosis rather than truly idiopathic. Additionally, the impact of social and behavioral barriers must be considered when treating this patient population.
III.
关于患有自闭症谱系障碍（ASD）和脊柱侧弯的青少年是否表现出不同的侧弯类型或与神经典型青少年相比需要不同的手术治疗，现有数据极少。我们在一家大型脊柱侧弯中心开展的研究比较了ASD患者和神经典型患者的脊柱侧弯模式。我们假设与神经典型青少年相比，患有ASD的青少年会呈现出非典型的脊柱侧弯曲线特征。
使用国际疾病分类第十版（ICD - 10）编码，我们构建了一个年龄在10至18岁、同时诊断患有脊柱侧弯和ASD的青少年电子数据库。为避免与综合征性疾病混淆，排除了与脊柱侧弯独立相关的综合征青少年。此外，进行了1:2匹配队列分析，以比较患有ASD和脊柱侧弯的青少年（ASD - S）与被诊断为青少年特发性脊柱侧弯（AIS）的神经典型个体。
在我们的研究中，我们描述了37例同时患有脊柱侧弯和ASD患者的人口统计学特征、影像学特征及并发症情况。几乎一半的ASD - S患者（18/37例患者；48.6%）表现出矢状面异常。与匹配的神经典型患者队列相比，ASD - S患者的T5 - 12胸椎后凸增加（31.6度对24.4度，p = 0.005）、最大胸椎后凸增加（36.8度对30.9度，p = 0.040）以及腰椎前凸增加（50.9度对46.1度，p = 0.043）。矢状垂直轴≥5 cm在ASD - S患者中比AIS患者更常见（p = 0.015）。此外，与神经典型队列相比，ASD - S患者更有可能表现出异常的躯干偏移（46%对19%）。社会和行为障碍导致3例ASD - S患者（8%）无法接受后路脊柱融合手术，而所有有手术指征的AIS患者均未出现此类情况。
与对照组和已发表的AIS标准相比，ASD - S患者的胸椎后凸增加，这表明ASD中的脊柱侧弯可能潜在地被视为综合征性脊柱侧弯的一种形式，而非真正的特发性脊柱侧弯。此外，在治疗这一患者群体时，必须考虑社会和行为障碍的影响。
III级。
