Scoliosis in Cerebral Palsy: Natural History and Risk Factors for Progression

Patients and Methods: A retrospective review of medical records and radiographs was performed of 135 CP patients who had a scoliotic curve of at least 25 , with adequate radiographs of the spine at initial presentation and minimum two year follow up. The effects of curve type, adolescent growth spurt, functional capacity of the patient and surgically treated previous hip subluxation on the rate of curve progression and pelvic obliquity were evaluated.

Results: The mean rate of curve progression was found to be 13.9 degrees/year. Scoliosis was diagnosed and treated at an earlier age in wheelchair bound patients compared to ambulatory patients. The rate of curve progression was greater in the most severely involved patients. Using an analysis of covariance, juvenile patients (<10 years old) had a significantly higher rate of curve progression than adolescent patients (>10 years old) (p<0 .05). Previous hip subluxation, even if surgically treated, significantly increased the magnitude of pelvic obliquity. Curve type or gender had no effect on rate curve progression. Lumbar curves were most common.

Conclusions: The adolescent growth spurt has a significant worsening effect on the rate of curve progression, and most curves increased with growth, at an average of 13.9 per year. Patients with spastic quadriplegic CP who develop curves at less than 10 years of age and who are nonambulatory with previous or co-existing spastic hip disease should be monitored at frequent intervals and their caretakers counseled on the natural history of progressive scoliosis since they have the highest risk of curve progression.