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. 2020 Oct;62(10):1147-1153.
doi: 10.1111/dmcn.14607. Epub 2020 Jul 8.

Symptomatic cervical spinal stenosis in spastic cerebral palsy

Chun Wai Hung  1   2 , Hiroko Matsumoto  1   2   3 , Jacob R Ball  1   2 , Stephen Plachta  1   2 , Joseph P Dutkowsky  1   2 , Heakyung Kim  1   4 , Joshua E Hyman  1   2 , K Daniel Riew  5 , David P Roye  1   2
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Symptomatic cervical spinal stenosis in spastic cerebral palsy

Chun Wai Hung et al. Dev Med Child Neurol. 2020 Oct.

Abstract

Aim: To describe the prevalence of symptomatic cervical spinal stenosis (CSS) in spastic cerebral palsy (CP) and associated characteristics.

Method: This cross-sectional study of adults (>18y) with CP (2006-2016) at a single institution compared the patient characteristics (demographics, comorbidities, surgical history, medications, Gross Motor Function Classification System [GMFCS] level, and CP type) of patients with and without CSS.

Results: Of 424 patients (mean age 33y 4mo, SD 13y 6mo, range 18-78y; 225 females, 199 males), 32 patients (7.5%) had symptomatic CSS. GMFCS levels in the study cohort were distributed as follows: level I, 25%; level II, 25%; level III, 22%; level IV, 19%; level V, 9%. Twenty-five out of 32 (78.1%) patients had spastic CP, two (6.3%) had dystonic CP, and one (3.1%) had mixed characteristics. Individuals with CSS were older (mean age 54y 6mo, SD 10y 5mo vs mean age 31y 7mo, SD 12y 1mo, p<0.05) and had a higher body mass index (26.1, SD 4.8 vs 23.4, SD 6.2, p<0.05) than those without CSS. Presentations included upper-extremity symptoms (73%), ambulation decline (70%), neck pain (53%), and incontinence (30%). Common stenosis levels were C5-C6 (59%), C4-C5 (56%), and C6-C7 (53%).

Interpretation: Symptomatic CSS was identified in 7.5% of this adult cohort during the 2006 to 2016 period. Diagnosis in CP is difficult due to impaired communication and pre-existing gait abnormalities and spasticity. Given the high prevalence of symptomatic CSS in adults, we propose developing screening guidelines. Physicians must maintain a high level of suspicion for CSS if patients present with changes in gait or spasticity.

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Comment in

  • Cervical myelopathy in cerebral palsy.
    Jia M, Ying J, Teng H. Jia M, et al. Dev Med Child Neurol. 2020 Oct;62(10):1114. doi: 10.1111/dmcn.14641. Epub 2020 Jul 25. Dev Med Child Neurol. 2020. PMID: 32710638 No abstract available.

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