Scoliosis in children with severe cerebral palsy: a population-based study of 206 children at GMFCS levels III-V

Abstract

Purpose: To evaluate the prevalence of scoliosis and the rate of scoliosis progression in children with severe cerebral palsy (CP) at GMFCS levels III-V.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Cerebral palsy; Cobb angle; Gross motor function classification system; Natural history; Scoliosis.