Tratamiento de la escoliosis neuromuscular en niños pequeños con parálisis cerebral espástica grave: revisión sistemática de la bibliografía
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Publicado:
jun 25, 2022
Palabras clave:
Parálisis cerebral, espasticidad, escoliosis, comienzo temprano, tratamiento
Contenido principal del artículo
Resumen
Objetivo: El riesgo de desarrollar escoliosis de comienzo temprano es alto en niños con parálisis cerebral espástica, nivel IV y V del GMFCS. No hay acuerdo sobre el tratamiento para niños <5-6 años y esta revisión sistemática se centra en este tópico.
Materiales y Métodos: Búsqueda en PubMed, Google Scholar, Cochrane Library, BVS/BIREME, LILACS y SciELO, entre enero de 2009 y noviembre de 2020, con los descriptores: “cerebral palsy, scoliosis, early-onset, treatment”. Se eliminaron los artículos duplicados, no relacionados con la investigación, sin texto completo, con pocos pacientes con parálisis cerebral espástica, sin discriminación etiológica, sin resultados y con edad avanzada. Evaluaciones: nivel de evidencia, edad, nivel del GMFCS, tipo de deformidades, tratamientos, seguimiento, resultados y complicaciones.
Resultados: Se incluyeron 10 de 6770 artículos: 8 con nivel de evidencia IV, edad: 3.2-10 años, deformidad predominante: escoliosis, seguimiento: 1.5-9.8 años. Tratamientos: barras de crecimiento tradicionales o magnéticas, fusión instrumentada precoz, yesos, ortesis y prótesis costal expandible de titanio. La fusión precoz instrumentada logra una corrección ≥75% del ángulo de Cobb; las barras de crecimiento, las ortesis o la prótesis costal expandible de titanio, el 25-50%, y los yesos solo logran mantenerla. La tasa de complicaciones es menor en los tratamientos incruentos (5,8-36%) que en los quirúrgicos (21,5-73,1%). Las tasas de complicaciones quirúrgicas y de muerte poscirugía en espásticos son mayores que en hipotónicos.
Conclusiones: La cirugía no es una buena opción inicial para las escoliosis de comienzo temprano en niños pequeños con parálisis cerebral espástica, nivel IV y V del GMFCS.
Materiales y Métodos: Búsqueda en PubMed, Google Scholar, Cochrane Library, BVS/BIREME, LILACS y SciELO, entre enero de 2009 y noviembre de 2020, con los descriptores: “cerebral palsy, scoliosis, early-onset, treatment”. Se eliminaron los artículos duplicados, no relacionados con la investigación, sin texto completo, con pocos pacientes con parálisis cerebral espástica, sin discriminación etiológica, sin resultados y con edad avanzada. Evaluaciones: nivel de evidencia, edad, nivel del GMFCS, tipo de deformidades, tratamientos, seguimiento, resultados y complicaciones.
Resultados: Se incluyeron 10 de 6770 artículos: 8 con nivel de evidencia IV, edad: 3.2-10 años, deformidad predominante: escoliosis, seguimiento: 1.5-9.8 años. Tratamientos: barras de crecimiento tradicionales o magnéticas, fusión instrumentada precoz, yesos, ortesis y prótesis costal expandible de titanio. La fusión precoz instrumentada logra una corrección ≥75% del ángulo de Cobb; las barras de crecimiento, las ortesis o la prótesis costal expandible de titanio, el 25-50%, y los yesos solo logran mantenerla. La tasa de complicaciones es menor en los tratamientos incruentos (5,8-36%) que en los quirúrgicos (21,5-73,1%). Las tasas de complicaciones quirúrgicas y de muerte poscirugía en espásticos son mayores que en hipotónicos.
Conclusiones: La cirugía no es una buena opción inicial para las escoliosis de comienzo temprano en niños pequeños con parálisis cerebral espástica, nivel IV y V del GMFCS.
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Manzone, P. (2022). Tratamiento de la escoliosis neuromuscular en niños pequeños con parálisis cerebral espástica grave: revisión sistemática de la bibliografía. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(3), 422-432. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1330
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Citas
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children with cerebral palsy. Spine (Phila Pa 1976) 2012;37(12):E708-E713. https://doi.org/10.1097/BRS.0b013e318246a962
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validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Joint Surg Am 2014;96(16):1359-67.
https://doi.org/10.2106/JBJS.M.00253
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6. Manzone PP, Arce MSV, Avalos EM, Iñiguez MLC, Gemetro J. Prevalence of early spinal deformity in children
with GMFCS V cerebral palsy. Coluna/Columna 2019;18(1):21-27. https://doi.org/10.1590/s1808-185120191801190473
7. Skaggs DL, Guillaume T, El-Hawary R, Emans J, Mendelow M, Smith J. Early onset scoliosis consensus statement, SRS Growing Spine Committee. Spine Deform 2015;3(2):107. https://doi.org/10.1016/j.jspd.2015.01.002
8. Yoshida K, Kajiura I, Suzuki T, Kawabata H. Natural history of scoliosis in cerebral palsy and risk factors for
progression of scoliosis. J Orthop Science 2018;23(4):649-52. https://doi.org/10.1016/j.jos.2018.03.009
9. Saito N, Ebara S, Ohotsuka K, Kumeta H, Takaoka K. Natural history of scoliosis in spastic cerebral palsy. Lancet 1998;351(9117):1687-92. https://doi.org/10.1016/S0140-6736(98)01302-6
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https://doi.org/10.1111/j.1469-8749.2010.03617.x
11. Karol LA. The natural history of early-onset scoliosis. J Pediatr Orthop 2019;39(6Suppl 1):S38-S43.
https://doi.org/10.1097/BPO.0000000000001351
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nonambulatory spastic tetraplegic cerebral palsy. PM R 2011;3(1):27-32. https://doi.org/10.1016/j.pmrj.2010.09.015
13. Hardesty CK, Huang RP, El-Hawary R, Samdani A, Hermida PB, Bas T, et al. Early-onset scoliosis: updated
treatment techniques and results. Spine Deform 2018;6(4):467-72. https://doi.org/10.1016/j.jspd.2017.12.012
14. Hughes MS, Swarup I, Makarewich CA, Williams BA, Talwar D, Cahill PJ, et al. Expert Consensus for Early Onset
Scoliosis Surgery. J Pediatr Orthop 2020;40(7):e621-e628. https://doi.org/10.1097/BPO.0000000000001473
15. Akbarnia BA, Campbell RM, Dimeglio A, Flynn JM, Redding GJ, Sponseller PD, et al. Fusionless procedures for
the management of early-onset spine deformities in 2011: what do we know? J Child Orthop 2011;5(3):159-72.
https://doi.org/10.1007/s11832-011-0342-6
16. Vitale MG, Gomez JA, Matsumoto H, Roye DP. Variability of expert opinion in treatment of early-onset
scoliosis. Clin Orthop Rel Res 2011;469(5):1317-22. https://doi.org/10.1007/s11999-010-1540-0
17. Phillips JH, Knapp Jr DR, Herrera-Soto J. Mortality and morbidity in early-onset scoliosis surgery. Spine (Phila Pa 1976) 2013;38(4):324-7. https://doi.org/10.1097/BRS.0b013e31826c6743
18. Anari JB, Flynn JM, Cahill PJ, Vitale MG, Smith JT, Gomez JA, et al. Unplanned return to OR (UPROR) for
children with early onset scoliosis (EOS): a comprehensive evaluation of all diagnoses and instrumentation
strategies. Spine Deform 2020;8:295-302. https://doi.org/10.1007/s43390-019-00024-0
19. Helenius IJ, Viehweger E, Castelein RM. Cerebral palsy with dislocated hip and scoliosis: what to deal with first? J Child Orthop 2020;14(1):24-9. https://doi.org/10.1302/1863- 2548.14.190099
20. Smith JT, Johnston C, Skaggs D, Flynn J, Vitale M. A new classification system to report complications in growing spine surgery: a multicenter consensus study. J Pediatr Orthop 2015;35(8):798-803. https://doi.org/10.1097/BPO.0000000000000386
21. McElroy MJ, Sponseller PD, Dattilo JR, Thompson GH, Akbarnia BA, Shah SA, et al. Growing rods for
the treatment of scoliosis in children with cerebral palsy: a critical assessment. Spine (Phila Pa 1976) 2012;37(24):E1504-E1510. https://doi.org/10.1097/BRS.0b013e31826fabd3
22. Ramirez N, Olivella G, Rodriguez O, Marrero P, Smith J, Garg S, et al. Incidence of complications in the
management of non-ambulatory neuromuscular early-onset scoliosis with a rib-based growing system: high-versus low-tone patients. Eur J Orthop Surg Traumatol 2020;30(4):621-7. https://doi.org/10.1007/s00590-019-02614-0
23. Nakamura N, Uesugi M, Inaba Y, Machida J, Okuzumi S, Saito T. Use of dynamic spinal brace in the management of neuromuscular scoliosis: a preliminary report. J Pediatr Orthop B 2014;23(3):291-8.
https://doi.org/10.1097/BPB.0000000000000034
24. Oyoun NA, Stuecker R. Bilateral rib-to-pelvis Eiffel Tower VEPTR construct for children with neuromuscular
scoliosis: a preliminary report. Spine J 2014;14(7):1183-91. https://doi.org/10.1016/j.spinee.2013.07.484
25. Matthews M, Blandford S, Marsden J, Freeman J. The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes. Scoliosis Spinal Disord 2016;11:14. https://doi.org/10.1186/s13013-016-0073-z
26. Sitoula P, Holmes Jr L, Sees J, Rogers K, Dabney K, Miller F. The long-term outcome of early spine fusion for
scoliosis in children with cerebral palsy. Clin Spine Surg 2016;29(8): E406-E412. https://doi.org/10.1097/BSD.0000000000000184
27. Yaszay B, Sponseller PD, Shah SA, Asghar J, Miyanji F, Samdani AF, et al. Performing a definitive fusion in
juvenile CP patients is a good surgical option. J Pediatr Orthop 2017;37(8):e488-e491. https://doi.org/10.1097/BPO.0000000000000793
28. Helenius IJ, Oksanen HM, McClung A, Pawelek JB, Yazici M, Sponseller PD, et al. Outcomes of growing rod
surgery for severe compared with moderate early-onset scoliosis: a matched comparative study. Bone Joint
J 2018;100(6):772-9. https://doi.org/10.1302/0301-620X.100B6.BJJ-2017-1490.R1
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2. Oskoui M, Coutinho F, Dykeman J, Jette N, Pringsheim T. An update on the prevalence of cerebral palsy: a
systematic review and meta‐analysis. Develop Med Child Neurol 2013;55(6):509-19. https://doi.org/10.1111/dmcn.12080
3. Persson-Bunke M, Hägglund G, Lauge-Pedersen H, Wagner P, Westbom L. Scoliosis in a total population of
children with cerebral palsy. Spine (Phila Pa 1976) 2012;37(12):E708-E713. https://doi.org/10.1097/BRS.0b013e318246a962
4. Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR, et al. Development and initial
validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Joint Surg Am 2014;96(16):1359-67.
https://doi.org/10.2106/JBJS.M.00253
5. Hägglund G, Pettersson K, Czuba T, Persson-Bunke M, Rodby-Bousquet E. Incidence of scoliosis in cerebral palsy. Acta Orthop 2018;89(4):443-7. https://doi.org/10.1080/17453674.2018.1450091
6. Manzone PP, Arce MSV, Avalos EM, Iñiguez MLC, Gemetro J. Prevalence of early spinal deformity in children
with GMFCS V cerebral palsy. Coluna/Columna 2019;18(1):21-27. https://doi.org/10.1590/s1808-185120191801190473
7. Skaggs DL, Guillaume T, El-Hawary R, Emans J, Mendelow M, Smith J. Early onset scoliosis consensus statement, SRS Growing Spine Committee. Spine Deform 2015;3(2):107. https://doi.org/10.1016/j.jspd.2015.01.002
8. Yoshida K, Kajiura I, Suzuki T, Kawabata H. Natural history of scoliosis in cerebral palsy and risk factors for
progression of scoliosis. J Orthop Science 2018;23(4):649-52. https://doi.org/10.1016/j.jos.2018.03.009
9. Saito N, Ebara S, Ohotsuka K, Kumeta H, Takaoka K. Natural history of scoliosis in spastic cerebral palsy. Lancet 1998;351(9117):1687-92. https://doi.org/10.1016/S0140-6736(98)01302-6
10. Loeters MJ, Maathuis CG, Hadders‐Algra M. Risk factors for emergence and progression of scoliosis in children with severe cerebral palsy: a systematic review. Develop Med Child Neurol 2010;52(7):605-11.
https://doi.org/10.1111/j.1469-8749.2010.03617.x
11. Karol LA. The natural history of early-onset scoliosis. J Pediatr Orthop 2019;39(6Suppl 1):S38-S43.
https://doi.org/10.1097/BPO.0000000000001351
12. Gu Y, Shelton JE, Ketchum JM, Cifu DX, Palmer D, Sparkman A, et al. Natural history of scoliosis in
nonambulatory spastic tetraplegic cerebral palsy. PM R 2011;3(1):27-32. https://doi.org/10.1016/j.pmrj.2010.09.015
13. Hardesty CK, Huang RP, El-Hawary R, Samdani A, Hermida PB, Bas T, et al. Early-onset scoliosis: updated
treatment techniques and results. Spine Deform 2018;6(4):467-72. https://doi.org/10.1016/j.jspd.2017.12.012
14. Hughes MS, Swarup I, Makarewich CA, Williams BA, Talwar D, Cahill PJ, et al. Expert Consensus for Early Onset
Scoliosis Surgery. J Pediatr Orthop 2020;40(7):e621-e628. https://doi.org/10.1097/BPO.0000000000001473
15. Akbarnia BA, Campbell RM, Dimeglio A, Flynn JM, Redding GJ, Sponseller PD, et al. Fusionless procedures for
the management of early-onset spine deformities in 2011: what do we know? J Child Orthop 2011;5(3):159-72.
https://doi.org/10.1007/s11832-011-0342-6
16. Vitale MG, Gomez JA, Matsumoto H, Roye DP. Variability of expert opinion in treatment of early-onset
scoliosis. Clin Orthop Rel Res 2011;469(5):1317-22. https://doi.org/10.1007/s11999-010-1540-0
17. Phillips JH, Knapp Jr DR, Herrera-Soto J. Mortality and morbidity in early-onset scoliosis surgery. Spine (Phila Pa 1976) 2013;38(4):324-7. https://doi.org/10.1097/BRS.0b013e31826c6743
18. Anari JB, Flynn JM, Cahill PJ, Vitale MG, Smith JT, Gomez JA, et al. Unplanned return to OR (UPROR) for
children with early onset scoliosis (EOS): a comprehensive evaluation of all diagnoses and instrumentation
strategies. Spine Deform 2020;8:295-302. https://doi.org/10.1007/s43390-019-00024-0
19. Helenius IJ, Viehweger E, Castelein RM. Cerebral palsy with dislocated hip and scoliosis: what to deal with first? J Child Orthop 2020;14(1):24-9. https://doi.org/10.1302/1863- 2548.14.190099
20. Smith JT, Johnston C, Skaggs D, Flynn J, Vitale M. A new classification system to report complications in growing spine surgery: a multicenter consensus study. J Pediatr Orthop 2015;35(8):798-803. https://doi.org/10.1097/BPO.0000000000000386
21. McElroy MJ, Sponseller PD, Dattilo JR, Thompson GH, Akbarnia BA, Shah SA, et al. Growing rods for
the treatment of scoliosis in children with cerebral palsy: a critical assessment. Spine (Phila Pa 1976) 2012;37(24):E1504-E1510. https://doi.org/10.1097/BRS.0b013e31826fabd3
22. Ramirez N, Olivella G, Rodriguez O, Marrero P, Smith J, Garg S, et al. Incidence of complications in the
management of non-ambulatory neuromuscular early-onset scoliosis with a rib-based growing system: high-versus low-tone patients. Eur J Orthop Surg Traumatol 2020;30(4):621-7. https://doi.org/10.1007/s00590-019-02614-0
23. Nakamura N, Uesugi M, Inaba Y, Machida J, Okuzumi S, Saito T. Use of dynamic spinal brace in the management of neuromuscular scoliosis: a preliminary report. J Pediatr Orthop B 2014;23(3):291-8.
https://doi.org/10.1097/BPB.0000000000000034
24. Oyoun NA, Stuecker R. Bilateral rib-to-pelvis Eiffel Tower VEPTR construct for children with neuromuscular
scoliosis: a preliminary report. Spine J 2014;14(7):1183-91. https://doi.org/10.1016/j.spinee.2013.07.484
25. Matthews M, Blandford S, Marsden J, Freeman J. The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes. Scoliosis Spinal Disord 2016;11:14. https://doi.org/10.1186/s13013-016-0073-z
26. Sitoula P, Holmes Jr L, Sees J, Rogers K, Dabney K, Miller F. The long-term outcome of early spine fusion for
scoliosis in children with cerebral palsy. Clin Spine Surg 2016;29(8): E406-E412. https://doi.org/10.1097/BSD.0000000000000184
27. Yaszay B, Sponseller PD, Shah SA, Asghar J, Miyanji F, Samdani AF, et al. Performing a definitive fusion in
juvenile CP patients is a good surgical option. J Pediatr Orthop 2017;37(8):e488-e491. https://doi.org/10.1097/BPO.0000000000000793
28. Helenius IJ, Oksanen HM, McClung A, Pawelek JB, Yazici M, Sponseller PD, et al. Outcomes of growing rod
surgery for severe compared with moderate early-onset scoliosis: a matched comparative study. Bone Joint
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