Treatment of Neuromuscular Scoliosis in Young Children With Severe Spastic Cerebral Palsy: A Systematic Review of the Literature
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Published:
Jun 25, 2022
Keywords:
Cerebral palsy, spasticity, scoliosis, early-onset, treatment
Main Article Content
Abstract
Introduction: Children with GMFCS IV and V spastic cerebral palsy (CP) are at risk of developing early-onset scoliosis (EOS). There is no agreement about treatment for very young children (less than 5 or 6 years old). This systematic review focuses on this problem.
Materials and Methods: We conducted a search in the PubMed, Scholar Google, Cochrane Library, BVS/BIREME, LILACS, and SCIELO databases from 1/2009 to 11/2020, using the following keywords: “cerebral palsy”, “scoliosis”, “early-onset”, “treatment”. We eliminated duplicated articles, those with unrelated research, without complete text, with very few spastic CP patients or patients aged over 6, and without clear etiology or results. The variables evaluated in the selected articles were: level of evidence, average age, GMFCS level, deformity types, treatments, follow-up, outcomes, and complications.
Results: From the 6770 articles retrieved, only 10 were included: 8/10 with evidence level IV, average ages 3.2 to 10 years old, scoliosis as prevalent deformity, average follow-up 1.5 to 9.8 years. Treatment: traditional growing rods (3), magnetic growing rods (1), early instrumented fusion (2), casting (1), orthotics (2), and VEPTR (1). Early instrumented fusion provides >/= 75% of Cobb correction; growing rods, orthotics, and VEPTR, between 25 and 50%, and plaster casts only prevent progression. Non-surgical treatments have a lower rate of complications (5.8%-36%) than surgical ones (21.5% - 73.1%). Surgical complications and postoperative mortality are higher in spastic than in hypotonic patients.
Conclusions: Surgery is not a good initial option in very young children with spastic, GMFCS IV-V CP.
Materials and Methods: We conducted a search in the PubMed, Scholar Google, Cochrane Library, BVS/BIREME, LILACS, and SCIELO databases from 1/2009 to 11/2020, using the following keywords: “cerebral palsy”, “scoliosis”, “early-onset”, “treatment”. We eliminated duplicated articles, those with unrelated research, without complete text, with very few spastic CP patients or patients aged over 6, and without clear etiology or results. The variables evaluated in the selected articles were: level of evidence, average age, GMFCS level, deformity types, treatments, follow-up, outcomes, and complications.
Results: From the 6770 articles retrieved, only 10 were included: 8/10 with evidence level IV, average ages 3.2 to 10 years old, scoliosis as prevalent deformity, average follow-up 1.5 to 9.8 years. Treatment: traditional growing rods (3), magnetic growing rods (1), early instrumented fusion (2), casting (1), orthotics (2), and VEPTR (1). Early instrumented fusion provides >/= 75% of Cobb correction; growing rods, orthotics, and VEPTR, between 25 and 50%, and plaster casts only prevent progression. Non-surgical treatments have a lower rate of complications (5.8%-36%) than surgical ones (21.5% - 73.1%). Surgical complications and postoperative mortality are higher in spastic than in hypotonic patients.
Conclusions: Surgery is not a good initial option in very young children with spastic, GMFCS IV-V CP.
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Manzone, P. (2022). Treatment of Neuromuscular Scoliosis in Young Children With Severe Spastic Cerebral Palsy: A Systematic Review of the Literature. 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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strategies. Spine Deform 2020;8:295-302. https://doi.org/10.1007/s43390-019-00024-0
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https://doi.org/10.1097/BPB.0000000000000034
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scoliosis in children with cerebral palsy. Clin Spine Surg 2016;29(8): E406-E412. https://doi.org/10.1097/BSD.0000000000000184
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https://doi.org/10.1302/1863- 2548.13.180203
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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
J 2018;100(6):772-9. https://doi.org/10.1302/0301-620X.100B6.BJJ-2017-1490.R1
29. Studer D, Heidt C, Büchler P, Hasler CC. Treatment of early onset spinal deformities with magnetically controlled growing rods: a single centre experience of 30 cases. J Child Orthop 2019;13(2):196-205.
https://doi.org/10.1302/1863- 2548.13.180203
30. LaValva S, Adams A, MacAlpine E, Gupta P, Hammerberg K, Thompson GH, et al. Serial casting in neuromuscular and syndromic early-onset scoliosis (EOS) can delay surgery over 2 years. J Pediatr Orthop 2020;40(8):e772-e779. https://doi.org/10.1097/BPO.0000000000001568
31. Mehta MH. Growth as a corrective force in the early treatment of progressive infantile scoliosis. J Bone Joint Surg Br 2005;87(9):1237-47. https://doi.org/10.1302/0301-620X.87B9.16124
32. Mahajan R, Kishan S, Mallepally AR, Shafer C, Marathe N, Chhabra HS. Evolution of casting techniques in earlyonset and congenital scoliosis. J Clin Orthop Trauma 2020;11(5):810-5. https://doi.org/10.1016/j.jcot.2020.06.034
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