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Published on: October 16, 2013
Scoliosis in Pediatric Patients With Acute Flaccid Myelitis
Krishna V Suresh1, Alexander Karius1, Kevin Y Wang1
1Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Pediatric patients with acute flaccid myelitis (AFM) who develop scoliosis often experience paralysis and require ventilator support. This spinal condition is linked to more severe thoracic spinal cord lesions in AFM cases.
Area of Science:
- Neurology
- Pediatric Orthopedics
- Spinal Cord Injury
Background:
- Acute flaccid myelitis (AFM) is a neurological disorder causing rapid muscle weakness or paralysis.
- Scoliosis development in pediatric AFM patients is anecdotally reported but lacks defined risk factors or incidence data.
Purpose of the Study:
- To determine the incidence and risk factors associated with scoliosis in pediatric patients diagnosed with acute flaccid myelitis.
- To identify clinical and radiological characteristics of AFM patients who develop scoliosis.
Main Methods:
- Retrospective review of pediatric AFM patients over 10 years at a tertiary care center.
- Scoliosis defined as coronal curvature ≥15 degrees on radiography.
- Assessment of limb involvement, ambulation, head control, ventilator use, muscle strength (MMT), functional status (PAMS), and spinal cord MRI findings.
Main Results:
- Of 56 AFM patients, 27 developed scoliosis (mean Cobb angle 31.7°).
- Scoliosis was associated with lack of independent ambulation, ventilator dependence, more affected limbs, and lower MMT/PAMS scores (p < .05).
- Patients with scoliosis showed more extensive thoracic spinal cord lesions on MRI (p = .03).
Conclusions:
- Pediatric AFM patients who develop scoliosis are more likely to be ventilator-dependent and have impaired ambulation.
- Extensive thoracic spinal cord involvement is a significant factor in the development of scoliosis among AFM patients.
Background:
Acute flaccid myelitis (AFM) is an anterior horn disorder that manifests as rapid onset muscle weakness or paralysis. Development of scoliosis in pediatric AFM patients has been anecdotally reported, but associated risk factors or incidence have yet to be determined.
Methods:
Pediatric AFM patients treated over a 10-year period at a tertiary care center were identified. Patients were considered to have scoliosis if there was radiographic evidence of coronal curvature ≥15 degrees. Number of limbs affected, independent ambulation and head control, ventilator requirement at initial admission, and long-term ventilatory support (≥1 year) were recorded. Muscle strength and functional status were assessed by manual muscle testing (MMT) and Physical Abilities and Mobility Scale (PAMS), respectively. Areas of spinal cord lesion on initial MRI were recorded. Bivariate analyses were performed, with alpha set to 0.05.
Results:
Fifty-six AFM patients (27 scoliosis, 29 no scoliosis) were identified. Mean time from AFM presentation to scoliosis diagnosis was 0.93 years. Mean major Cobb angle at first radiograph was 31.7 ± 14.3 degrees. Lack of independent ambulation, ventilator dependence at time of admission or long term, number of limbs affected, and decreased MMT and PAMS scores were more common in patients who developed scoliosis (all, p < .05). Patients who developed scoliosis had more extensive thoracic spinal cord involvement on initial MRI (p = .03).
Conclusion:
AFM patients who develop scoliosis are more likely to be ventilator dependent, lack independent ambulation, and have more extensive thoracic SCI.
