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Paralytic spinal deformity following traumatic spinal-cord injury in children and adolescents
Insights
Childhood spinal cord injury can lead to scoliosis due to lost muscular support. Younger age at injury and spasticity are key risk factors for developing spinal deformities like kyphosis.
Area of Science:
- Orthopedics
- Neurology
- Pediatric Medicine
Background:
- Loss of muscular support following spinal cord injury can impact spinal column development.
- Pediatric spinal cord injuries can lead to secondary spinal deformities.
Purpose of the Study:
- To evaluate the effect of lost muscular support on the spinal column after childhood spinal cord injury.
- To identify risk factors for scoliosis development in pediatric patients with spinal cord injuries.
Main Methods:
- Analysis of fifty patient cases, aged newborn to seventeen years at the time of injury.
- Evaluation of scoliotic curves, specifically paralytic curves, and spinal deformities on lateral roentgenograms.
Main Results:
- Thirty-one patients (62%) developed scoliosis exceeding 20 degrees; 21 (42%) had severe paralytic curves (≥40 degrees).
- Age at injury was the most significant risk factor; spasticity was also highly significant.
- Reversal of lumbar lordosis into kyphosis, forming long thoracolumbar kyphosis, was the predominant finding. Thoracolumbar lordosis occurred in five patients.
Conclusions:
- Childhood spinal cord injury poses a significant risk for developing scoliosis and other spinal deformities.
- Early age at injury and spasticity are critical factors influencing the development and severity of these spinal deformities.
Abstract:
We attempted to evaluate the effect on the spinal column of loss of muscular support following trauma to the spinal cord during childhood. The cases of fifty patients, newborn to seventeen years old at the time of injury, were analyzed. Thirty-one patients had scoliotic curves of more than 20 degrees; twenty-one of these were long paralytic curves of 40 degrees or more. Age at injury was the single most important risk factor in the development of scoliosis; spasticity was also a very significant factor. Patients with lesions at all neural levels were at risk, while laminectomy was not a significant cause of scoliosis. On lateral roentgenograms the predominant finding was a reversal of the lumbar lordosis into a kyphosis, with the resultant development of a long thoracolumbar kyphosis. In five patients the opposite deformity, thoracolumbar lordosis, developed.