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Scoliosis in paediatric onset spinal cord injuries


Study design

This is a retrospective longitudinal review.


The purpose of this review was to identify predictors of developing clinical scoliosis and compare between traumatic and neurological aetiologies of SCI.


This study was conducted at the Midland Centre of SCI.


Case notes of all patients injured at an age up to 18 years and admitted between 1971 and 2013 were reviewed.


Sixty-nine individuals were identified, of which seven were excluded: three with pre-existing scoliosis and four with spina bifida. The remaining 62 (44 males, 18 females) had a median age at injury of 17 years (inter quartile range 13–17). Of these, 51 (82%) had traumatic and 11 (18%) had neurological injury. Most (42/51; 82%) of the children who had a traumatic injury were older than 13 years. The risk of developing scoliosis was lower for older patients (RR 0.68 per year, 95% CI 0.52–0.83) or following a traumatic injury (RR 0.36, 95% CI 0.20–0.66). A multivariable analysis based on age and trauma showed that only older age decreased the risk. A robust Receiver Operator Curve analysis suggested 14.6 years as the optimal threshold to predict development of scoliosis within 10 years (Area Under the Curve; AUC 0.83 (95% CI 0.73–0.93), sensitivity 70% (95% CI 50–89%), specificity 89% (95% CI 74–100%).


Our results suggest that age below 14.6 years was a predictor for scoliosis. Once adjustment is made for age, the incidence of scoliosis does not differ between traumatic and neurological aetiologies of paediatric SCI injury.

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Fig. 1
Fig. 2: Age as a predictor of admission with traumatic injury.
Fig. 3: Age as a predictor of developing scoliosis.
Fig. 4: ROC curve, showing sensitivity and specificity at various cut-off points when using age to identify patients at higher risk of developing scoliosis within 10 years from admission.

Data availability

Data supporting the results can be obtained from the corresponding author.


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Author information




RK: oversaw the design of the study, wrote the manuscript, did data collection and contributed to the analysis and interpretation of results. JK: performed statistical analysis and edited the main article. WElM: contributed to revising the manuscript and data interpretation. JC: contributed to study design, methodology and data interpretation. SK: helped with radiology data collection. NK: contributed to study design, methodology and data interpretation. RL: helped with radiology data analysis. AO: contributed to study design, methodology and data interpretation.

Corresponding author

Correspondence to R. Kulshrestha.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Healthcare quality improvement partnership (HQIP) provides guidance intended to help those responsible to review and develop arrangements for the effective ethics oversight of quality improvement and clinical audit activities, as required. Our local audit department follows the principles of HQIP. This study was approved by the local audit department allowing use of clinical data for service evaluation (Supplementary Appendix 2, certificate from audit department).

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Kulshrestha, R., Kuiper, J.H., Masri, W.E. et al. Scoliosis in paediatric onset spinal cord injuries. Spinal Cord 58, 711–715 (2020).

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