Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Scoliosis in paediatric onset spinal cord injuries

Abstract

Study design

This is a retrospective longitudinal review.

Objective

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

Setting

This study was conducted at the Midland Centre of SCI.

Method

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

Results

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%).

Conclusion

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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

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.

References

  1. 1.

    Regional trauma networks NHS clinical advisory group on major trauma workforce. CFWI Regional Trauma Network Team. 2011. Accessed 16 Sept 2014.

  2. 2.

    Parent S, Dimer J, Dekutoski M, Roy-Beaudry M. Unique feature of pediatric spinal cord injury. Spine. 2010;35:S202–8.

    Article  Google Scholar 

  3. 3.

    Lancourt JE, Dickson JH, Carter RE. Paralytic spinal deformity following traumatic spinal cord injury in children and adolescents. J Bone Jt Surg Am. 1981;63:47–53.

    CAS  Article  Google Scholar 

  4. 4.

    Mayfield JK, Erkkila JC, Winter RB. Spine deformity subsequent to acquired childhood spinal cord injury. J Bone Jt Surg Am. 1981;63:1401–11.

    CAS  Article  Google Scholar 

  5. 5.

    Mulcahey MJ, Gaughan JP, Betz RR, Samdani AF, Barakat N, Hunter LN. Neuromuscular scoliosis in children with spinal cord injury. Top Spinal Cord Inj Rehabil. 2013;19:96–103.

    CAS  Article  Google Scholar 

  6. 6.

    Schottler J, Vogel LC, Strum P. Spinal cord injuries in young children: a review of children injured at 5 years of age and younger. Dev Med Child Neurol. 2012;54:1138–43.

    Article  Google Scholar 

  7. 7.

    Dearolf WW, Betz RR, Vogel LC, Levin J, Clancy M, Steel HH. Scoliosis in pediatric spinal cord-injured patients. J Pediatr Orthop. 1990;10:214–8.

    Article  Google Scholar 

  8. 8.

    Driscoll SW, Skinner J. Musculoskeletal complicationsof neuromuscular disease in children. Phys Med Rehabil Clin N Am. 2008;19:163–94.

    Article  Google Scholar 

  9. 9.

    Ahmed R, Menezes AH, Awe OO, Mahaney KB, Torner JC, Weinstein SL. Long-term incidence and risk factors for development of spinal deformity following resection of pediatric intramedullary spinal cord tumors. J Neurosurg Pediatr. 2014;13:613–21.

    Article  Google Scholar 

  10. 10.

    Birney TJ, Hanley EN Jr. Traumatic cervical spine injuries in childhood and adolescence. Spine. 1989;14:1277–128210.

    CAS  Article  Google Scholar 

  11. 11.

    Sherk HH, Schut L, Lane JM. Fractures and dislocations of the cervical spine in children. Orthop Clin North Am. 1976;7:593–604.

    CAS  PubMed  Google Scholar 

  12. 12.

    Bilston LE, Brown J. Pediatric spinal injury type and severity are age and mechanism dependent. Spine. 2007;32:2339–234710.

    Article  Google Scholar 

  13. 13.

    El Masri W. International child health care manual: Child Advocacy International. A practical manual for hospitals worldwide. London, UK: BMJ Books; 2002. pp. 518–20. ISBN No 0727914766.

  14. 14.

    El Masri W and D Southall. Care of children and young people with a spinal cord injury. In: International maternal and child health care textbook. London, UK: Radcliffe Publishing Ltd, 2014. pp. 406–20.

  15. 15.

    El Masri W, Kumar N. Active physiological conservative management in 271 traumatic spinal cord injuries—an evidence-based approach. Trauma. 2017;19:S10–22.

    Article  Google Scholar 

  16. 16.

    Biering-Sørensen F, Burns AS, Curt A, Harvey LA, Mulcahey MJ, Nance PW, et al. International spinal cord injury musculoskeletal basic data set. Spinal Cord. 2012;50:797.

    Article  Google Scholar 

  17. 17.

    Frankel HL, Hancock DO, Hyslop G, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969;7:179–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    D Hosmer, S Lemeshow, RX Sturdivant. Applied Logistic Regression. 3rd ed. Wily, Chichester; 2013. https://doi.org/10.1002/9781118548387.

  19. 19.

    Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–1.

    CAS  Article  Google Scholar 

  20. 20.

    Grant RL. Converting an odds ratio to a range of plausible relative risks for better communication of research findings. BMJ. 2014;348:f7450.

    Article  Google Scholar 

  21. 21.

    Tsirikos AI, Markham P, McMaster MJ. Surgical correction of spinal deformities following spinal cord injury occurring in childhood. J Surg Orthop Adv. 2007;16:174–86.

    PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

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.

Ethics declarations

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).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kulshrestha, R., Kuiper, J.H., Masri, W.E. et al. Scoliosis in paediatric onset spinal cord injuries. Spinal Cord 58, 711–715 (2020). https://doi.org/10.1038/s41393-020-0418-6

Download citation

Further reading

Search

Quick links