| 저자 |
Ji Cheol Shin, M.D., PhD1†, Sang Won Hwang, M.D.1*, Sang Hee Im, M.D., PhD1, Min Cheol Ha, M.D.1 |
Objective
Neuromuscular scoliosis is a complex secondary condition of pediatric spinal cord injury that develops in high percent of children whose spinal cord is injured prior to skeletal maturity. The effects of paralysis on growth of musculoskeletal system should be carefully considered in case of pediatric spinal cord injury (SCI). In many studies, significant efforts have been made to prevent spinal cord deformation while maintaining upright posture or maintaining ambulation using orthosis. At 12 years of age, the fulcrum last settles at C5 to C6, where it remains throughout adulthood. Younger children are therefore at higher risk of upper cervical injury and spinal deformity. Therefore this study aims to assess the related factors with the scoliosis in pediatric and adolescent spinal cord injured patients.
Method
Medical records of pediatric and adolescent SCI patients aged 18 years old or younger, who visited the University rehabilitation hospital during year 2000-2015, were reviewed retrospectively. Only the scoliosis patients who were diagnosed by whole spine radiographs (AP and lateral) were included. Exclusion criteria was the patient with a history of scoliosis or spinal deformity before spinal cord injury. The relevance between scoliosis severity and several parameters such as onset age of injury, etiology of injury, neurological status, ASIA classification, level of spinal cord lesion and functional level were analyzed.
Result
Total 64 patients (34 males and 30 females) were included in this study and their onset age of injury was 7.65±5.19 years (range 0y-17y 5mo). There was a significant difference between Cobb’s angle values according to onset age, etiology, level of injury, completeness, ASIA classification. Scoliosis occurred more severe those injured at younger age than 12, 18.62’, compared with 8.2’ in those injured later (P<0.05). Complete injury and ASIA classification A showed higher cobb’s angle (P<0.05). In terms of injury caused by the trauma, the Cobb’s angle of sports injured patients was significantly higher than other traumas (P<0.05). Patients with thoracic level injury showed Cobb’s angle 20.72’ which is significantly higher than cervical and lumbar injury patients (P<0.05).
Conclusion
As subjects with complete cord lesion, thoracic lesion, younger onset age demonstrated more severe scoliosis than other conditions, more careful consideration about spinal care is needed during rehabilitation treatment of pediatric and adolescent SCI patients with above characteristics.
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