The effect of childhood spinal cord injury on skeletal development: a retrospective study

Study design: Cross-sectional clinical review. Objectives: To assess the relationship between late spinal. deformity in ch ildhood onset spinal cord injury (SCI) and level of spinal cord lesion, sev erity of lesion, age at onset, duration of paralysis and pelvic deformities . Setting: People with spinal cord injury (onset in childhood) treated and fo llowed up at the National Spinal Injuries Center (identified from case note s review, contacted and agreed to participate). Method: One hundred and eighty-nine subjects satisfying study inclusion cri teria (acute onset SCI before the 16th birthday) were identified by case no te review of 8200 records. Eighty formed the group attending for clinical r eview including whole spine radiographs (AP and lateral). Clinical examinat ion included neurological status and joint range of movements. Demographic data was recorded. Results: Scoliosis occurred more frequently and was more severe in those in jured at a younger age, 38 degrees, compared with 24 degrees in those injur ed later (P<0.05), in paraplegia, 33 degrees, versus tetraplegia, 17 degree s, (P<0.01) and in complete, 36 degrees, versus incomplete lesions, Is', (P <0.001). Lordosis angulation in paraplegic subjects was significantly great er than in tetraplegic subjects in both seated, 50 degrees versus 25 degree s (P<0.014) and standing subjects 78 degrees versus 59 degrees (P<0.017) re spectively and for kyphosis in standing subjects, 52 degrees versus 31 degr ees (P<0.01). Sagittal measurements were influenced by habitual posture (wh ich also corresponded to the severity of the lesion). Conclusion: Younger age at onset was shown to be associated with more sever e scoliosis, as has been reported by others. Subjects with paraplegia and c omplete lesions demonstrated a greater and more frequently occurring scolio sis than those with tetraplegia and incomplete lesions respectively. Lordos is was greater in those with paraplegia than with tetraplegia and in those with very incomplete lesions compared with complete lesions. However the in fluence of the severity of the lesion cannot be separated from the postural position when analyzing spinal deformity.