NATURAL-HISTORY OF SCOLIOSIS IN THE INSTITUTIONALIZED ADULT CEREBRAL-PALSY POPULATION

Study Design. Fifty-six adult residents with cerebral palsy and signif icant scoliosis or kyphosis at the Hazelwood Center in Louisville, Ken tucky were studied periodically using radiographs to assess the degree of scoliosis, kyphosis, and pelvic obliquity and by clinical evaluati on to assess functional status and skin condition. Objectives. This st udy followed the natural history of untreated scoliosis to determine w hether a decline in functional status is related to curve progression and whether the development of decubiti is associated with ; :;the deg ree of pelvic obliquity. Identifying the factors that affect functiona l decline may help develop treatment plans to minimize it. Summary of Background Data. Significant structural deformities of the spine often accompany cerebral palsy. Despite the relatively large number of case s, little is known about the natural history of untreated scoliosis in the adult cerebral palsy population. Theoretically, curve progression will lead to pain, loss of ambulation or sitting balance, or even car diopulmonary compromise, but few studies have been done to verify this . Methods. Single-factor analysis of variance was used to compare the curve progression rate within groups based on the structure of the cur ve, and the two-sample student t test was used to compare the average initial curve, the average final curve, the progression rate, and the amount of progression between groups based on functional decline. The two sample t test also was used to correlate the average pelvic obliqu ity and the size of the final curve with the presence or absence of de cubiti. Results. Functionally, 10 patients (18%) declined during the c ourse of the study. In these 10 patients, the average initial Curve wa s 41.1 degrees, the average final curve was 80.6 degrees, and the aver age progression rate was 4.4 degrees per year. For the stable patients , the average initial curve was 33.9 degrees, the average final curve was 56.5 degrees, and the average progression rate was 3.0 degrees per year. The differences between the final curve and the absolute amount of progression were statistically significant (P = 0.018 and P = 0.03 , respectively). Three patients developed decubiti. Their curve averag ed 106 degrees, and their pelvic obliquity measured 45 degrees, both o f which were significantly higher than those of the patients without d ecubiti. Conclusions. The results of the present study demonstrate tha t in the adult patient with cerebral palsy and scoliosis, a definite c orrelation exists between deformity size and functional decline and de cubiti. Progression rate also seems to be a factor in functional decli ne. Additional studies are needed to determine whether surgical interv ention will halt or reverse this decline.