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 childhood onset spinal cord injury (SCI) and level of spinal cord lesion, severity of lesion, age at onset, duration of paralysis and pelvic deformities. Setting: People with spinal cord injury (onset in childhood) treated and followed up at the National Spinal Injuries Center (identified from case notes review, contacted and agreed to participate). Method: One hundred and eighty-nine subjects satisfying study inclusion criteria (acute onset SCI before the 16th birthday) were identified by case note review of 8200 records. Eighty formed the group attending for clinical review including whole spine radiographs (AP and lateral). Clinical examination included neurological status and joint range of movements. Demographic data was recorded. Results: Scoliosis occurred more frequently and was more severe in those injured at a younger age, 38°, compared with 24° in those injured later (P<0.05), in paraplegia, 33°, versus tetraplegia, 17°, (P<0.01) and in complete, 36°, versus incomplete lesions, 18°, (P<0.001). Lordosis angulation in paraplegic subjects was significantly greater than in tetraplegic subjects in both seated, 50° versus 25° (P<0.014) and standing subjects 78° versus 59° (P<0.017) respectively and for kyphosis in standing subjects, 52° versus 31° (P<0.01). Sagittal measurements were influenced by habitual posture (which also corresponded to the severity of the lesion). Conclusion: Younger age at onset was shown to be associated with more severe scoliosis, as has been reported by others. Subjects with paraplegia and complete lesions demonstrated a greater and more frequently occurring scoliosis than those with tetraplegia and incomplete lesions respectively. Lordosis was greater in those with paraplegia than with tetraplegia and in those with very incomplete lesions compared with complete lesions. However the influence of the severity of the lesion cannot be separated from the postural position when analyzing spinal deformity.