Symptomatic cervical spinal stenosis in spastic cerebral palsy. (8th July 2020)

• Record Type: Journal Article
• Authors: Hung, Chun Wai; Matsumoto, Hiroko; Ball, Jacob R; Plachta, Stephen; Dutkowsky, Joseph P; Kim, Heakyung; Hyman, Joshua E; Riew, K Daniel; Roye, David P
• Is Part Of: Developmental medicine & child neurology. Volume 62:Number 10(2020)
• Page Start: 1147
• Page End: 1153
• Publication Date: 2020-07-08
• Subjects: Child development -- Periodicals; Pediatric neurology -- Periodicals; 616.8
• DOI: 10.1111/dmcn.14607
• Languages: English
• ISSNs: 0012-1622

Abstract

Abstract : Aim: To describe the prevalence of symptomatic cervical spinal stenosis (CSS) in spastic cerebral palsy (CP) and associated characteristics. Method: This cross‐sectional study of adults (>18y) with CP (2006–2016) at a single institution compared the patient characteristics (demographics, comorbidities, surgical history, medications, Gross Motor Function Classification System [GMFCS] level, and CP type) of patients with and without CSS. Results: Of 424 patients (mean age 33y 4mo, SD 13y 6mo, range 18–78y; 225 females, 199 males), 32 patients (7.5%) had symptomatic CSS. GMFCS levels in the study cohort were distributed as follows: level I, 25%; level II, 25%; level III, 22%; level IV, 19%; level V, 9%. Twenty‐five out of 32 (78.1%) patients had spastic CP, two (6.3%) had dystonic CP, and one (3.1%) had mixed characteristics. Individuals with CSS were older (mean age 54y 6mo, SD 10y 5mo vs mean age 31y 7mo, SD 12y 1mo, p <0.05) and had a higher body mass index (26.1, SD 4.8 vs 23.4, SD 6.2, p <0.05) than those without CSS. Presentations included upper‐extremity symptoms (73%), ambulation decline (70%), neck pain (53%), and incontinence (30%). Common stenosis levels were C5–C6 (59%), C4–C5 (56%), and C6–C7 (53%). Interpretation: Symptomatic CSS was identified in 7.5% of this adult cohort during the 2006 to 2016 period. Diagnosis in CP is difficult due to impaired communication and pre‐existing gait abnormalities and spasticity. Given the high prevalence of symptomatic CSS in adults, we propose developing screening guidelines. Physicians must maintain a high level of suspicion for CSS if patients present with changes in gait or spasticity. Abstract : This original article is commented on by Jia, Ying, and Teng on page 1114 of this issue.