title: Neuromuscular scoliosis in children with spinal cord injury.
abstract: BACKGROUND
  The prevalence of neuromuscular scoliosis in children with spinal cord injury (SCI) is high. Published reports suggest that age at time of injury is the most important determinant. No studies have evaluated neurological characteristics using standardized methods to determine if they are strong predictors of scoliosis.
  
  
  OBJECTIVE
  To test the hypothesis that neurological level, motor score, and injury severity are strong predictors of neuromuscular scoliosis.
  
  
  METHODS
  Two hundred seventeen children were evaluated using the testing guidelines of the International Standards for Neurological Classification of Spinal Cord Injury. Cobb angles were calculated from plain radiographs as a measure of scoliosis. Multivariate analysis with statistical selection was used to determine predictors of worst Cobb angle and spinal fusion. The odds of having a spine fusion for subjects with at least 2-year follow-up and injured prior to (n=16) and after (n=91) 12 years of age were calculated.
  
  
  RESULTS
  The hypothesis was not supported. Although there was a very high prevalence (100%) of scoliosis in the study sample, age at time of injury was the only predictor of worst curve (P < .0001) and spine fusion (P < .007). The calculated odds ratio demonstrated that children injured <12 years were 3.7 times more likely to have a spine fusion (95% CI, 0.31-44.64).
  
  
  CONCLUSIONS
  There is a very high prevalence of neuromuscular scoliosis in pediatric SCI. Neurological level, motor level, and severity of injury are not strong predictors. Age is the only predictor of worst curve and spine fusion.
authors.affiliation: Jefferson School of Health Professions, Thomas Jefferson University , Philadelphia, Pennsylvania ; Shriners Hospitals for Children , Philadelphia, Pennsylvania.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mulcahey
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.forename: Nadia
authors.initials: N
authors.lastname: Barakat
authors.forename: Louis N
authors.initials: LN
authors.lastname: Hunter
keywords: neuromuscular scoliosis; outcomes; paraplegia; pediatric spinal cord injury; tetraplegia