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Symptomatic cervical spinal stenosis in spastic cerebral palsy.

TitleSymptomatic cervical spinal stenosis in spastic cerebral palsy.
Publication TypeJournal Article
Year of Publication2020
AuthorsHung CWai, Matsumoto H, Ball JR, Plachta S, Dutkowsky JP, Kim H, Hyman JE, K Riew D, Roye DP
JournalDev Med Child Neurol
Volume62
Issue10
Pagination1147-1153
Date Published2020 10
ISSN1469-8749
KeywordsAdolescent, Adult, Aged, Cerebral Palsy, Cervical Vertebrae, Comorbidity, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Muscle, Skeletal, Prevalence, Spinal Stenosis, Young Adult
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.

DOI10.1111/dmcn.14607
Alternate JournalDev Med Child Neurol
PubMed ID32639039