Natural History of Scoliosis in the Institutionalized Adult Cerebral Palsy Population

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Abstract
Fifty-six adult residents with cerebral palsy and significant scoliosis or kyphosis at the Hazelwood Center in Louisville, Kentucky were studied periodically using radiographs to assess the degree of scoliosis, kyphosis, and pelvic obliquity and by clinical evaluation to assess functional status and skin condition. This study followed the natural history of untreated scoliosis to determine whether a decline in functional status is related to curve progression and whether the development of decubiti is associated with the degree of pelvic obliquity. Identifying the factors that affect functional decline may help develop treatment plans to minimize it. Significant structural deformities of the spine often accompany cerebral palsy. Despite the relatively large number of cases, 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 cardiopulmonary compromise, but few studies have been done to verify this. Single-factor analysis of variance was used to compare the curve progression rate within groups based on the structure of the curve, 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 obliquity and the size of the final curve with the presence or absence of decubiti. Functionally, 10 patients (18%) declined during the course of the study. In these 10 patients, the average initial curve was 41.1°, the average final curve was 80.6°, and the average progression rate was 4.4° per year. For the stable patients, the average initial curve was 33.9°, the average final curve was 56.5°, and the average progression rate was 3.0° 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 averaged 106°, and their pelvic obliquity measured 45°, both of which were significantly higher than those of the patients without decubiti. The results of the present study demonstrate that in the adult patient with cerebral palsy and scoliosis, a definite correlation exists between deformity size and functional decline and decubiti. Progression rate also seems to be a factor in functional decline. Additional studies are needed to determine whether surgical intervention will halt or reverse this decline.