Resident Physician Lahey Hospital and Medical Center Woburn, Massachusetts, United States
Introduction: To investigate risk factors for progression of deformity in pediatric congenital cervical scoliosis (CCS) and evaluate the correlation between congenital cervical curves and compensatory thoracic and lumbar curves.
Methods: Medical records were retrospectively reviewed for 38 pediatric patients with CCS with minimum 2-year follow-up. Curve progression was defined as >10˚ increase in cervical coronal curve angle between presentation and last follow-up. Patients were stratified by progression status and compared using Student-t tests, Cohen’s d, risk ratios, and bivariate Pearson correlation. Significance was set to p< 0.05.
Results: 38 patients (16 girls, 22 boys) met criteria for inclusion with a mean age at presentation of 5.6 ± 4.1 years. Sixteen patients (42%) had curve progression with a mean follow-up of 3.1 ± 3.0 years. The apex of deformity was most commonly C5 (32%) with a mean cervical curve of 16.3˚ ± 18.1˚. At presentation, T1 slope was significantly larger among children with progressive deformities (p=0.041). No other measured parameters achieved significance; however, additional metrics approaching significance included lower C2 sagittal vertical axis translation at initial presentation (p=0.053), lower thoracic coronal curve angles (p=0.063), and greater lumbar lordosis (0.056) at last follow-up. 18 of 38 patients with only cervical spine deformity were then selected for sub-analysis to evaluate progression of compensatory curves. Cervical major coronal curves were found to significantly correlate with lumbar major coronal curves (r = 0.409), C2-central sacral vertical line (CSVL) (r = 0.407), and C7-CSVL (r = 0.403), p < 0.05. Thoracic major coronal curves did not significantly correlate with cervical major coronal curves (r = 0.218, p > 0.05). Thoracic and lumbar curve magnitudes did correlate with each other (r = 0.377, p < 0.05).
Conclusion : 42% of osseous CCS curves progressed over time in the overall cohort and high initial T1 slope was found to be most highly correlated with progression of cervical deformity. Cervical major coronal curves significantly correlated with lumbar curve magnitude but not thoracic curve size in isolated CCS, possibly due to increased flexibility of the lumbar spine which may allow greater compensatory balance and thus have a greater correlation with cervical curve magnitude and progression.
