Scoliosis in Adolescent Patients With Down Syndrome: Correlation Between Curve Magnitude and Functional Level.

Study Design: This is a retrospective, observational comparative study.

Objective: The aim of this study is to determine whether a relationship exists between the functional level and spinal deformity in patients with Down syndrome (DS).

Summary Of Background Data: Patients with DS have a higher incidence of scoliosis than the general population; however, it is unknown whether functional level influences the characteristics and severity of the deformity.

Materials And Methods: Of 649 patients with DS included in a pediatric referral center database, we identified 59 with a diagnosis of scoliosis (59.32% female; mean age, 14.19±1.82 y); the 46 patients who met the inclusion criteria comprised the study cohort. According to their functional gait skills and gross motor skills, they were classified into 2 levels. Different coronal and sagittal parameters were measured using full-spine standing radiographs. The need for surgical treatment and history of thoracotomy were recorded as well. Finally, a multivariate association analysis was performed between radiologic parameters and functional level.

Results: Twenty-two patients had a functional level consistent with level I and 24 with level II. Twelve curves were thoracic, 10 thoracolumbar, and 24 lumbar. A statistically significant relationship was found between functional level I and II and curve magnitude: 18.9 degrees (6.8) versus 36.9 degrees (20.3) ( P =0.001) with a cutoff point at 22.3 degrees (area under the curve=0.919, P <0.005, sensitivity=0.917 and specificity=0.818). The relationship between patients who required surgery and level II was also significant ( P =0.016). No relationship was found between functional level and coronal and sagittal balance, nor with other radiologic parameters or with curve location, or between the history of thoracotomy and thoracic curves.

Conclusions: DS adolescents with poorer functional level were associated with larger curves and greater risk for surgery. These findings may provide valuable guidance for the follow-up of scoliosis in patients with DS based on their functional level.

Level Of Evidence: Level III-retrospective comparative study.