Lumbar Spondylolysis in Ambulant Children with Spastic Cerebral Palsy

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Objectives: Lumbar spondylolysis is a common condition; nonetheless, its cause in patients with spastic cerebral palsy (CP) remains unknown. Furthermore, examination of children with CP may not accurately capture complaints, thus causing diseases to be overlooked. Understanding the clinical features and gait patterns of lumbar spondylolysis in CP can aid in diagnosis. This study aimed to identify the clinical features and specific gait patterns of lumbar spondylolysis in ambulatory children with CP.

Methods: Seventy-three children with CP were divided into two groups according to the presence or absence of lumbar spondylolysis on X-ray and magnetic resonance imaging. Three-dimensional gait analysis (3DGA) was performed to evaluate the kinematic data of the lower limbs.

Results: Eight participants (11.4%) had lumbar spondylolysis primarily affecting the L5 vertebra. The lumbar spondylolysis group had a higher body weight and Body Mass Index, along with a smaller left popliteal angle on the spastic side. In 3DGA, detailed kinematic data indicated significant group differences in the mean angles of hip internal rotation (39.6° vs. 20.2°) during an entire gait cycle. The gait profile score was 19.7° in the lumbar spondylolysis group and 14.9° in the spinal uninvolved group; the difference in gait profile score between the two groups showed a minimal clinically important difference of 2.75.

Conclusions: The overall gait profile score revealed that the gait of the lumbar spondylolysis group was deteriorated. Excessive internal rotation of the hip during gait might be a contributing factor to lumbar spondylolysis in children with CP.