{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:52:49Z","timestamp":1775148769495,"version":"3.50.1"},"reference-count":48,"publisher":"American Spinal Injury Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022]]},"abstract":"\n Background:<\/jats:title>\n Acute flaccid myelitis (AFM) is an anterior horn disorder that manifests as rapid onset muscle weakness or paralysis. Development of scoliosis in pediatric AFM patients has been anecdotally reported, but associated risk factors or incidence have yet to be determined.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Pediatric AFM patients treated over a 10-year period at a tertiary care center were identified. Patients were considered to have scoliosis if there was radiographic evidence of coronal curvature \u226515 degrees. Number of limbs affected, independent ambulation and head control, ventilator requirement at initial admission, and long-term ventilatory support (\u22651 year) were recorded. Muscle strength and functional status were assessed by manual muscle testing (MMT) and Physical Abilities and Mobility Scale (PAMS), respectively. Areas of spinal cord lesion on initial MRI were recorded. Bivariate analyses were performed, with alpha set to 0.05.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Fifty-six AFM patients (27 scoliosis, 29 no scoliosis) were identified. Mean time from AFM presentation to scoliosis diagnosis was 0.93 years. Mean major Cobb angle at first radiograph was 31.7 \u00b1 14.3 degrees. Lack of independent ambulation, ventilator dependence at time of admission or long term, number of limbs affected, and decreased MMT and PAMS scores were more common in patients who developed scoliosis (all,\n p<\/jats:italic>\n < .05). Patients who developed scoliosis had more extensive thoracic spinal cord involvement on initial MRI (\n p<\/jats:italic>\n = .03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n AFM patients who develop scoliosis are more likely to be ventilator dependent, lack independent ambulation, and have more extensive thoracic SCI.<\/jats:p>\n <\/jats:sec>","DOI":"10.46292\/sci21-00017","type":"journal-article","created":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T12:59:19Z","timestamp":1629723559000},"page":"34-41","source":"Crossref","is-referenced-by-count":3,"title":["Scoliosis in Pediatric Patients With Acute Flaccid Myelitis"],"prefix":"10.46292","volume":"28","author":[{"given":"Krishna V.","family":"Suresh","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Karius","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Sadowsky","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland"},{"name":"International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul D.","family":"Sponseller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"25425","reference":[{"issue":"9","key":"i1945-5763-28-1-34-b1","series-title":"Viruses","doi-asserted-by":"publisher","DOI":"10.3390\/v11090821","article-title":"Understanding enterovirus d68-induced neurologic disease: A basic science review","volume":"11","year":"2019","unstructured":"Hixon\n AM,\n \n \n Frost\n J,\n \n \n Rudy\n MJ,\n \n \n Messacar\n K,\n \n \n Clarke\n P,\n \n \n Tyler\n KL.\n \n \n Understanding enterovirus d68-induced neurologic disease: A basic science review.\n\t\t\t\t\tViruses.\n\t\t\t\t\t2019;\n\t\t\t\t\t11(\n\t\t\t\t\t9).\n\t\t\t\t\tdoi:10.3390\/v11090821"},{"key":"i1945-5763-28-1-34-b2","article-title":"AFM cases and outbreaks","unstructured":"Centers for Disease Control and Prevention.\n \n AFM cases and outbreaks.\n\t\t\t\t\tAccessed January 12, 2021. https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/cases-in-us.html"},{"issue":"3","key":"i1945-5763-28-1-34-b3","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1002\/ana.24730","article-title":"Acute flaccid myelitis: A clinical review of US cases 2012\u20132015","volume":"80","year":"2016","unstructured":"Messacar\n K,\n \n \n Schreiner\n TL,\n \n \n Van Haren\n K,\n \n \n .\n\t\t\t\t\tAcute flaccid myelitis: A clinical review of US cases 2012\u20132015.\n\t\t\t\t\tAnn Neurol.\n\t\t\t\t\t2016;\n\t\t\t\t\t80(\n\t\t\t\t\t3):\n\t\t\t\t\t326\u2013\n\t\t\t\t\t338.\n\t\t\t\t\tdoi:10.1002\/ana.24730"},{"issue":"10271","key":"i1945-5763-28-1-34-b4","series-title":"Lancet (London, England)","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/S0140-6736(20)32723-9","article-title":"Acute flaccid myelitis: cause, diagnosis, and management","volume":"397","year":"2021","unstructured":"Murphy\n OC,\n \n \n Messacar\n K,\n \n \n Benson\n L,\n \n \n .\n\t\t\t\t\tAcute flaccid myelitis: cause, diagnosis, and management.\n\t\t\t\t\tLancet (London, England).\n\t\t\t\t\t2021;\n\t\t\t\t\t397(\n\t\t\t\t\t10271):\n\t\t\t\t\t334\u2013\n\t\t\t\t\t346.\n\t\t\t\t\tdoi:10.1016\/S0140-6736(20)32723-9"},{"issue":"3","key":"i1945-5763-28-1-34-b5","series-title":"J Pediatr Rehabil Med","doi-asserted-by":"publisher","first-page":"245","DOI":"10.3233\/PRM-180549","article-title":"Acute flaccid myelitis: Rehabilitation challenges and outcomes in a pediatric cohort","volume":"12","year":"2019","unstructured":"Melicosta\n ME,\n \n \n Dean\n J,\n \n \n Hagen\n K,\n \n \n .\n\t\t\t\t\tAcute flaccid myelitis: Rehabilitation challenges and outcomes in a pediatric cohort.\n\t\t\t\t\tJ Pediatr Rehabil Med.\n\t\t\t\t\t2019;\n\t\t\t\t\t12(\n\t\t\t\t\t3):\n\t\t\t\t\t245\u2013\n\t\t\t\t\t253.\n\t\t\t\t\tdoi:10.3233\/PRM-180549"},{"issue":"2","key":"i1945-5763-28-1-34-b6","series-title":"J Pediatr Orthop","first-page":"214","article-title":"Scoliosis in pediatric spinal cord-injured patients","volume":"10","year":"1990","unstructured":"Dearolf\n WW\n 3rd,\n \n \n Betz\n RR,\n \n \n Vogel\n LC,\n \n \n Levin\n J,\n \n \n Clancy\n M,\n \n \n Steel\n HH.\n \n \n Scoliosis in pediatric spinal cord-injured patients.\n\t\t\t\t\tJ Pediatr Orthop.\n\t\t\t\t\t1990;\n\t\t\t\t\t10(\n\t\t\t\t\t2):\n\t\t\t\t\t214\u2013\n\t\t\t\t\t218."},{"issue":"2","key":"i1945-5763-28-1-34-b7","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"185","DOI":"10.3171\/2014.10.SPINE14185","article-title":"Management of spinal cord injury-related scoliosis using pedicle screw-only constructs","volume":"22","year":"2015","unstructured":"Hwang\n SW,\n \n \n Safain\n MG,\n \n \n King\n JJ,\n \n \n .\n\t\t\t\t\tManagement of spinal cord injury-related scoliosis using pedicle screw-only constructs.\n\t\t\t\t\tJ Neurosurg Spine.\n\t\t\t\t\t2015;\n\t\t\t\t\t22(\n\t\t\t\t\t2):\n\t\t\t\t\t185\u2013\n\t\t\t\t\t191.\n\t\t\t\t\tdoi:10.3171\/2014.10.SPINE14185"},{"issue":"2","key":"i1945-5763-28-1-34-b8","series-title":"Top Spinal Cord Inj Rehabil","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1310\/sci1902-96","article-title":"Neuromuscular scoliosis in children with spinal cord injury","volume":"19","year":"2013","unstructured":"Mulcahey\n MJ,\n \n \n Gaughan\n JP,\n \n \n Betz\n RR,\n \n \n Samdani\n AF,\n \n \n Barakat\n N,\n \n \n Hunter\n LN.\n \n \n Neuromuscular scoliosis in children with spinal cord injury.\n\t\t\t\t\tTop Spinal Cord Inj Rehabil.\n\t\t\t\t\t2013;\n\t\t\t\t\t19(\n\t\t\t\t\t2):\n\t\t\t\t\t96\u2013\n\t\t\t\t\t103.\n\t\t\t\t\tdoi:10.1310\/sci1902-96"},{"issue":"2","key":"i1945-5763-28-1-34-b9","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1097\/01241398-198403000-00008","article-title":"Scoliosis and trunk muscles","volume":"4","year":"1984","unstructured":"Duval-Beaup\u00e8re\n G,\n \n \n Lespargot\n A,\n \n \n Grossiord\n A.\n \n \n Scoliosis and trunk muscles.\n\t\t\t\t\tJ Pediatr Orthop.\n\t\t\t\t\t1984;\n\t\t\t\t\t4(\n\t\t\t\t\t2):\n\t\t\t\t\t195\u2013\n\t\t\t\t\t200.\n\t\t\t\t\tdoi:10.1097\/01241398-198403000-00008"},{"key":"i1945-5763-28-1-34-b10","series-title":"Encyclopedia of epidemiology.","doi-asserted-by":"publisher","DOI":"10.4135\/9781412953948.n93","article-title":"Revision to the standardized case definition, case classification, and public health reporting for acute flaccid myelitis","unstructured":"DeBolt\n C,\n \n \n Vogt\n M.\n \n \n Revision to the standardized case definition, case classification, and public health reporting for acute flaccid myelitis.\n\t\t\t\t\tIn:BoslaughS,\n\t\t\t\t\ted.Encyclopedia of epidemiology.SAGE Publications.\n\t\t\t\t\tdoi:10.4135\/9781412953948.n93"},{"issue":"7","key":"i1945-5763-28-1-34-b11","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1016\/j.apmr.2012.12.004","article-title":"Physical Abilities and Mobility Scale: reliability and validity in children receiving inpatient rehabilitation for acquired brain injury","volume":"94","year":"2013","unstructured":"Trovato\n MK,\n \n \n Bradley\n E,\n \n \n Slomine\n BS,\n \n \n Salorio\n CF,\n \n \n Christensen\n JR,\n \n \n Suskauer\n SJ.\n \n \n Physical Abilities and Mobility Scale: reliability and validity in children receiving inpatient rehabilitation for acquired brain injury.\n\t\t\t\t\tArch Phys Med Rehabil.\n\t\t\t\t\t2013;\n\t\t\t\t\t94(\n\t\t\t\t\t7):\n\t\t\t\t\t1335\u2013\n\t\t\t\t\t1341.\n\t\t\t\t\tdoi:10.1016\/j.apmr.2012.12.004"},{"issue":"4","key":"i1945-5763-28-1-34-b12","series-title":"Top Spinal Cord Inj Rehabil","doi-asserted-by":"publisher","first-page":"275","DOI":"10.46292\/sci20-00010","article-title":"Improvements in function following inpatient activity-based therapy for children with acute flaccid myelitis","volume":"26","year":"2020","unstructured":"Hagen\n K,\n \n \n Porter\n C,\n \n \n Martin\n R,\n \n \n Dean\n J,\n \n \n Salorio\n C,\n \n \n Sadowsky\n C.\n \n \n Improvements in function following inpatient activity-based therapy for children with acute flaccid myelitis.\n\t\t\t\t\tTop Spinal Cord Inj Rehabil.\n\t\t\t\t\t2020;\n\t\t\t\t\t26(\n\t\t\t\t\t4):\n\t\t\t\t\t275\u2013\n\t\t\t\t\t282.\n\t\t\t\t\tdoi:10.46292\/sci20-00010"},{"issue":"5","key":"i1945-5763-28-1-34-b13","series-title":"J Head Trauma Rehabil","article-title":"The Physical Abilities and Mobility Scale","volume":"21","year":"2006","unstructured":"Suskauer\n S,\n \n \n Slomine\n B,\n \n \n Salorio\n C,\n \n \n .\n\t\t\t\t\tThe Physical Abilities and Mobility Scale.\n\t\t\t\t\tJ Head Trauma Rehabil.\n\t\t\t\t\t2006;\n\t\t\t\t\t21(\n\t\t\t\t\t5). \n\t\t\t\t\thttps:\/\/journals.lww.com\/headtraumarehab\/Fulltext\/2006\/09000\/The_Physical_Abilities_and_Mobility_Scale.31.aspx"},{"key":"i1945-5763-28-1-34-b14","series-title":"Chiropr Osteopat","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1746-1340-15-4","article-title":"On the reliability and validity of manual muscle testing: A literature review","volume":"15","year":"2007","unstructured":"Cuthbert\n SC,\n \n \n Goodheart\n GJJ.\n \n \n On the reliability and validity of manual muscle testing: A literature review.\n\t\t\t\t\tChiropr Osteopat.\n\t\t\t\t\t2007;\n\t\t\t\t\t15:\n\t\t\t\t\t4.\n\t\t\t\t\tdoi:10.1186\/1746-1340-15-4"},{"issue":"50","key":"i1945-5763-28-1-34-b15","series-title":"J Vis Exp","doi-asserted-by":"publisher","DOI":"10.3791\/2632","article-title":"Manual muscle testing: A method of measuring extremity muscle strength applied to critically ill patients","year":"2011","unstructured":"Ciesla\n N,\n \n \n Dinglas\n V,\n \n \n Fan\n E,\n \n \n Kho\n M,\n \n \n Kuramoto\n J,\n \n \n Needham\n D.\n \n \n Manual muscle testing: A method of measuring extremity muscle strength applied to critically ill patients.\n\t\t\t\t\tJ Vis Exp.\n\t\t\t\t\t2011; (\n\t\t\t\t\t50).\n\t\t\t\t\tdoi:10.3791\/2632"},{"issue":"7","key":"i1945-5763-28-1-34-b16","series-title":"J Arthroplasty","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1016\/j.arth.2018.01.059","article-title":"Evidence-based thresholds for the volume and length of stay relationship in total hip arthroplasty: Outcomes and economies of scale","volume":"33","year":"2018","unstructured":"Ramkumar\n PN,\n \n \n Navarro\n SM,\n \n \n Frankel\n WC,\n \n \n Haeberle\n HS,\n \n \n Delanois\n RE,\n \n \n Mont\n MA.\n \n \n Evidence-based thresholds for the volume and length of stay relationship in total hip arthroplasty: Outcomes and economies of scale.\n\t\t\t\t\tJ 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stratum-specific likelihood ratios with the analysis of ROC curves","volume":"13","year":"1993","unstructured":"Peirce\n JC,\n \n \n Cornell\n RG.\n \n \n Integrating stratum-specific likelihood ratios with the analysis of ROC curves.\n\t\t\t\t\tMed Decis Mak an Int J Soc Med Decis Mak.\n\t\t\t\t\t1993;\n\t\t\t\t\t13(\n\t\t\t\t\t2):\n\t\t\t\t\t141\u2013\n\t\t\t\t\t151.\n\t\t\t\t\tdoi:10.1177\/0272989X9301300208"},{"issue":"1","key":"i1945-5763-28-1-34-b19","series-title":"J Child Orthop","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11832-012-0457-4","article-title":"Epidemiology of adolescent idiopathic scoliosis","volume":"7","year":"2013","unstructured":"Konieczny\n MR,\n \n \n Senyurt\n H,\n \n \n Krauspe\n R.\n \n \n Epidemiology of adolescent idiopathic scoliosis.\n\t\t\t\t\tJ Child 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Orthop.\n\t\t\t\t\t1993;\n\t\t\t\t\t13(\n\t\t\t\t\t4):\n\t\t\t\t\t478\u2013\n\t\t\t\t\t488.\n\t\t\t\t\tdoi:10.1097\/01241398-199307000-00012"},{"issue":"1","key":"i1945-5763-28-1-34-b24","series-title":"J Bone Joint Surg Am","first-page":"24","article-title":"The patterns of spinal deformity in Duchenne muscular dystrophy","volume":"58","year":"1976","unstructured":"Wilkins\n KE,\n \n \n Gibson\n DA.\n \n \n The patterns of spinal deformity in Duchenne muscular dystrophy.\n\t\t\t\t\tJ Bone Joint Surg Am.\n\t\t\t\t\t1976;\n\t\t\t\t\t58(\n\t\t\t\t\t1):\n\t\t\t\t\t24\u2013\n\t\t\t\t\t32."},{"issue":"9","key":"i1945-5763-28-1-34-b1","series-title":"Viruses","doi-asserted-by":"publisher","DOI":"10.3390\/v11090821","article-title":"Understanding enterovirus d68-induced neurologic disease: A basic science review","volume":"11","year":"2019","unstructured":"Hixon\n AM,\n \n \n Frost\n J,\n \n \n Rudy\n MJ,\n \n \n Messacar\n K,\n \n \n Clarke\n P,\n \n \n Tyler\n KL.\n \n \n Understanding enterovirus d68-induced neurologic disease: A basic science review.\n\t\t\t\t\tViruses.\n\t\t\t\t\t2019;\n\t\t\t\t\t11(\n\t\t\t\t\t9).\n\t\t\t\t\tdoi:10.3390\/v11090821"},{"key":"i1945-5763-28-1-34-b2","article-title":"AFM cases and outbreaks","unstructured":"Centers for Disease Control and Prevention.\n \n AFM cases and outbreaks.\n\t\t\t\t\tAccessed January 12, 2021. https:\/\/www.cdc.gov\/acute-flaccid-myelitis\/cases-in-us.html"},{"issue":"3","key":"i1945-5763-28-1-34-b3","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1002\/ana.24730","article-title":"Acute flaccid myelitis: A clinical review of US cases 2012\u20132015","volume":"80","year":"2016","unstructured":"Messacar\n K,\n \n \n Schreiner\n TL,\n \n \n Van Haren\n K,\n \n \n .\n\t\t\t\t\tAcute flaccid myelitis: A clinical review of US cases 2012\u20132015.\n\t\t\t\t\tAnn Neurol.\n\t\t\t\t\t2016;\n\t\t\t\t\t80(\n\t\t\t\t\t3):\n\t\t\t\t\t326\u2013\n\t\t\t\t\t338.\n\t\t\t\t\tdoi:10.1002\/ana.24730"},{"issue":"10271","key":"i1945-5763-28-1-34-b4","series-title":"Lancet (London, England)","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/S0140-6736(20)32723-9","article-title":"Acute flaccid myelitis: cause, diagnosis, and management","volume":"397","year":"2021","unstructured":"Murphy\n OC,\n \n \n Messacar\n K,\n \n \n Benson\n L,\n \n \n .\n\t\t\t\t\tAcute flaccid myelitis: cause, diagnosis, and management.\n\t\t\t\t\tLancet (London, England).\n\t\t\t\t\t2021;\n\t\t\t\t\t397(\n\t\t\t\t\t10271):\n\t\t\t\t\t334\u2013\n\t\t\t\t\t346.\n\t\t\t\t\tdoi:10.1016\/S0140-6736(20)32723-9"},{"issue":"3","key":"i1945-5763-28-1-34-b5","series-title":"J Pediatr Rehabil Med","doi-asserted-by":"publisher","first-page":"245","DOI":"10.3233\/PRM-180549","article-title":"Acute flaccid myelitis: Rehabilitation challenges and outcomes in a pediatric 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MA.\n \n \n Evidence-based thresholds for the volume and length of stay relationship in total hip arthroplasty: Outcomes and economies of scale.\n\t\t\t\t\tJ Arthroplasty.\n\t\t\t\t\t2018;\n\t\t\t\t\t33(\n\t\t\t\t\t7):\n\t\t\t\t\t2031\u2013\n\t\t\t\t\t2037.\n\t\t\t\t\tdoi:10.1016\/j.arth.2018.01.059"},{"key":"i1945-5763-28-1-34-b17","series-title":"Surg Technol Int","first-page":"415","article-title":"Stratum-specific likelihood ratio analysis: An evidence-based and pragmatic approach to meaningful thresholds in lower extremity arthroplasty","volume":"34","year":"2019","unstructured":"Navarro\n SM,\n \n \n Haeberle\n HS,\n \n \n Mont\n MA,\n \n \n Krebs\n V,\n \n \n Ramkumar\n PN.\n \n \n Stratum-specific likelihood ratio analysis: An evidence-based and pragmatic approach to meaningful thresholds in lower extremity arthroplasty.\n\t\t\t\t\tSurg Technol 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Senyurt\n H,\n \n \n Krauspe\n R.\n \n \n Epidemiology of adolescent idiopathic scoliosis.\n\t\t\t\t\tJ Child Orthop.\n\t\t\t\t\t2013;\n\t\t\t\t\t7(\n\t\t\t\t\t1):\n\t\t\t\t\t3\u2013\n\t\t\t\t\t9.\n\t\t\t\t\tdoi:10.1007\/s11832-012-0457-4"},{"issue":"3","key":"i1945-5763-28-1-34-b20","series-title":"Prosthet Orthot Int","doi-asserted-by":"publisher","first-page":"202","DOI":"10.3109\/03093649709164558","article-title":"Scoliosis in Duchenne muscular dystrophy: Aspects of orthotic treatment","volume":"21","year":"1997","unstructured":"Heller\n KD,\n \n \n Forst\n R,\n \n \n Forst\n J,\n \n \n Hengstler\n K.\n \n \n Scoliosis in Duchenne muscular dystrophy: Aspects of orthotic treatment.\n\t\t\t\t\tProsthet Orthot Int.\n\t\t\t\t\t1997;\n\t\t\t\t\t21(\n\t\t\t\t\t3):\n\t\t\t\t\t202\u2013\n\t\t\t\t\t209.\n\t\t\t\t\tdoi:10.3109\/03093649709164558"},{"issue":"1","key":"i1945-5763-28-1-34-b21","series-title":"Bone Joint 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