Spinal Deformities and Autism Spectrum Disorders: A Systematic Review

Background: The function of the vertebral column is to support humans in upright positions, mechanically balance the stress of gravity, permit locomotion and assist in purposeful movements. The term “spinal deformity” includes conditions such as post-traumatic deformities, iper-kyphosis, iper-lordosis and idiopathic adolescent scoliosis. Severe spinal curvatures may be associated with adverse long-term health outcomes (e.g. pulmonary disorders, disability, back pain, psychological effects, and reduced quality of life). Early identification and effective treatment of mild scoliosis could slow or stop curvature progression before skeletal maturity, thereby improving long-term outcomes in adulthood. There is scientific evidence to support the value of spinal deformity screening in general population. This is true also for children with Autism Spectrum Disorder (ASD) for which untreated spinal deformity can interplay with impairments in fine and gross motor skills, motor planning, motor coordination and praxis.

Objectives: The aim of this systematic review is to critically describe the current knowledge on spinal deformities in ASD subjects in terms of prevalence, assessment methods and treatment.

Methods: The systematic review protocol was previously registered on the PROSPERO database (registration number CRD 42018100894). We conducted an extensive literature search in PubMed, CINAHL, PsycINFO, The Cochrane Library, and Scopus databases. We also considered grey literature sources such as: Opengray, Penn Libraries and International Society for Autism Research (INSAR) Congress archives. There were no restrictions on the types of study design eligible for inclusion, publication date or language. The main keywords used were: ASD, Autism, Autistic Disorder, Spinal deformities, Scoliosis and Spine.

Results: Following the PRISMA statement study selection process, we screened 2640 records after removing duplicates for eligibility. We found 11 eligible studies (figure 1). All of them were excluded because the main object was not pertinent to our aim. The main topics found were genetics, spinal surgery or surgery outcomes, since ASD is also used in the literature as the acronym for Adult Spine Deformity.

Conclusions: Spinal deformities appear to be an understudied topic within autism research. At present, in all the literature screened, there is no evidence on prevalence, assessment methodology and treatment of spinal deformities in ASD subjects. Since adolescent idiopathic scoliotic curves typically progress most rapidly during adolescent growth and clinical settings reveal it is possible to find developing ASD subjects presenting spinal deformities, it becomes relevant and important to conduct studies that verify the applicability of screening protocols in developing ASD subjects.