- Discussion:
- preadolescents w/ spinal cord injury have > 95% prevalence of scoliosis & 50% of pts have a pelvic obliquity;
- progressive kyphoscoliosis results from effects of gravity & loss of spinal musculature;
- up to 2/3 of these patients will requre arthrodesis to prevent severe curve progression;
- Non Operative Treatment:
- no evidence that bracing delays or prevents deformity during adolescence;
- bracing may be helpful, in pts too young for surgery (10 yrs old);
- if bracing is to be used, avoid using the Milwaukee brace in neuromuscular patients, because patients may hang on the neck piece;
- Operative Treatment:
- delay surgery until pts are > 10 yrs old, unless pts progress w/ bracing;
- procedure of choice is anterior and posterior arthrodesis w/ fusion down to sacrum (because of pelvic obliquity);
- surgery has a high incidence of pseudoarthrosis and infection;
- Luque rodding:
- Luque rodding (w/ anterior discectomies ant + post fusion) is solid enough to avoid need for bracing (which is poorly tolerated in spastic pts)
Spine deformity subsequent to acquired childhood spinal cord injury.
Paralytic spinal deformity following traumatic spinal-cord injury in children and adolescents.