Scoliosis

Epidemiology

 

Scoliosis 10 to 15 x more common in patients with spastic quadriplegia than spastic diplegia

 

Typically

- spastic quadriplegic patient

- long C shaped curve

- lumbar apex

- progressive past maturity

- pelvic obliquity / dislocated or subluxed hips

- can extend into cervical spine

- high risk of respiratory compromise

 

Issues

 

Sitting in wheelchair

Hygiene

Respiratory problems

Feeding difficulties (can lose peg in abdominal folds)

 

Non operative Management

 

Options

 

Brace

- difficult to use

 

Modified chairs with supports

 

Operative Management

 

Indications 

 

Curves > 45º

Documented progression of >10º

Deterioration in function especially respiratory

 

Aims

 

Sitting balance

- level pelvis and shoulders

 

Surgery

 

Typically long instrumented posterior fusion

- proximal TP and pedicle hooks

- distal pedicle screws

- sublaminar wires to aid correction

 

Complications

 

Post operative pneumonia very high

- need to admit to ICU

 

Post operative ileus common

 

Infection rates high /  poor nutrition