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