The Journal of Bone and Joint Surgery, Vol 64, Issue 6 841-856, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
Surgical treatment of paralytic scoliosis associated with myelomeningocele
WR Osebold, JK Mayfield, RB Winter and JH Moe
The spines of forty patients with myelomeningocele and paralytic scoliosis
were surgically stabilized at the Twin Cities Scoliosis Center between 1960
and 1979. Treatment with posterior spine fusion and Harrington
instrumentation extending to the sacrum, combined with anterior fusion
using either Dwyer or Zielke instrumentation, gave the best results,
correcting scoliosis by an average of 45 degrees (comparing preoperative
values with those at the last visit), lordosis by an average of 20 degrees,
torso decompensation by an average of 5.7 centimeters, and pelvic obliquity
by an average of 7 degrees. This combined fusion method reduced the rate of
pseudarthrosis to 23 per cent (compared with 46 per cent when only
posterior fusion and instrumentation were used). Prophylactic antibodies
(selected on the basis of preoperative cultures of urine) reduced the
infection rate to 8 per cent. Posterior fusion or anterior fusion alone was
inadequate, even with instrumentation. Early mobilization wearing a
bivalved polypropylene body jacket minimized osteoporosis, pressure sores,
and social isolation. Unsolved technical problems remain, however,
especially in relation to obtaining fusion across the lumbosacral joint.
CiteULike 
Connotea 
Del.icio.us 
Technorati What's this?
