The Journal of Bone and Joint Surgery, Vol 70, Issue 5 696-703, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Failure of fixation after segmental spinal instrumentation without arthrodesis in the management of paralytic scoliosis
CF Eberle
King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
Between April and October 1981, nineteen children who were between five and
twelve years old (median age, seven years), and who had severe paralytic
scoliosis secondary to poliomyelitis, were treated by segmental spinal
instrumentation without arthrodesis. Three patients could not be followed,
and the cases of the remaining sixteen patients were reviewed in April
1984. In fifteen patients, the implant system had failed to control the
deformity. In six patients, the rods had fractured at the apex of the
original deformity; in five, longitudinal shift of the rods had allowed
recurrence of the deformity; and in four, the short limb of one or both of
the L-shaped rods had rotated out of the pelvis and perforated the skin,
resulting in an infection that necessitated removal of the rods. At the
time of the review, the deformity was essentially the same as before the
original instrumentation in all but the sixteenth patient, in whom failure
had not occurred. The instrumented vertebrae had grown measurably in some
of the patients, but spontaneous fusion--particularly in the thoracic
spine--was observed when the rods were removed. This finding indicates
that, using presently available materials, segmental instrumentation of the
spine without arthrodesis does not effectively control paralytic scoliosis
secondary to poliomyelitis in a growing child.
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