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Post-Polio Health (ISSN 1066-5331)

Vol. 8, No. 4, Fall 1992

 

Special Feature on Scoliosis, continued

 
Hook-rod systems

Variable hook-rod systems have been recently developed and successfully applied in idiopathic scoliosis. The most well-known is Cotrel-Dubousset instrumentation (CDI). Other systems are the Texas-Scottish Rite Hospital (TSRH also known as Danek) and Isola systems. These offer very good correction of the deformity in most cases, and, like the Luque-Galveston technique, often do not require brace or cast wear post-operatively. However, they may not be optimal for some curve patterns, for osteoporotic bone, or where significant pelvic obliquity exists, each of which is common in neuromuscular scoliosis. Because of the relatively fewer numbers of patients with post-polio scoliosis who are requiring spine surgery since the development of the last two techniques, neither of the two has been proven to be "best" for this condition

Anterior fusion

Anterior fusion may be indicated to improve curve correction or fusion rate. This is performed on the front of the spine, through an incision on the side of the chest and/or abdomen, sometimes accompanied by anterior instrumentation such as Zielke or TSRH. Anterior fusion necessitates the surgical removal of intervertebral disc material in the front of the spine, the placing of bone to facilitate fusion, and the subsequent healing together of the individual vertebrae.

Anterior instrumentation systems require screw placement into the vertebra, their interconnection with a rod, and the rotation and compression of the entire system to effect correction. Although
anterior instrumentation appeared to improve fusion rates and correction, it is often not necessary with the more recent posterior fixation techniques (Luque-Galveston, Cotrel-Dubousset, e tc.) . However, anterior fusion may still be recommended to improve correction or the likelihood of successful fusion.

A surgeon with experience with scoliosis secondary to poliomyelitis and similar neuromuscular disorders should recommend the technique he or she feels is most appropriate for the particular curve
pattern being addressed. The patient should feel free to inquire about and understand the rationale for selecting the recommended technique.

Risks of surgery

Risks of surgery and potential complications are of concern for those contemplating surgical correction and stabilization of their scoliosis. Paralysis and death, the two most devastating complications, are quite rare, unless, for the latter, the person has
an extremely compromised cardiopulmonary system. Patients with severe pulmonary involvement may need to be on a respirator for prolonged periods of time. Some experts may recommend a tracheostomy to facilitate pulmonary care and weaning from the respirator, but this is rarely necessary today.

Other possible complications include infection, pseudarthrosis (failure of fusion), instrumentation failure, loss of correction, complications of anesthesia, thromboembolic phenomenon (phlebitis or blood clots traveling to the lungs, the latter of which can be fatal), cardiac and pulmonary complications (including heart attack or pneumonia), need for additional ambulatory aids, and etc. The likelihood of any specific complication occurring in a particular patient, depends of course, upon that patient, including their cardiopulmonary status, curve magnitude, previous surgery, and other underlying medical conditions. These should be
discussed on an individual basis with the surgeon.

Conclusion

Spine fusion which is performed to correct or prevent progression of a curved spine, immobilize
degenerated segments of the spine, or stabilize a collapsing spine for improvement of function is
often successful in poliomyelitis patients. Clearly the goals of surgery should be discussed carefully
prior to surgery – it should be understood, for example, that complete curve correction is not the
goal and indeed, not preferable. An arthritic spine may be fused but the aging process affects the
entire spine and lesser amounts of pain may be present post-operatively from these sources.

Because of the improvement in surgical techniques and advances in instrumentation, the amount of
surgical correction gained and maintained has been markedly improved in the last two decades. More importantly, solid fusion is more commonly achieved with current techniques. Overall, the
polio survivor with scoliosis who is determined to need surgery can look forward to a high likelihood
of successful surgical treatment.


RESOURCES

The Scoliosis Association, Inc., P.O. Box 51353, Raleigh, NC, 27609 (919-846-2639) will send
"Scoliosis, a Fact Sheet and Home Screening Test," to anyone who sends a business size, self-addressed, stamped envelope. It is also available in Spanish. The Association offers membership to individuals and families for $12.00 and to corporations, businesses, and institutions for $30.00. Membership entitles you to receive Backtalk, which is published several times each year.

Scoliosis Research Society, 222 S. Prospect Ave., Park Ridge, 1L 60068 (708-698-1627). If you call or write, the Society will provide the names of Board Certified orthopedic surgeons specializing in scoliosis in your area.

National Scoliosis Foundation, 72 Mount Auburn St., Watertown, MA 02172 (617-926-
0397). The Foundation has prepared packets of information for parents of children with scoliosis,
for adults with scoliosis, and for health professionals. In addition to the packets, pamphlets and a
newsletter are also available.


REFERENCES

Bonnett, C. et al. Evolution of Treatment of Paralytic Scoliosis at Rancho Los Amigos Hospital. J. Bone and Joint Surg. 57A(2):206-215. 1975.

Bradford, D.S. Neuromuscular Spinal Deformity. Moe's Textbook of Scoliosis. Ch. 13. ed. Bradford, D.S. et al. W.B. Saunders, 1976. p. 271-305. (A new edition is being prepared.)

Broom, J. J. et al. Spinal Fusion Augmented by Luque-Rod Segmental Instrumentation for Neuromuscular Scoliosis. J. Bone Joint Surg. 71A(1):32-44. 1989.

Swank, S.M., Winter, R.B. and Moe, J.H. Scoliosis and Cor Pulmonale. Spine 7(4)343-354. 1982.


A Friend Remembered

In 1923, when she was two, Hope Thornson contracted polio which affected her arm, legs,
and throat. After years of therapy and surgery she recovered almost completely and established the
first professional department of social work at Temple University Hospital in Philadelphia.

During an interview in 1990 on National Public Radio, she related her polio experience and recalled her dread of walking down the long hallway at Temple. She equally disliked waiting for the elevator. The problem of standing or walking indicated to her something was wrong with her legs.

Over the years she went "from doctor to doctor, being told that no thing was wrong." The last thing
she expected in retirement was not to be active. "I was going to be such a political activist, pushing for reforms in social work. Now I am in bed more and more hours a day, hire an attendant part- time, and use creative assistive devices. You become determined that you can't afford attendants all of the time and determined that you are going to be independent."

Hope Thomson died March 27,1991, and was remembered at a service in appreciation of her life
as a woman of integrity, courage, warmth, humor, and compassion.

Intemational Polio Network is grateful to Hope for remembering the organization in her will. Her contribution will assist us in fulfilling our mission – supporting the independent living, self-direction,
dignity, and personal achievement of people with disabilities everywhere.

 

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