The Outcome of Scoliosis Surgery in the Severely Physically Handicapped Child

Abstract

STUDY DESIGN: A prospective, functional assessment based on physical ability and independence in daily activities was performed of patients who had severe physical handicaps and spinal deformities and were undergoing scoliosis surgery. OBJECTIVES: To determine whether improving spinal alignment and truncal balance improved the functional abilities of handicapped patients. SUMMARY OF BACKGROUND DATA: Loss of truncal stability compromises the physical independence of children who are severely handicapped. Physiologic function also may be compromised. It is not clear whether improving truncal balance actually improves their level of independence or merely halts further deterioration. METHODS: Twenty patients with significant physical handicaps resulting from neuromuscular disorders or multiple congenital anomalies and significant spinal deformity and truncal imbalance were treated surgically to realign and stabilize their spines. Their level of physical independence was evaluated before surgery, including their ability to sit, ambulate, and complete activities of daily living. Evaluation was done before surgery, 6 months after surgery, and 12 months after surgery. A subjective assessment of cosmesis also was made. RESULTS: Corrective spinal surgery resulted in a deterioration of physical ability for the first 6 months. Most patients subsequently returned to their preoperative level of function. An improvement of function exceeding their preoperative level was not seen after 12 months. The cosmetic results of surgery were excellent. CONCLUSIONS: Corrective spinal surgery in patients with severe physical handicap should be performed early to preserve function and should not be dictated solely by the severity of the curvature. Improvement in the patient's level of independence may not necessarily occur after truncal stabilization. Cosmetic results in these patients with severe disabilities were extremely gratifying to the patients and their caregivers.