Orthopedics - Oleksa A.P. 2006

Scoliosis
Paralytic Scoliosis

Paralytic Scoliosis most commonly occurs in children following poliomyelitis. Typically, it manifests clinically during the recovery phase of the disease As a result of Muscle imbalance between paralyzed Muscles and those that have retained or regained their innervation. Occasionally, spinal curvature develops during the acute phase due to paralysis of the deep muscles and spinal rotators, which can lead to double or even triple curves (Bogdanov, F.R., 1968).

The spinal curvature progresses under METABOLISM/18.html">The Influence of static loading and asymmetric vertebral growth. In turn, asymmetric growth combined with spinal mobility causes Torsion of the underlying vertebrae. In the primary curve, rotation occurs clockwise with concomitant antetorsion in right-sided curvatures, and counterclockwise in left-sided curvatures.

Myographic examinations reveal pronounced Asymmetry in the parameters of the oblique Abdominal muscles, erector spinae, quadratus lumborum, and occasionally the Muscles of the lower extremities.

Bogdanov, F.R. (1968) identifies the following types of poliomyelitic scoliosis:

1) paralytic scoliosis associated with widespread muscle paralysis, accounting for 5% of all forms of paralytic scoliosis;

2) paralytic scoliosis associated with pelvic obliquity, where myography reveals severe alterations in the quadratus lumborum and iliopsoas muscles, and less pronounced Changes in the erector spinae. This occurs in 23% of patients. Pelvic obliquity results in lateral curvature of the lumbar spine followed by vertebral torsion, which can reach 65° or more;

3) paralytic scoliosis associated with flexion-adduction and flexion-abduction contractures of the hip joints — 9% of cases;

4) paralytic scoliosis of the upper spine (1.5%) caused by paralysis of the shoulder girdle muscles;

5) mixed (atypical) forms of scoliosis (1.5%).

In cases of severe crossed paralysis involving the quadratus lumborum and iliopsoas on one side and the gluteal muscles on the other, the spinal curve is directed toward the paralyzed iliopsoas. This is followed by deformation of the pelvic ring: one side of the pelvis drops, while the contralateral iliac wing sharply protrudes toward the hypochondrium. In the thoracic spine, a prominent rib hump develops at the level of the compensatory counter-curve.

Treatment. Paralytic spinal curvature following poliomyelitis should be managed during the recovery period using corrective and stabilizing braces as part of a comprehensive conservative treatment plan, including massage. If Muscle Function fails to recover, surgical intervention is performed at a mature age.

The Procedure consists of posterior spinal fusion along the convex side using bone grafts. Spinal arthrodesis is the only effective method to prevent the progression of scoliosis and maintain the spinal axis in a corrected position.