Scoliosis in patients with infantile cerebral paralysis (ICP)Conservative treatment, in particular, massage, manual therapy in case of ICP, may exacerbate the condition of the child. Corsets, swimming, electric procedures, etc. are ineffective. Often children with ICP can not keep balance, so they can not walk or even sit in a wheelchair.
1. Patient, 9 years old. Diagnosis: ICPThe boy could not walk and used to fall while trying to walk. He moved with great difficulty and needed assistance. When bending forward, he leaned with his hands on his knee joints. His torso was curved, and the treatment in a rehabilitation centre (in Moscow) proved ineffective. Scoliosis in the patient progressed quickly.
The X-rays revealed scoliosis of Grade 4. Despite his age – nine years, noticeable curvatures of his ribs and the whole chest had been formed. Such anatomical deformations become irreversible at the time of formation. There is an opportunity to correct them in children, because tissues of a child are highly plastic. We benefited from this property of child body. The boy was operated on, and no element of his spine was injured during the surgical operation. A Russian-made springy extending titanium structure was implanted.
In three months after the operation, the boy keeps balance well, is very active, moves independently and can run. The functions of the pelvic organs, which had been disturbed before the surgery, have been restored.
2. Female patient, 11 years old. Diagnosis: ICPMarked spasticity of the upper and lower extremities. Scoliosis in the patient began to develop since the age of seven. Her parents came to us because, according to them, during the previous two years their child could not sit in a wheelchair or keep balance and fell while in sitting position due to the curvature of the chest. The patient could not walk due to the marked spastic hyper tonus of her leg muscles. Lying on her stomach, she could not straighten her posture. At the same time, the patient’s intelligence is preserved, she reads much, and studies at a regular school with a regular curriculum.
In a single year (2011-2012), the curvature of the patient’s spine increased by 31 degrees! And a year later, by almost 20 degrees. This rapid development of deformations, which is very typical of scoliosis, should have served as a signal for immediate surgery back in 2011, when the anatomic changes were yet not very significant and easily correctable, yet, for some reason, physicians did not direct the girl for the surgery in due time.
Surgery (2013): correction of the chest and spine was performed using a growing (extending) structure that does not injure the spine and helps the child develop normally without any additional surgeries.
In three days after the surgery, the patient’s chest and ribs took the correct anatomical shape. The spine would not curve any longer. Now it is possible to reduce the degree of spasticity of the leg muscles to teach the child to walk.
Children with ICP can be helped if the surgery for scoliosis is performed in time. Such an opportunity has appeared due to the development of the extending structure that does not interfere with the child’s growth and does not injure the spine.
3. Female patient, 14 years old. Diagnosis: ICP, scoliosis of Grade 4 (130 degrees)The patient walks with difficulty, often loses her balance and experiences a persistent back pain. Her intellectual development is good. She suffers a severe depression due to the cosmetic defect.
Radiographs in the standing and lying down positions: The curvature angle of 130 degrees. Good flexibility of the spine suggests a good result after the surgery.
After the surgery: the cosmetic and functional result is good. In this case, there was delay in seeking medical assistance, although the plastic possibilities of the patient had been preserved at a reasonable level. They allowed achieving a good result without any damage to the spine.
The earlier the surgery is performed, the better the result can be expected. According to our observations, the most favourable age for the surgery is the age of 9-11. The basic criterion for the surgery, regardless of the cause of scoliosis, is the deformation of 25-35 degrees and the progression of the curvature.
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