[Technics and strategy in the treatment of severe paralytic scoliosis]

Sixty-three paralytic scolioses with severe disability have been treated between 1973 and 1982. Fifty-two were due to poliomyelitis. The average angular deformity was 95.8 degrees and was related to delay in treatment and rapid progress of the curve. All cases were operated on. Spine fusion was performed either by the anterior approach (Dwyer or V.D.S.) or by a posterior approach (Harrington or Harrington - Luque). The pre-operative management was based on Cotrel or Halo traction. There were several complications - three non-unions, three neurological impairments, and nine cases of sepsis. It was concluded that the pre-operative management should be as short as possible, that the spine fusions should be done systematically and that any paralytic scoliosis increasing by more than 10 degrees a year between the ages of 8 and 10 years should be operated on early. This type of treatment should lower the incidence of severe disability and allow good functional and educational rehabilitation. The degree of diminished growth of the spine was moderate.