Conservative Treatment Of Neuromuscular Scoliosis In Adult Tetraplegia: A Case Report
Archives Of Physical Medicine And Rehabilitation
We report successful correction of new onset neuromuscular scoliosis without spinal surgery in an adult male, 30 years post American Spinal Injury Association Impairment Scale (AIS) C6A injury with new onset of left neuromuscular scoliosis (Cobb angle 45 degrees ) following a motor vehicle accident. Interventions included nightly low load prolonged stretching (LLPS) (4 hours left side lying over bolster), a series of 6 botulinum toxin injections (BTI) at 3 month intervals, and progressive seating adjustments to counteract the spinal curvature. Monthly seating adjustments included rear quadrant wedging, lateral supports, and hip blocking to promote erect and symmetrical posture. A normal Cobb angle (5 degrees ) was achieved after 8 months of treatment. Improvements in alignment were demonstrated in physical exam outcome measures at the final session and follow-up. CONCLUSION: LLPS, seating adjustments, and paraspinal BTI are a non-surgical option for treating neuromuscular scoliosis in adults with tetraplegia. Further studies are necessary to determine optimum protocols and examine generalizability of these treatment methods.
Hastings, Jennifer D., J. Dickson, L. Tracy, C. Baniewich, et al. 2014. "Conservative treatment of neuromuscular scoliosis in adult tetraplegia: a case report." Archives Of Physical Medicine And Rehabilitation.