The Management of Unusual Types of Scoliosis

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UNUSUAL types of scoliosis present many challenges in regard to management. Often there are no guide lines for the physician. Each case must be carefully analyzed and categorized according to the following classification described by Cobb1 and by Ponseti and Friedman.2

  1. Postural

  2. Structural

    1. Myopathic

      Muscular dystrophy, etc.

    2. Neuropathic

      1. Poliomyelitis

      2. Congenital

      3. Syringomyelia

      4. Neurofibromatosis

      5. Friedrich’s ataxia

      6. Cerebral palsy

    3. Osteopathic

      1. Congenital vertebral anomalies

      2. Thoracogenic after thoracoplasty

      3. Osteochondrodystrophy, etc.

    4. Idiopathic

      1. Main lumbar curve

      2. Thoracolumbar curve

      3. Main thoracic curve

      4. Combined thoracic and lumbar curve

      5. Cervicothoracic curve

The most common type of scoliosis is idiopathic. It occurs most often in girls and demonstrates characteristic spinal curve patterns. The cause is not known. The other types of scoliosis are manifestations of underlying diseases or anatomic abnormalities and do not demonstrate characteristic spinal curve patterns. Certain types require early recognition and treatment in order to prevent severe deformities.3 The four cases reported here are examples of: (1) combined neuropathic and osteopathic curve in a child who has multiple vertebral, rib, and spinal cord anomalies; (2) a neuropathic curve in a spastic adolescent; (3) an osteopathic curve in an adult with a congenital vertebral anomaly; and (4) an osteopathic curve after dorsal laminectomy in an adolescent. The use of Harrington instrumentation and the halo apparatus is described. Rib osteotomy, costotransversectomy, and neural arch osteotomy are employed as adjuncts of operative treatment.

Report of Illustrative Cases

Case 1. A six. . .



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