|
|||||||||||||||||||||
|
|||||||||||||||||||||
|
|||||||||||||||||||||
Scoliosis Scoliosis is a side bending and twisting of the spinal column away from its correct anatomical form. Unlike so called 'Idiopathic Scoliosis' wherein the cause of asymmetrical growth is unclear, in neuromuscular diseases the causes are usually known. Patients with spasticity, for example, have an array of bodily contortions or restrictions due to limitation of range or overt contracture of specific muscle groups (see above A-B). See also a fuller discussion of scoliosis. In patients with spasticity, it is our hypothesis that the very same problems of muscle based contracture as seen in the hands, arms, mouth, abdomen, hips, knees, and ankles, are also at work on the spine (see right 1 & 2). The surgery rate for such 'paralytic scoliosis' is very very high. It also tends toward very severe curves at very young ages. Surgery is frequently forced at a an age before a desired span of growth has been attained and before further growth and its strong deforming force has dissipated. Even with the usual posterior spinal fusion, a crankshaft deformity can develop afterward. We try to slow the progression of the spastic scoliosis deformity by weakening the muscles of the more actively contracting side of the curve. One method is the injection into the shortened muscles of botulinum toxin, a paralyzing chemical, which can render the overactive muscles less active (by interfering with the release of neurotransmitter at the nerve muscle "endplate" where the overactive nerve drives these muscles). Under the best of circumstances, this drug has a duration of activity of about 3 months. If it dispersed in too many places, giving each site too low a dose, the effect will be more short-lived. The injection is guided by an electrical muscle
stimulator using an insulated injection needle. That muscle which is most deforming when stimulated gets botulinum toxin. After the deforming forces are made less vigorous by the toxin, brace treatment is used to try to correct the posture during the period of maximum activity of the drug. In essence, the injections will be used to try to make brace treatment more effective in cases where it was unable to hold back the deformity. There is a section on Botulinum Toxin.
|
|||||||||||||||||||||
|