THE OUTCOME OF SCOLIOSIS SURGERY IN THE SEVERELY PHYSICALLY-HANDICAPPED CHILD - AN OBJECTIVE AND SUBJECTIVE ASSESSMENT

Study Design. A prospective, functional assessment based on physical a bility and independence in daily activities was performed of patients who had severe physical handicaps and spinal deformities and were unde rgoing scoliosis surgery. Objectives. To determine whether improving s pinal alignment and truncal balance improved the functional abilities of handicapped patients. Summary of Background Data. Loss of truncal s tability compromises the physical independence of children who are sev erely handicapped. Physiologic function also may be compromised. It is not clear whether improving truncal balance actually improves their l evel of independence or merely halts further deterioration. Methods. T wenty patients with significant physical handicaps resulting from neur omuscular disorders or multiple congenital anomalies and significant s pinal deformity and truncal imbalance were treated surgically to reali gn and stabilize their spines. Their level of physical independence wa s evaluated before surgery, including their ability to sit, ambulate, and complete activities of daily living. Evaluation was done before su rgery, 6 months after surgery, and 12 months after surgery. A subjecti ve assessment of cosmesis also was made. Results. Corrective spinal su rgery resulted in a deterioration of physical ability for the first 6 months. Most patients subsequently returned to their preoperative leve l of function. An improvement of function exceeding their preoperative level was not seen after 12 months. The cosmetic results of surgery w ere excellent. Conclusions. Corrective spinal surgery in patients with severe physical handicap should be performed early to preserve functi on and should not be dictated solely by the severity of the curvature. Improvement in the patient's level of independence may not necessaril y occur after truncal stabilization. Cosmetic results in these patient s with severe disabilities were extremely gratifying to the patients a nd their caregivers.