CP and Scoliosis

[RUOkie]

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I need some help from the Pedi or inpatient people here.

I saw a young woman in my office yesterday as a favor to her mom (mom owns the company that cleans my office)

30 y/o female with severe spastic tetraplegia and developmental delay from CP. Needs a new wheelchair and asked if I would do the Rx.

Has been in a custom seating system her entire life because of scoliosis. On exam she had a huge curve. I asked for x-rays and found a close to 90deg Lumbar C-shaped curve. Much smaller thoracic curve (less than 30)

Would you send her to a reconstructive spine surgeon? She does not walk, rarely is ill, and has no difficulty with bowels. Pulmonary function is pretty good.

My gut tells me to do nothing. But if this was a thoracic curve this big, I would certainly send to a surgeon.

 

[bedrock]

I need some help from the Pedi or inpatient people here.

I saw a young woman in my office yesterday as a favor to her mom (mom owns the company that cleans my office)

30 y/o female with severe spastic tetraplegia and developmental delay from CP. Needs a new wheelchair and asked if I would do the Rx.

Has been in a custom seating system her entire life because of scoliosis. On exam she had a huge curve. I asked for x-rays and found a close to 90deg Lumbar C-shaped curve. Much smaller thoracic curve (less than 30)

Would you send her to a reconstructive spine surgeon? She does not walk, rarely is ill, and has no difficulty with bowels. Pulmonary function is pretty good.

My gut tells me to do nothing. But if this was a thoracic curve this big, I would certainly send to a surgeon.

What are you going to accomplish with a major deformity surgery?

Her cardio-pulmonary system is ok, bowels are okay. No neuro deficits secondary to stenosis from your description. A big whack could cause lots of complications, life-long chronic pain, and is helping what??? (other than cosmetics)

 

[Jitter Bug]

Your gut is correct. Focus on function. With severe scoliosis the chair should be custom molded to fit her. The job of the chair for a non-ambulatory girl is to keep her comfortable and mobile.

You can't undo in one surgery (or even a series of surgeries) what nature has done slowly over 30 years. What would they do, reset each bone, disc, ligament, muscle attachment etc? And the risks are terrible for a basically healthy girl.