title: The outcome of scoliosis surgery in the severely physically handicapped child. An objective and subjective assessment.
abstract: METHODS
  A prospective, functional assessment based on physical ability and independence in daily activities was performed of patients who had severe physical handicaps and spinal deformities and were undergoing scoliosis surgery.
  
  
  OBJECTIVE
  To determine whether improving spinal alignment and truncal balance improved the functional abilities of handicapped patients.
  
  
  BACKGROUND
  Loss of truncal stability compromises the physical independence of children who are severely handicapped. Physiologic function also may be compromised. It is not clear whether improving truncal balance actually improves their level of independence or merely halts further deterioration.
  
  
  METHODS
  Twenty patients with significant physical handicaps resulting from neuromuscular disorders or multiple congenital anomalies and significant spinal deformity and truncal imbalance were treated surgically to realign and stabilize their spines. Their level of physical independence was evaluated before surgery, including their ability to sit, ambulate, and complete activities of daily living. Evaluation was done before surgery, 6 months after surgery, and 12 months after surgery. A subjective assessment of cosmesis also was made.
  
  
  RESULTS
  Corrective spinal surgery resulted in a deterioration of physical ability for the first 6 months. Most patients subsequently returned to their preoperative level of function. An improvement of function exceeding their preoperative level was not seen after 12 months. The cosmetic results of surgery were excellent.
  
  
  CONCLUSIONS
  Corrective spinal surgery in patients with severe physical handicap should be performed early to preserve function and should not be dictated solely by the severity of the curvature. Improvement in the patient's level of independence may not necessarily occur after truncal stabilization. Cosmetic results in these patients with severe disabilities were extremely gratifying to the patients and their caregivers.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital, Nottingham, United Kingdom.
authors.forename: G N
authors.initials: GN
authors.lastname: Askin
authors.forename: R
authors.initials: R
authors.lastname: Hallett
authors.forename: N
authors.initials: N
authors.lastname: Hare
authors.forename: J K
authors.initials: JK
authors.lastname: Webb
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D006801:Humans; D008124:Locomotion; D008297:Male; D008603:Mental Health; D017060:Patient Satisfaction; D011446:Prospective Studies; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome