Scapular stabilization in patients with spinal cord injury.
BACKGROUND
Severe scapular instability can be a considerable problem for people with high-level cervical spinal cord injury. Scapular instability reduces the effectiveness of the already weakened shoulder flexors and abductors, thereby limiting hand-to-mouth and hand-to-head activities. The winged scapula may cause inferior pole skin breakdown, as well as neck and shoulder pain.


OBJECTIVE
To report the efficacy of a fusionless scapular stabilization procedure as a means to enhance function in a consecutive group of patients with high-level cervical spinal cord injury.


METHODS
Four people with spinal cord injury at C4-C5 (2 male, 2 female; mean age = 17.3 years, range = 14-20 years) underwent scapular stabilization via scapulothoracic fusion (N=2) or by tethering the scapula to the rib cage with Mersilene tape as a fusionless stabilization (N=2). One patient died of unrelated causes 18 months after surgery, and the remaining 3 were followed for 26, 39, and 41 months, respectively. Data collection included radiographic analysis, active range of motion measures, and functional assessment.


RESULTS
Active shoulder flexion and abduction remained unchanged in 2 patients, but functional scores improved with regard to feeding and grooming capability. All patients reported satisfaction with postoperative appearance, and 3 patients reported considerable reduction in shoulder pain after surgery. Radiographs demonstrated maintenance of stable scapular alignment in all patients at final follow up. Wound breakdown, requiring removal of instrumentation, occurred in 2 patients.


CONCLUSIONS
Scapular stabilization with or without fusion is a viable option to improve appearance, pain, and upper extremity function in people with high-level tetraplegia and scapular instability.
Department of Orthopaedic Surgery, Albert Einstein Medical Center, and Shriners Hospitals for Children, Philadelphia, Pennsylvania 19140, USA.
Joshua M
JM
Pahys
M J
MJ
Mulcahey
David
D
Hutchinson
Randal R
RR
Betz
D000203:Activities of Daily Living; D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability; D008297:Male; D011597:Psychomotor Performance / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000473:pathology / Q000628:therapy*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult