title: Conservative treatment of neuromuscular scoliosis in adult tetraplegia: a case report.
abstract: We report successful correction of new onset neuromuscular scoliosis without spinal surgery in a man who is 30-years post-American Spinal Injury Association Impairment Scale grade A C6 injury with new onset of left neuromuscular scoliosis (Cobb angle 45°) after a motor vehicle collision. Interventions included nightly low-load prolonged stretching (LLPS) (4h left side lying over bolster), a series of 6 botulinum toxin injections (BTIs) at 3-month intervals, and progressive seating adjustments to counteract the spinal curvature. Monthly seating adjustments included rear quadrant wedging, lateral supports, and hip blocking to promote erect and symmetrical posture. A normative Cobb angle (5°) was achieved after 8 months of treatment. Improvements in alignment were demonstrated in physical examination outcome measures at the final session and follow-up. LLPS, seating adjustments, and paraspinal BTI are nonsurgical options for treating neuromuscular scoliosis in adults with tetraplegia. Further studies are necessary to determine optimum protocols and examine generalizability of these treatment methods.
authors.affiliation: School of Physical Therapy, University of Puget Sound, Tacoma, WA. Electronic address: jhastings@pugetsound.edu.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Hastings
authors.affiliation: School of Physical Therapy, University of Puget Sound, Tacoma, WA.
authors.forename: Julie
authors.initials: J
authors.lastname: Dickson
authors.affiliation: School of Physical Therapy, University of Puget Sound, Tacoma, WA.
authors.forename: Linsey
authors.initials: L
authors.lastname: Tracy
authors.affiliation: School of Physical Therapy, University of Puget Sound, Tacoma, WA.
authors.forename: Christine
authors.initials: C
authors.lastname: Baniewich
authors.affiliation: School of Physical Therapy, University of Puget Sound, Tacoma, WA.
authors.forename: Cedar
authors.initials: C
authors.lastname: Levine
mesh_terms: D001905:Botulinum Toxins / Q000008:administration & dosage; D002574:Cervical Vertebrae; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D052580:Muscle Stretching Exercises; D009465:Neuromuscular Agents / Q000008:administration & dosage; D009468:Neuromuscular Diseases / Q000209:etiology / Q000534:rehabilitation*; D009989:Orthotic Devices; D064170:Paraspinal Muscles; D011782:Quadriplegia / Q000150:complications*; D012600:Scoliosis / Q000209:etiology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000150:complications*
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins
keywords: Botulinum toxins; Rehabilitation; Scoliosis; Spinal cord injuries; Wheelchairs