Melissa

In the most typical case of a child who is a dependent sitter with quadriplegic pattern involvement, there tends to be a postural scoliosis and kyphosis in early and middle childhood, which is controlled easily with seating adaptations. Often, in early and middle childhood, the structural component and the flexibility of the scoliosis change very little. As the children enter adolescence, especially as they start with a rise in pubertal hormones and the adolescent growth spurt, the magnitude of the scoliosis increases dramatically, often at a rate of two to four degrees a month (567)(552). Almost uniformly, the magnitude of the scoliosis increases to about the 60- to 90-degree range, and then the stiffness of the structural curve follows approximately six to 12 months later. During this rapid increase in curve magnitude, there often is a sudden realization by the family and caretakers of increased problems with sitting, head control, and arms. Melissa, a 9-year-old girl with severe quadriplegia and mental retardation, had an initial radiograph at age 5 when caretakers complained about her painful hips and difficulty sitting. An examination of her spine demonstrated no scoliosis, and plans were made to address her hip pathology. Image 10-1.1 Seven years following her hip surgery she was again having more problems with seating and a radiograph demonstrated a lumbar curve. Image 10-1.2 Melissa was comfortable with appropriate seating adjustments until 18 months later when a rapid increase in the scoliosis made sitting more difficult. Image 10-1.3 The scoliosis was then addressed with surgical correction using Unit rod instrumentation and was well maintained five years postoperatively. Image 10-1.4

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