Surgical correction of scoliosis in patients with generalized seizures. Risk of vertebral body fracture.

STUDY DESIGN

A retrospective evaluation of the outcome of surgical management of progressive scoliosis in institutionalized patients with frequent, uncontrolled, generalized tonic clonic seizures.

OBJECTIVES

To determine the safety and stability of internal fixation devices in patients with progressive scoliosis and intractable seizures.

SUMMARY OF BACKGROUND DATA

Progressive scoliosis is a common problem in severely disabled patients. It has been the belief among some spine physicians that the coexistence of intractable seizures with progressive scoliosis is a contraindication for surgery, because most of the thoracic and lumbar spine is fixed and "unyielding" after internal fixations, increasing the risk of vertebral fractures. There have been reports of fracture of fixation devices, particularly Harrington rods, under conditions of massive trauma or mechanical stress, such as seizures.

METHODS

The authors reviewed the outcome of six profoundly retarded institutionalized patients with a history of intractable seizures who underwent internal fixation of the spine between 1984 and 1987 because of progressive scoliosis. Seizure types and frequency of convulsion were obtained from the institutional charts. Follow-up radiographs of the spine obtained at 1, 3, and 6 months after the surgery and once a year thereafter were reviewed by the radiologist and orthopedic surgeon with special attention paid to fractures, stability of the fusion, and integrity of the instrumentation.

RESULTS

Six patients underwent spinal fusion with internal spinal fixation, four patients with Harrington rods and two with Luque rods. All patients had refractory tonic clonic seizures ranging from 11 to 80 generalized tonic clonic convulsions per year for the 10-year follow-up period after surgery. There were no fractures, subluxation, or pseudoarthrosis of the fused vertebrae or the vertebral bodies adjacent to the fusion. There were no fractures of the instrumentation.

CONCLUSIONS

The authors' findings suggest that when appropriate fusion is attained, the use of internal fixation devices is not contraindicated in the management of progressive scoliosis in patients with intractable seizures.