Between April and October 1981, nineteen children who were between five
and twelve years old (median age, seven years), and who had severe
paralytic scoliosis secondary to poliomyelitis, were treated by segmental
spinal instrumentation without arthrodesis. Three patients could not be
followed, and the cases of the remaining sixteen patients were reviewed in
April 1984. In fifteen patients, the implant system had failed to control
the deformity. In six patients, the rods had fractured at the apex of the
original deformity; in five, longitudinal shift of the rods had allowed
recurrence of the deformity; and in four, the short limb of one or both of
the L-shaped rods had rotated out of the pelvis and perforated the skin,
resulting in an infection that necessitated removal of the rods. At the
time of the review, the deformity was essentially the same as before the
original instrumentation in all but the sixteenth patient, in whom failure
had not occurred. The instrumented vertebrae had grown measurably in some
of the patients, but spontaneous fusion--particularly in the thoracic
spine--was observed when the rods were removed. This finding indicates
that, using presently available materials, segmental instrumentation of the
spine without arthrodesis does not effectively control paralytic scoliosis
secondary to poliomyelitis in a growing child.