In spite of the brevity of this series of cases of scoliosis complicated by spinal-cord involvement, the following conclusions seem justifiable and are in accord with the literature.
1. The level of the apex of the curve shows no correlation with the distribution of the neurological changes.
2. All motor changesare of the spastic type.
3. There is no definite sequence in the appearance of the sensory or motor manifestations.
4. Conservative therapy shows little, if any, permanent improvement in the neurological status; therefore, laminectomy should be performed if a short period of conservative treatment fails to relieve the signs and symptoms present, or if the neurological signs increase,—whether the sensory or motor changes are in precedence.
5. Laminectomy incisions should be drained.
6. In this series progression of signs and symptoms following laminectomy developed in all patients, but receded after a variable period, except in Case 3. This patient did not regain function.
7. Laminectomy offers the best prognosis in cases of scoliosis with signs of compression, despite the fact that torsion and tension are the etiological factors of these signs.
8. It is desirable to combine fusion with laminectomy when the patient's condition will stand this added operative procedure. The fusion should extend from horizontal vertebra to horizontal vertebra. The combined method of Steindler is a rapid procedure which has proved satisfactory. There may be an increase in the curve if solid fusion is done before the end of the period of rapid growth.
Department of Orthopaedic Surgery, The State University of Iowa Hospitals, Iowa City, Iowa