Surgical treatment of scoliosis following poliomyelitis. A review of one hundred and ten cases.

We reviewed the cases of 110 patients with paralytic scoliosis due to poliomyelitis who were operated on. In the lumbar region, anterior Dwyer instrumentation with posterior fusion gave excellent correction of scoliosis and pelvic obliquity. In the more rigid thoracic curves, combined anterior Dwyer instrumentation and posterior fusion gave better results than posterior fusion alone, but had more morbidity. Long c-shaped curves benefited more from a combined anterior Dwyer procedure at the apex of the curve and long posterior Harrington instrumentation. Traction was found to be of use only in rigid curves and in those larger than 80 degrees. With combined anterior and posterior fusion, there was a pseudarthrosis rate of 7 per cent in lumbar curves, none in thoracic curves, and 12.5 per cent in long c-shaped curves. The pseudarthrosis rate rose to more than 25 per cent in patients who had a posterior fusion alone.

The place of Dwyer anterior instrumentation in scoliosis.

The technique of Dwyer instrumentation and fusion has now become estabilished as having a definite place in the surgery of scoliosis. It is complementary to the Harrington technique of posterior instrumentation and fusion. The latter is especially suited to thoracic and double scoliotic curves, while the particular indication of the Dwyer method is the lumbar curve. Thoracolumbar curves maybe treated by either method, and paralytic curves are often best handled by a combination of the two. A significant element of kyphosis constitutes an absolute contraindication to the Dwyer procedure.

Actinomycosis of bone.

Actinomycosis is a rare disease, which is most commonly seen in the cervicofacial region and provides problems in diagnosis and treatment. Cervicofacial actinomycotic osteomyelitis is a curable disease. Its natural history and guides to its management are described.