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History
A 2-year-old white female presented in 1973 with an awkward gait, and the chief complaint of dysesthesias in the lower extremities. By history, there had been an insidious onset of discomfort and withdrawal when the patient's legs were touched. The initial examination demonstrated a limp, referable to the left leg, and refusal to allow an examiner to test sharp and dull sensation in the left lower extremity. Atrophy of the left quadriceps was also appreciated.
Initial evaluation for systemic arthritis or collagen vascular disease, and radiographs of the spine and lower extremities were unremarkable. However, in follow up several months later, the patient was more ataxic, and neurologically demonstrated paraparesis of the lower extremities, areflexia. and pain on movement of the spine, especially when the spine was extended. Oil myelography demonstrated an intramedullary lesion, and in April 1974, in two staged operations, astrocytoma of the spinal cord was excised via laminectomy from T7 to L5. Postoperatively the patient also received radiotherapy, though the exact dosage was unknown.
In follow up, 3 months following surgery, it was noted that the patient had no significant spinal deformity (Fig. I) and that there was diffuse, almost complete paraplegia of the lower extremities. Only a flicker of right sided iliopsoas and hip flexor function was present. The patient was also felt to be anesthetic below the T12 dermatome. The patient was fitted with long leg braces extending to the low thorax, in order to assume an upright position. She was able to achieve exercise ambulation with braces and crutches.
TWo years postoperatively, kyphoscoliosis was noted to be developing (Fig. 2), in spite of bracing with a thoracoabdominal corset. At this time, the patient was placed in a total contact, Vithrathene TLSO, which achieved much better control of her kyphoscoliosis (Fig. 3). The patient was able to continue exercise ambulation. It was noted, however, that the patient was developing equinocavovarus feet with multiple decubiti being produced because of continued ambulation on anesthetic feet. The patient's parents refused surgery to produce plantigrade feet, and there were continuous decubiti problems in spite of numerous shoe and orthotic modifications.
By age 11, the patient had assumed full-time wheelchair ambulation, because of her increasing size (weight 120 lbs), and the impossibility of...