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CONGENITAL SCOLIOSIS: REPORT OF CASE.
J Bone Joint Surg Am. 1908;s2-6:256-259.
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Publisher Information The Journal of Bone and Joint Surgery
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R E P O R T OF C.iSE.
BY XATHANIEL ALLISON, M. D., ST. LOUIS.
The study of numerical variations in the bones of the vertebral
column and of malformations and deficiencies in the vertebra
has thrown considerable light on a group of cases that were all
supposed formerly to be acquired. Emphasis has been laid by
many observers in the last decade on the importance of the r61e
played by these prenatal conditions in the production of scoliosis.
Special stress has been laid by Bohml on the importance of numeri-
cal variations as a causative factor in the development of habitual
scoliosis. Radiographic examination has established a variation
at the primary seat of deformity in 16 of the 24 cases he examined.
Bardeen2 has established the percentage of numerical variations
in spines as from 15 to 16 percent.
Coville3 examined 1015 new-born infants and discovered scolio-
sis in but one child, confirming the statement advanced by Bohm
that these curves, even when due to congenital defects in develop-
ment, often are not manifest until growth has considerably ad-
vanced. Lovett4 states that the two most common locations of
congenital defects are the cervico-dorsal and lumbar regions and
that they depend clinically on the following conditions: Cervical
ribs, lumbar ribs, extra lumbar vertebra:, sacralized vertebra:
and deficient vertebra. Spina bifida and spina bifida occulta
are often associated with these defects when located in the lumbar
Codivilla (Gaz. hebd. med. et Chir., July 7, 1901, p. 637),
*Read before the American Orthopedic Association at its Twenty-second Annual
Meeting, held at Chicago, June 4-6, 1908.
FIG.I.-Skiagram of case showing numerical variation of vertebrz in
the lumbo-sacral region of the spine.
2 ~ 8 CONGENITAL SCOLIOSIS.
reported an interesting case due to faulty segmentation of verte-
b r z in the lumbar region wherein
the defect consisted of an addi-
tional half vertebra between the
second and third lumbar. He
claims the distinction of making
the diagnosis for the first time
on the living-thanks to the
radiogram. This case was not
associated with any trace of
spina bifida occulta.
The cause of these develop-
mental errors is a matter of sur-
mise. Regarding it, Dwight
makes the following statement:
"The cause of the original error
is as yet undetermined, but there
is no reason to suppose that it is
either hereditary or a step toward
T h e case I wish to report is
that of a girl of six years, first
seen in October, 1906. T h e
child's mother has severe scoliosis
of right dorsal, left lumbar type
with marked rotation. This
developed during adolescence.
As soon after the birth of the
infant as possible, the mother
examined her spine and dis-
covered a slight curve in the
lumbar region. T h e child was
otherwise perfectly healthy and
well formed. T h e parents think
FIG.a.-Compensatory lateral devia- that this curve has increased
tion of the spinal column due to con-
genital variation in the vertebrze of the during growth and have noticed
lumbo-sacral region. a compensatory curve in the
dorsal region. Aside from this,
development has been normal and she has been an active and
NATHANIEL ALLISON. 259
healthy girl. No treatment for the correction of the deformity
has been undertaken.
Physical examination revealed a well-developed and well-
nourished girl; heart and lungs normal; extremities of equal
length; there is no sign of rickets. I n standing, there is an ap-
parent inequality in the height of the anterior superior spines of
the ilia and of the angles of the scapulz. T h e spine is flexible
to a normal degree in all directions. There is a marked lumbar
curve to the right and a long dorsal curve to the left, unaccom-
panied by marked rotation. T h e dorsal curve can be easily over-
corrected but the lumbar curve remains fixed. A radiogram of
the entire spine reveals the following conditions: I , A marked
lumbar curve to the right; 2, a decided insufficiency of the right
sacro-iliac articulation; R , a marked deformity of the last
lumbar and the first sacral vertebra; 4, a compensatory devia-
tion to the left in the dorsal region of the spine. T h e lumbar
region of the spine on palpation reveals no cleft or evidence of
s~ina bifida occulta.
T h e radiogram in the case clearly establishes the diagnosis as
one of congenital scoliosis, depending on anomalies at the sacro-
lumbar region of the spine-these anomalies consisting of a
variation in the svmmetrv of the last two lumbar vertebrae with
fusion and asymketry oi the first and second sacral vertebrae.
These variations are joined with a marked deficiency of the sacro-
iliac articulation on the right side.
Treatment.-It was fouid that an elevation of three-quarters
of an inch under the left lower extremity slightly overcorrected
the dorsal deviation. A plaster cast was taken of the child's
trunk, holding the lateral deviation of the dorsal region overcor-
rected, and on this a light celluloid apparatus was made, which
has been worn constantly for the last year and a half. Daily
exercises to increase the flexibilitv of the s ~ i n e
have been carried
out. At the last examination, t&o months' ago, the child showed
a marked increase in spinal flexibility and a good physical develop-
ment. T h e lumbar-sacral curve shows no increase, and the
general attitude in standing is much improved.
I.Bohm, Boston Med. and Sur. Jour., Nov. 22, 1906.
2.Bardeen, Numerical Variation in the Human Adult and Em-
bryo, Anat. Anz. Bd. xxv, 1904.
3. Coville, Rev. d. Orth., 1896-7.
4. Lovett, Lateral Curvature of the Spine and Round Shoulders,