Development of Scoliosis Following Complex Combat-Related Lower-Extremity Amputations: Two Case Reports.

Abstract

Combat casualties that have been subjected to high-energy blast trauma have experienced devastating lower-extremity injuries and soft-tissue damage, resulting in complex lower-extremity amputations. There have been limited reports of scoliosis following upper and lower-extremity amputations1-4. We report the development of scoliosis in two combat casualties following hemipelvectomy and hip disarticulation, respectively, for injuries sustained during the current conflicts in Iraq and Afghanistan. Both patients were informed that data concerning their cases would be submitted for publication, and they both provided consent. Case 1. A twenty-one-year-old active duty Army soldier had had a right hemipelvectomy and left hip disarticulation following the explosion of a rocket-propelled grenade (RPG). Approximately two years after injury, the patient had sitting imbalance. A sitting spinal radiograph demonstrated a right lumbar scoliosis from L1 to L5 of 37°, with a 1+ Nash-Moe rotation (Fig. 1). He had limited prosthetic use and no back pain; he had some mobility with use of a manual wheelchair. He was able to perform independent transfers to and from the wheelchair as well as most activities of daily living (ADL). Fig. 1 Anteroposterior radiograph of the spine (left) and anteroposterior radiograph of the pelvis (right) of the patient in Case 1 following a right hemipelvectomy and left hip disarticulation, demonstrating a right lumbar scoliosis from L1 to L5 of 37°, with a 1+ Nash-Moe rotation. Case 2. Following injury from an improvised explosive device (IED), a twenty-year-old active duty Marine had had bilateral transfemoral amputations, with the right lower-limb amputation considered a functional hip disarticulation. Approximately one year after injury, the patient reported moderate back pain. Radiographs demonstrated a right lumbar scoliosis from T12 to L5 …