Related Issues

After your amputation, many have been told that you have developed a functional scoliosis. When initially informed of this, my response was "Good grief! Don’t I have enough to worry about?" If you are told you’ve developed a scoliosis, do NOT panic, but be aware and educate yourself. Do not ignore this like I did - learn from my mistakes. To my knowledge, this issue has not been investigated from our unique perspective and I have found only one reference published in the medical literature which specifically addresses this issue. We high level amps with scoliosis are so uncommon that we do not fall into any of the classic categories listed in medical textbooks. However, in my personal experience, in speaking with other amputees and to some experienced Orthopedic Surgeons and Prosthetists, it appears that it is not unusual for high level amputees to develop a functional scoliosis over time.

Note the lumbar sacral curve

Functional scoliosis is the development of an abnormal curvature of the spine (back bones). Surgical disruption of the normal muscular-skeletal attachments and the effects of gravity are the causes of a deviated spine in our case. Generally the abnormal curve is in the lower back, the sacrum and lumbar area, and usually the spine straightens out in the thoracic (chest) region. Scoliosis in the high level amputee has a different clinical course from other types of pathological scoliosis which occur in the general population. The causes and treatments of our scoliosis are different.

For the hemipelvectomies, the reasons are simply mechanical and fairly obvious for both prosthetic and crutch users. With removal of one half of the pelvis, the normal attachments of muscles and tendons between the lower back and pelvis are lost. The muscular forces holding the back straight are now uneven. In order to sit upright we automatically will shift our weight to the sound side, tilting the sacrum. While standing on crutches our bodies will shift slightly in order to balance on one leg by finding a new center of gravity. For prosthetic users, frequently the leg is intentionally made slightly shorter to help with toe clearance during swing phase which will make our posture and gait uneven. Lastly, our gaits are usually abnormal, excessive forces are placed on the remaining muscles in the lower and upper back and torso in order to propel the prosthetic forward. All these may accentuate the scoliosis.

For those with a hip-disarticulation, having an intact pelvis will make sitting evenly and upright more anatomically correct, but the other reasons for developing scoliosis are still present. Partial, or semi-hemi’s fall somewhere in between. A rare few have had parts of their lower vertebrae and sacrum removed at surgery, causing a further weakening of their back’s support structure.

The diagnosis of scoliosis is usually made by x-rays taken both standing and lying down to determine the initial degree of curvature and to determine if the curve is mobile or in a fixed state. Classically, most Orthopedic Surgeons look at serial x-rays taken at variable intervals of time to monitor progression and to determine if the curve is increasing. Scoliosis is more likely to develop in a child or young adult, in the elderly, the sedentary, and those with weak bones (osteoporosis). The longer you have been an amputee, the more likely that natural physical forces of unequal musculature and the effects of gravity may affect your back.

A common symptom of scoliosis in our situation is lower back pain although just the presence of scoliosis does not necessarily mean that pain will result. Many have an abnormal curvature of the back on x-ray, sometimes quite significant, but have no symptoms or pain. Some people may have back pain due to pre-existing disc disease totally unrelated to the amputation or scoliosis or may develop disc disease after amputation. Some may not develop any significant scoliosis at all. Each person should be evaluated on an individual basis to access one’s personal situation, and seek appropriate care. Become aware of this condition and determine your personal risk factors to prevent potential problems and minimize symptoms. Seek the advice of a qualified and educated Orthopedic specialist and/or Physical Therapist. Determine if you have a curve and to what extent, what is your baseline and if your curve is mobile or fixed.

Treatment of functional scoliosis is conservative (non-surgical). The goal should be to obtain correction of the curve, if possible, and to prevent further deformity. General exercises to maintain good posture and mobility of the spine should be prescribed by an experienced Physical Therapist for all high level amputees. Back strengthening exercises should be done regularly, and daily stretching is mandatory for all. The most important thing that you can do for yourself is to keep your back as strong and flexible as possible.


Tilting of the pelvis and scoliosis in a HP patient	This is the same patient. Scoliosis is reduced drastically when the support is used

Although hip-disarticulations have an intact pelvis and are able to sit more anatomically correctly, many have told me that they've developed back problems over time due to abnormal gaits with a prosthetic or crutch usage. Therefore they should not ignore daily stretching and strengthening exercises.

Hemipelvectomies usually have more problems with scoliosis. Many non- prosthetic users may find that a sitting socket or supportive pillows will relieve their discomfort. Orthotic bracing of the back may be indicated as well for some individuals. (See Miscellaneous in Non-Prosthetic Options). For HP prosthetic users, a talented educated Prosthetist/Orthotist should be able to incorporate appropriate back support as part of your socket. This means bringing the socket up higher on the ribcage to prevent twisting and turning of the spine. I know that everyone prefers to keep the socket as low as possible for comforts sake, but some of us have learned that this support is beneficial and worth the trade off.