Perspectives on surgery for scoliosis in mentally retarded patients.

The goals of surgery in the retarded patient with spinal deformity are to maximize function (for example, free the hands, decrease the occurrence of pressure sores, and so forth). Concomitantly, the goal while treating the patient should be to minimize the interference with social, intellectual, and general development while counting on no operation by the patient. The new tools of internal fixation available to the surgeon have made spinal surgery possible in these patients despite their lack of cooperation and their other medical problems, seizures, and spasticity. Although combined Dwyer instrumentation with subsequent posterior Harrington instrumentation or posterior fusion and Harrington instrumentation alone have been used most commonly, recent favorable experience suggests a larger role for segmental stabilization of the spine because of the greater purchase on the spine and the lack of need for prolonged external mobilization.