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An 11-year old girl with lumbar scoliosis caused by LLD
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Figure 0001: An 11-year old girl with lumbar scoliosis caused by LLD

Mentions: Limb length discrepancy (LLD) causes pelvic obliquity in the frontal plane [1–9]. Quite rigid junction of L5 vertebra with sacral bone results in lumbar scoliosis with convexity directed towards the short extremity (Figure 1). Later, unequalized length discrepancy of lower limbs leads to posture deformation, gait asymmetry, low back pain, discopathy as well as gonarthrosis, coxarthrosis and hip flexion contracture on the side of the longer extremity or ankle joint contracture in the equinal position on the side of the shorter extremity [3–5]. In sporadic cases LLD can be secondary in relation to scoliosis, particularly in the case of compensatory scoliosis. In these cases LLD appears as the result of asymmetrical load of lower extremities [8, 9].

Functional scoliosis caused by leg length discrepancy

Raczkowski JW, Daniszewska B, Zolynski K - Arch Med Sci (2010)

Bottom Line: The time needed for real equalization of the discrepancy was 11.3 months.Leg length discrepancy equalization results in elimination of scoliosis.Leg length discrepancy < 2 cm is a static disorder; that is why measurements should be performed in a standing position using blocks of adequate thickness and the position of the posterior superior iliac spine should be estimated.

Affiliation: 1 Department of Orthopaedics and Rehabilitation, Medical University of Lodz, Lodz, Poland.

ABSTRACT

Introduction: Leg length discrepancy (LLD) causes pelvic obliquity in the frontal plane and lumbar scoliosis with convexity towards the shorter extremity. Leg length discrepancy is observed in 3-15% of the population. Unequalized lower limb length discrepancy leads to posture deformation, gait asymmetry, low back pain and discopathy.

Material and methods: In the years 1998-2006, 369 children, aged 5 to 17 years (209 girls, 160 boys) with LLD-related functional scoliosis were treated. An external or internal shoe lift was applied.

Results: Among 369 children the discrepancy of 0.5 cm was observed in 27, 1 cm in 329, 1.5 cm in 9 and 2 cm in 4 children. During the first follow-up examination, within 2 weeks, the adjustment of the spine to new static conditions was noted and correction of the curve in 316 examined children (83.7%). In 53 children (14.7%) the correction was observed later and was accompanied by slight low back pain. The time needed for real equalization of limbs was 3 to 24 months. The time needed for real equalization of the discrepancy was 11.3 months.

Conclusions: Leg length discrepancy equalization results in elimination of scoliosis. Leg length discrepancy < 2 cm is a static disorder; that is why measurements should be performed in a standing position using blocks of adequate thickness and the position of the posterior superior iliac spine should be estimated.

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