Current concepts in neuromuscular scoliosis

Abstract

Purpose of review: Spinal deformity is a common issue in pediatric patients with an underlying neurological diagnosis or syndrome. Management of neuromuscular scoliosis (NMS) is a major part of the orthopedic care of such patients, as the deformity is often progressive, and may affect gait, seating and positioning. In addition, untreated large spinal deformities may be associated with pain and/or cardiopulmonary issues over time.

Recent findings: Recent changes in medical management of the underlying disease process appears to alter the natural history of certain neuromuscular conditions, and in the case of patients with Duchenne's muscular dystrophy significantly diminish the incidence of spinal deformity. In the most common diagnosis associated with NMS, cerebral palsy, there is evidence that despite a high complication rate, surgical management of spinal deformity is associated with measurable improvements in validated health-related quality-of-life measures. Spinal deformity is a common finding in patients with neurological diagnoses. It is important for those involved in the care of these patients to understand the natural history of NMS, as well as the potential risks and benefits to the patient and caregivers, of surgical and non-surgical interventions.

Keywords: Caregiver/patient outcome studies; Cerebral palsy; Neuromuscular scoliosis.

Fig. 1

NMS patient with CP and severe curve leading to the ribs resting on the iliac crest. This has resulted in ulceration

Fig. 2

a and b NMS patient with low body mass index 10 years following PSF with placement of PSIS starting point iliac bolts. Note the prominent distal hardware and the exposure of the screw tulip and set screw outside the wound

Fig. 3

Upright AP full-length radiograph of a NMS patient who underwent distal fixation with S2AI screws. Note that the screws are in line with the remainder of the fusion construct