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Neuromuscular Scoliosis

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Topic updated on 07/31/16 10:16am
Introduction
  • Defined as an irregular spinal curvature caused by disorders of the brain, spinal cord, and muscular system.
  • Neurogenic curves (relative to idiopathic curves) tend to be
    • more rapidly progressive
    • may progress after maturity
    • associated with pelvic obliquity
    • are longer and involve more vertebrae (may involve cervical vertebrae)
    • have a higher rate of pulmonary complications with surgery
Classification & Treatment
  • Outcomes
    • surgical correction of spinal fusion is only treatment that has a documented beneficial impact on deformity
    • parents and caretakers report excellent improvement in the child's quality of life after deformity correction
Classification and Treatment
(for more detail go to disease content)
Category
Disease
Nonoperative Treatment
Operative Treatment
Upper motor neuron Cerebral palsy  Boston-type underarm bracing until puberty (age 10-12) and wheelchair modification
  • Group I treat with PSF with instumentation
  • Group II treat with PSF +/- ASF with instrumentation and fusion to pelvis (Luque-Galveston)
  • Indications for surgery
    • curve > 50°
    • worsening pelvic obliquity with sitting imbalance
  Rett Syndrome   Bracing for C-shaped curves
  • Bracing
    • C shaped curves
  • Posterior Spinal Fusion indications
    • thoracic curve that intefers with sitting and balance
    • C shaped curves that do not respond to bracing
Muscle Weakness Spinal muscular atrophy  Boston-type underarm bracing until puberty (age 10-12)
  • Treat with PSF with fusion to pelvis for improved wheelchair sitting
    • address hip contractures before PSF
    • may lead to temporary loss of upper extremity function
Muscular dystrophy  bracing is contraindicated
  • PSF with or without fusion to pelvis (fusion to pelvis is controversial)
    • indications
      • absolute curve > 20°
      • progressive curve
    • Treat early before pulmonary function declines (curve from 20 to 30°)
Paralytic Syndromes Spinal bifida and spinal cord injuries  bracing is contraindicated
  • ASF/PSF with instumentation and pelvic fixation
    • anterior fusion required because minimal posterior element to obtain fusion
Polio  Boston-type underarm bracing until puberty (age 10-12)
  • PSF


 

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