NEUROMUSCULAR SCOLIOSIS

Neuromuscular Scoliosis

Children who develop scoliosis often have a number of other medical issues.  This is why treatment often involves a team of doctors with different medical specialties working together to provide the best care.

As with other types of scoliosis, the curves of those with this condition often worsen during periods of rapid growth. The curves of those with this affliction often develop at a younger age than those with other types of scoliosis. In addition, these curves affect the entire spine (as opposed to a small section).  The curves tend to progress more rapidly and continue to get worse into adulthood. 

This condition does not occur in every child with a neuromuscular disease.  However, it is common, in children with a condition that requires the use of a wheelchair. In most cases of this spinal problem, surgery is required to correct the curvature and stabilize the spine.

Neuromuscular Scoliosis Symptoms

• Tilted, uneven shoulders and shoulder blades
• The ribs on one side stick out
• Uneven waistline
• One hip higher than the other
• Back pain

In children who require wheelchairs, spinal curves may cause changes like those mentioned above, as well as the following:

• Tilted pelvis
• difficulty in sitting and the need to use the hands and arms for support while seated
• Pressure sores due to the pelvic tilt and overall imbalance
• A change in overall posture, such as slouching or leaning more to one side

Children with this condition may also develop other types of spinal curves,  Also, large curves in the upper back or large inward curves in the lower back may decrease the space in the chest for the lungs and lead to breathing problems.

Diagnosing Neuromuscular Scoliosis

To help the doctors at Southwest Scoliosis and Spine Institute determine the severity of this condition, spinal curves are closely monitored.  To assist us, we use our advanced EOS imaging system. This system allows doctors to determine the location of the curve on the spine.  Also, it measures the degree of curvature while delivering a very low dose of radiation.  Because patients with neuromuscular scoliosis are often unable to stand, the EOS imaging system provides another advantage.  Our EOS system allows us to obtain images of the patient in a seated position.

MRI scans may also be necessary, especially in patients who require surgery, because an MRI is able to provide clear images of the soft tissues and spinal cord.

Treatments

Treatment for Neuromuscular Scoliosis includes specialists in other medical fields.  All elements of care must follow best practices to ensure that every aspect of treatment provides the best outcome.

Treatment for this condition depends largely on the type and severity of the spinal curve and the nature of any other conditions, as well as the patient’s age and the stage of the curve.

Nonsurgical Treatment

Although nonsurgical treatments will not prevent your child’s curve from getting worse, they may delay the progression and help improve function and quality of life.

Wheelchair modification

This is the most common nonsurgical treatment for neuromuscular scoliosis. If the patient’s pelvis has shifted in a way that affects their balance, changing the wheelchair to improve posture can lead to improvements. Changes may include adding specially molded backings and adjusting the side positioners to improve balance while in a seated position.

Scoliosis brace

For some patients who require wheelchairs, doctors recommend a molded plastic brace.  The brace goes around the upper body — stabilizing the patient and permitting the patient to use their arms and hands.

In patients who are able to walk, bracing is not recommended, as it can make them more likely to lose their balance while walking and fall – especially patients who have muscle weakness or an unsteady gait.

Surgical Treatment

The decision to proceed with surgery depends on several factors, such as the curve, the nature of the condition, the age of the patient, ambulatory status, and how much their condition affects their ability to function normally. The doctors will consider many other options, especially with patients who are non-communicative.

Should your child require surgery to correct this condition, the expert surgeons and caregivers at our practice can provide the care and attention they deserve. Our expert physicians, Richard Hostin, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD have been treating children and adolescents for more than 12 years.

Spinal Fusion

This is the most common surgical procedure used to treat neuromuscular scoliosis. The surgeons use metal rods, screws, etc. to fuse together two or more vertebrae to stabilize the spine.  This procedure will also straighten out the curve.

In patients who are still quite young and growing rapidly, the treatment team may opt to use growing rods that facilitate changing every few months as the child grows. This allows the spine to continue growing while the rods stabilize it, but it is a temporary solution, and a spinal fusion procedure may become necessary later in life if the curve continues to progress.