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Neuromuscular Scoliosis

Neuromuscular scoliosis is a spinal curvature that arises in children often associated cerebral palsy, muscular dystrophy, spina bifida, and many other conditions. These types of disorders can prevent the spine from being properly supported by the muscles, which can lead to scoliosis and other abnormal curvatures of the spine.

Children who develop neuromuscular scoliosis often have a number of other medical issues, which 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 scoliotic curves of those with neuromuscular scoliosis often worsen during periods of rapid growth, especially during adolescence. The curves of those with neuromuscular scoliosis often develop at a younger age than those with idiopathic scoliosis. In addition, the curves typically affect their entire spine (as opposed to a small section), and they tend to progress more rapidly and continue to get worse into adulthood.

Neuromuscular scoliosis does not occur in every child with a neuromuscular disease, but it is common, especially in children with a condition that requires the use of a wheelchair. In most cases of neuromuscular scoliosis, surgery is required to correct the curvature and stabilize the spine.

Symptoms

In patients with a neuromuscular disease who are able to walk, the signs of neuromuscular scoliosis are similar to those seen in children with idiopathic scoliosis:

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

In children who require wheelchairs, abnormal spinal curves may cause changes in appearance (like those mentioned above), as well as changes that negatively affect daily functions, such as:

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

Children with neuromuscular scoliosis may also develop other types of spinal curves, such as kyphosis or lordosis. Additionally, large curves in the upper back or excessive inward curves in the lower back (hyperlordosis) may decrease the space in the chest for the lungs and lead to breathing problems.

Diagnosing Neuromuscular Scoliosis

To help the physicians at Southwest Scoliosis Institute determine the severity of neuromuscular scoliosis, spinal curves are evaluated using our advanced EOS imaging system. This system allows doctors to determine the location of the curve on the spine and measure the degree of the curvature while delivering an extremely low dose of radiation.

Because patients with neuromuscular scoliosis are often unable to stand, another advantage of this afvanced imaging system is that it allows us to obtain images of the patient in a seated position to assess the progression of any curve.

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

Treating Neuromuscular Scoliosis

Treatment for neuromuscular scoliosis requires a multidisciplinary approach and often includes specialists in orthopedics, pediatrics, pulmonology, neurology, urology, nutrition, and gastroenterology. All elements of care must be carefully coordinated to make sure that every aspect of treatment is taken into account in order to provide the best outcome for each patient.

Treatment for neuromuscular scoliosis depends largely on the type and severity of the spinal curve and the nature of any underlying condition, as well as the patient’s age and stage of development.

Nonsurgical Treatment

Although nonsurgical treatments will not prevent your child’s curve from progressing, 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, modifying the wheelchair to improve posture can lead to improvements. Modifications 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, the use of a molded plastic brace around the upper body to stabilize them while they are seated while still allowing them to use their arms and hands.

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

Surgery for Neuromuscular Scoliosis

The decision to proceed with surgery for neuromuscular scoliosis depends on several factors, such as the severity of the curve, the nature of the underlying neuromuscular condition, the age of the patient, ambulatory status, and how much the scoliosis affects their ability to function normally. Many other factors will also be considered, especially with patients who are non-communicative.

Should your child require surgery to correct neuromuscular scoliosis, the expert surgeons and caregivers at Southwest Scoliosis Institute can provide the care and attention they deserve. Drs. Richard Hostin, Kathryn Wiesman and Shyam Kishan have been treating children and adolescents for more than 10 years.

Spinal Fusion. This is the most common surgical procedure used to treat neuromuscular scoliosis. The surgeons use instrumentation (metal rods, screws, etc.) to fuse together two or more vertebrae in order to stabilize the spine and correct the abnormal curve.

In patients who are still quite young and growing rapidly, the treatment team may opt to use growing rods, a specialized form of instrumentation that can be adjusted 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 be necessary later in life if the curve continues to progress.

For more information or to make an appointment, call 214-308-0227.