Neuromuscular Scoliosis

Question 1

Neuromuscular Scoliosis

Answer 1

Onset at early age
Associated with systemic or chronic diseases
Rapid progression

Direct cause not understood

Curves tend to progress more rapidly with disabling outcomes

May result in increased energy consumption during ADL’s, decreased sitting balance, back pn

Have variation in curve pattern
- long C curve is common beginning in thoracic region and ending at sacrum

Severity of curve correlates with pelvic obliquity

Highest prevalence of spinal deformity occurs with a dystrophy dx (MD, SMA), SCI, myelomeningocele, CP

Question 2

Interventions

Answer 2

Clinical observation- look at present and potential fxn, level of comprehension, and ability to cooporate
Radiographic exam

Orthotic Mgmt

• orthosis eliminates normal flexibility of the spine- decreases ability to adjust AD independently
• orthotic musc stabilize curve without limiting functional abilities
• custom modeled seating d/t pelvic obliquity
• Goal: postpone surgery during growing years

Custom seating- reduces and prevents progression of curves

If NM scoliosis continues to progress it impacts: hygiene, functional abilities, pulmonary fxn, and life expectancy

Question 3

Surgical Options

Answer 3

Fusion to sacrum is common d/t pelvic obliquity or lack of sitting balance, blood loss is greater d/t osteopenia, mm are in poor condition so surgery is usually longer

Curve may require anterior and posterior fusions with instrumentation

Two stage procedure use for higher magnitude curves or severe kyphoscoliotic- anterior release of mm followed by posterior fusion

Orthosis- always used postoperatively for support and immobilization