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What You Should Know About Neuromuscular Scoliosis
Neuromuscular scoliosis develops as a result of imbalance in the muscle and nerve pathways of the spine. This type of scoliosis progresses more frequently than other types of idiopathic scoliosis. Bracing does not prevent curve progression, and the curves are more severe in patients who are unable to ambulate.
Underlying disorders that develop neuromuscular scoliosis are:
- Cerebral palsy
- Spinal muscular atrophy
- Freidreich ataxia
- Duchenne muscular dystrophy
- Traumatic paraplegia
Adults may also develop neuromuscular scoliosis with disorders such as Parkinson's Disease and Multiple Sclerosis.
Neuromuscular scoliosis is typically non-painful unless it progresses into a very large curve. The first signs of scoliosis may be a postural change, meaning, that the patient leans forward or to one side while standing or in a wheelchair. Patients in wheelchairs may be unable to sit upright in the chair and slump to one side. Patients that ambulate may have difficulty standing upright, and may begin to lean when ambulating.
The diagnosis is made through a clinical exam and long, full, spine x-rays. The x-rays will typically show a long C-shaped scoliosis affecting the entire spine.
Surgical treatment is indicated with progressive curves >50 degrees, inability to sit balanced in wheel chair, pain, and cardiopulmonary problems. Smaller curves may be treated with molding the wheelchair back to help correct. If surgery becomes necessary, the procedure is typically a long fusion with rod instrumentation. Neuromuscular scoliosis usually affects the whole spine and requires a longer rod and fusion to adequately treat and prevent further deformity. The goal of treatment is to stop the scoliosis from progressing and allow balanced sitting if the patient is confined to a wheelchair, and improved walking if the patient is able to walk.