Current concepts in neuromuscular scoliosis

Abstract

Purpose of Review Spinal deformity is a common issue in pediatric patients with an underlying neurological diagnosis or syndrome. Management of neuromuscular scoliosis (NMS) is a major part of the orthopedic care of such patients, as the deformity is often progressive, and may affect gait, seating and positioning. In addition, untreated large spinal deformities may be associated with pain and/or cardiopulmonary issues over time. Recent Findings Recent changes in medical management of the underlying disease process appears to alter the natural history of certain neuromuscular conditions, and in the case of patients with Duchenne's muscular dystrophy significantly diminish the incidence of spinal deformity. In the most common diagnosis associated with NMS, cerebral palsy, there is evidence that despite a high complication rate, surgical management of spinal deformity is associated with measurable improvements in validated health-related quality-of-life measures. Summary Spinal deformity is a common finding in patients with neurological diagnoses. It is important for those involved in the care of these patients to understand the natural history of NMS, as well as the potential risks and benefits to the patient and caregivers, of surgical and non-surgical interventions.

Quadris espásticos da paralisia cerebral – Estudo retrospectivo do salvamento com a cirurgia de McHale

“…40°were deemed moderately severe. 23 Angles and distances with up to 2 decimal places were determined with the MB-Ruler software, version 5.3 for Windows (MB-Softwaresolutions, Iffezheim, Germany). The radiographic measurements were made by two experienced and independent evaluators, and the interobserver intraclass correlation coefficient (ICC) was calculated.…”

Ahead of the Curve: Pediatric Scoliosis

“…Neuromuscular scoliosis is a curve associated with abnormalities of the nervous or musculoskeletal system. 12 These abnormalities may be relatively self-contained (such as a Chiari I malformation and syrinx) 13 or may be associated with more global anomalies, such as cerebral palsy. 12 Syndromes such as Marfan syndrome (up to 60%) or neurofibromatosis (25%) have particularly high incidences of scoliosis.…”

“…12 These abnormalities may be relatively self-contained (such as a Chiari I malformation and syrinx) 13 or may be associated with more global anomalies, such as cerebral palsy. 12 Syndromes such as Marfan syndrome (up to 60%) or neurofibromatosis (25%) have particularly high incidences of scoliosis. 14 Neuromuscular scoliosis may behave atypically, including more rapid progression and progression at earlier ages.…”

“…Symptoms related to neuromuscular scoliosis may present sooner than other curves of a similar magnitude. 12 Thoracogenic scoliosis is the result of a disruption of the chest wall, either through disease or operative trauma. 18 Examples include a history of sternotomy or thoracotomy as part of the surgical treatment of congenital heart or pulmonary defects.…”

Deformities of the spine and limbs in patients with Duchenne myodystrophy: clinical features, diagnosis and treatment. Interstate consensus protocol

“…Важно, чтобы специалист, отвечающий за координацию медицинской помощи, знал о доступных показателях оценки, методах диагностики и вмешательствах. Это необходимо для того, чтобы тактика ведения МДД была упреждающей по отношению ко всем потенциальным проблемам, которые могут возникнуть у пациента [1][2][3][4].…”