Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders

Abstract

Neuromuscular disorders (NMDs) are diseases involving the upper and lower motor neurons and muscles. In patients with NMDs, cervical spinal deformities are a very common issue; however, unlike thoracolumbar spinal deformities, few studies have investigated these disorders. The patients with NMDs have irregular spinal curvature caused by poor balance and poor coordination of their head, neck, and trunk. Particularly, cervical deformity occurs at younger age, and is known to show more rigid and severe curvature at high cervical levels. Muscular physiologic dynamic characteristics such as spasticity or dystonia combined with static structural factors such as curvature flexibility can result in deformity and often lead to traumatic spinal cord injury. In addition, postoperative complication rate is higher due to abnormal involuntary movement and muscle tone. Therefore, it is important to control abnormal involuntary movement perioperatively along with strong instrumentation for correction of deformity. Various methods such as botulinum toxin injection, physical therapy, muscle division technique, or intrathecal baclofen pump implant may help control abnormal involuntary movements and improve spinal stability. Surgical management for cervical deformities associated with NMDs requires a multidisciplinary effort and a customized strategy.

Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

“…This result was likely because among patients with CP, surgical invasiveness, need for surgical release, and utilization of osteotomies significantly increased in those with fixed cervical kyphosis than in those with semi-rigid or flexible kyphosis. In patients with CP, fixed cervical kyphosis is often accompanied by severe degenerative changes; thus, surgical treatment of such patients is challenging and requires invasive surgery to correct and stabilize the deformity while decompressing neural elements and restoring sagittal alignment [ 11 , 13 , 15 ]. Hence, patients with CSM and CP tend to undergo staged operations or combined approaches.…”

“…Typically, conservative treatments are ineffective; patients often require surgical treatment [ 2 ]. The most important surgical objectives for such patients are adequate decompression of the spinal cord and nerve roots, stabilization of the cervical spine, and alignment correction [ 11 , 12 , 15 ]. Recent advances in medical technology have led to the development of improved internal fixation methods, which promote stronger initial mechanical stability resulting from anterior plating or posterior screw fixation [ 7 ].…”

Scoliosis and Gastroesophageal Reflux Disease in Adults

“…Although the sagittal plane parameters revealed positive and negative values in kyphosis and lordosis, respectively, the direction of the curve was not taken into consideration while evaluating the magnitude of the curve in scoliosis. Nonetheless, because of the left-sided location of the gastroesophageal junction, the difference between the right and the left-sided curves can be important in the evaluation of the relation between the symptoms of GERD and scoliosis [ 18 ]. Therefore, to analyze the direction of the curve when evaluating the risk factors of GERD, we explained the left-sided convex curve of the thoracolumbar or lumbar region as positive and the right-sided as negative.…”

Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era

“…12 Cervical deformities associated with neuromuscular disorders also should be considered. 13 The effects of sagittal alignment after A c c e p t e d A r t i c l e 6 scoliosis operation on the cervical alignment in patients who could not stand independently are unknown.…”