Neuromuscular Scoliosis - Spine

Introduction

Defined as an irregular spinal curvature caused by disorders of the brain, spinal cord, and muscular system.
Neurogenic curves (relative to idiopathic curves) tend to be
- more rapidly progressive
- may progress after maturity
- associated with pelvic obliquity
- are longer and involve more vertebrae (may involve cervical vertebrae)
- have a higher rate of pulmonary complications with surgery

Classification & Treatment

Classification and Treatment (for more detail go to disease content)
Category	Disease	Nonoperative Treatment	Operative Treatment
Upper motor neuron	Cerebral palsy	Boston-type underarm bracing until puberty (age 10-12) and wheelchair modification	Group I treat with PSF with instumentation Group II treat with PSF +/- ASF with instrumentation and fusion to pelvis (Luque-Galveston) Indications for surgery curve > 50° worsening pelvic obliquity with sitting imbalance
	Rett Syndrome	Bracing for C-shaped curves	Bracing C shaped curves Posterior Spinal Fusion indications thoracic curve that intefers with sitting and balance C shaped curves that do not respond to bracing
Muscle Weakness	Spinal muscular atrophy	Boston-type underarm bracing until puberty (age 10-12)	Treat with PSF with fusion to pelvis for improved wheelchair sitting address hip contractures before PSF may lead to temporary loss of upper extremity function
Muscle Weakness	Muscular dystrophy	bracing is contraindicated	PSF with or without fusion to pelvis (fusion to pelvis is controversial) indications absolute curve > 20° progressive curve Treat early before pulmonary function declines (curve from 20 to 30°)
Paralytic Syndromes	Spinal bifida and spinal cord injuries	bracing is contraindicated	ASF/PSF with instumentation and pelvic fixation anterior fusion required because minimal posterior element to obtain fusion
Paralytic Syndromes	Polio	Boston-type underarm bracing until puberty (age 10-12)	PSF