Neuromuscular Scoliosis is the curvature of the spine with a disorder of the neurological system such as cerebral palsy, spina bifida, or muscular dystrophy or spinal cord injuries. Most of these patients have a weakness of the trunk. The curvature of the spine is progressive, and worsens during growth spurts. Many patients require a wheelchair due to other neurological conditions. As the trunk muscles weaken, the spine collapses into a C shaped curve making it difficult for the patient to sit upright. Progressive curves may affect the child’s ability to be seated comfortably, thereby affecting their quality of life and function.
The treatment of neuromuscular scoliosis is individualized. Bracing may provide support for the trunk in the seated position, but is usually not effective at stopping progression of the curve over time. Seating modifications such as inserts into wheelchairs may help with positioning the child, but are also not corrective in terms of the scoliosis. Alternative therapies such as insertion of an Intrathecal Baclophen Pump will produce a reduction in spasticity but will not affect the long-term progression of the scoliosis. Injection of Botox into the paraspinal musculature will temporarily reduce the tone in these muscles but has no proven long-term efficacy in the treatment of neuromuscular curves.
The fundamental question to be addressed by families and their physician is whether surgical intervention will maintain or improve the child’s quality of life and function. If surgical intervention is necessary, it should be performed before the pulmonary system is compromised.