Understanding Neuromuscular Scoliosis

By: Dr. Puneet Girdhar 

Neuromuscular scoliosis is a complex spinal deformity that develops due to various neurological or muscular conditions. It primarily affects individuals with conditions such as cerebral palsy, muscular dystrophy, spina bifida, spinal cord injuries, and neurofibromatosis. This guide aims to provide a comprehensive overview of neuromuscular scoliosis, including its causes, progression, treatment options, and the risks associated with untreated severe deformities.

What is Neuromuscular Scoliosis?

Neuromuscular scoliosis is a type of scoliosis that occurs due to problems with the nerves and muscles that support the spine. Unlike idiopathic scoliosis, which has no known cause, neuromuscular scoliosis is directly linked to underlying neuromuscular conditions.

Causes

Neuromuscular scoliosis can be caused by:

1. Cerebral Palsy: A group of disorders that affect movement and muscle tone.
2. Muscular Dystrophy: A group of genetic disorders that cause muscle weakness and degeneration.
3. Spina Bifida: A birth defect in which the spine and spinal cord don’t form properly.
4. Spinal Cord Injuries: Damage to the spinal cord that affects mobility and sensation.
5. Neurofibromatosis: A genetic disorder that causes tumors to form on nerve tissue, affecting spinal development.
6. Other Neuromuscular Conditions: Conditions that impair the nervous system’s ability to control muscle function.

Reasons for Progression

The progression of neuromuscular scoliosis can be rapid due to several factors:

1. Muscle Imbalance: Weakness or spasticity in muscles around the spine leads to uneven forces acting on the spine.
2. Poor Postural Control: Inability to maintain a balanced and upright posture can exacerbate spinal curvature.
3. Growth Spurts: Rapid growth periods during adolescence can accelerate the progression of scoliosis.

Risks of Leaving Severe Deformities Untreated

Untreated severe neuromuscular scoliosis can lead to:

1. Increased Deformity: Worsening of the spinal curvature over time.
2. Respiratory Problems: Reduced lung capacity and difficulty breathing.
3. Cardiovascular Issues: Strain on the heart due to compromised lung function.
4. Pain and Discomfort: Chronic pain and difficulty performing daily activities.
5. Reduced Quality of Life: Impaired ability to participate in social, educational, and recreational activities.

Treatment Options

Observation

For mild cases or early stages of neuromuscular scoliosis, regular monitoring by a healthcare professional is essential. This involves:

• Regular Check-ups: Periodic visits to monitor the progression of the spinal curvature.
• Physical Therapy: Exercises to maintain mobility and strength.

Guidelines for Observation

Observation is typically recommended for curves less than 20 degrees, particularly if the patient is still growing. The frequency of check-ups usually depends on the rate of progression of the curvature:

• Every 4-6 Months: For growing children with mild curves.
• Annually: For children with stable curves or those who have completed their growth.

If the curve progresses or if the patient shows signs of rapid growth, more frequent monitoring or a shift to more active treatment options may be necessary.

Bracing

Bracing is less commonly recommended for neuromuscular scoliosis compared to idiopathic scoliosis because it is generally less effective in preventing curve progression. However, in some cases, bracing may be used for:

• Postural Support: To help maintain an upright position and improve sitting balance.
• Comfort: To provide some stability and reduce discomfort.

Surgery

Surgery is typically recommended for severe scoliosis (curves greater than 50 degrees) or when the curvature affects the patient’s ability to breathe or sit comfortably.

Indications for Surgery:

• Severe Spinal Curvature: Curves that are likely to progress.
• Pain and Discomfort: Persistent pain that affects daily activities.
• Functional Impairment: Difficulty with sitting, standing, or walking.
• Respiratory Issues: Curvature affecting lung function.

Surgical Procedure: Posterior Spinal Fusion and Instrumentation

• Goal: To correct the spinal curvature and stabilize the spine.
• Approach: A posterior (back) approach is commonly used.
• Steps:

1. Incision: A midline incision is made along the back.
2. Exposure: The spine is exposed by retracting the muscles.
3. Instrumentation: Rods, screws, and other hardware are attached to the spine to correct the curvature.
4. Fusion: Bone grafts are placed to promote the fusion of the spinal segments.
5. Closure: The incision is closed with sutures or staples.

Risks and Complications

As with any surgery, there are potential risks, including infection, blood loss, and complications related to anesthesia. However, the benefits of correcting severe spinal deformities often outweigh these risks.

The writer is Principal Director & Head – Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, Delhi