There is no need to avoid sport or exercise when you have neuromuscular scoliosis. The rib cage can also push out on one side so that it becomes prominent - this is known as a rib hump. 14–2). ASF with instrumentation alone provided nice correction: (B) AP and (C) lateral post-op radiographs. However, other websites, including wiki, claim that it has no effect on life expectancy and say that it is a myth. Because the deformity can occur in the very young, curve control without resorting to definitive spinal fusion and the subsequent trunk shortening that would occur with such treatment would be desirable. Results. Only gold members can continue reading. Sometimes the shoulders aren’t level anymore. Figure 14–4 This older teenage girl with Rett syndrome has a severe kyphosis as her main deformity. The severity of the abnormalities can vary between people and can change with time. Some syndromes have associated spinal deformities, which are particularly “malignant” in their severity and progression as well as their “refractoriness” to even surgical treatment (e.g., familial dysautonomia). This is to see if the scoliosis is worsening. Surgical treatment of the initial injury was performed but failed: (A) AP and (B) lateral radiographs. Either you, your child or someone else may notice that there are changes in the shape of the spine or that they are sitting or standing as straight as before. parents and caretakers report excellent improvement in the child's quality of life after deformity correction; Increased risk of wound complications with: Poor nutritional status (serum albumin <3.5 g/dL) ... - Neuromuscular Scoliosis B 11/22/2020 26 . This is also backed up by a study done by Iowa University. Figure 14–3 This adolescent male had a spinal injury associated with an incomplete spinal cord injury. Spinal Interface Training Group (STIG) PilotJune 17, 2019, MAGEC Rods - BSS Statement - 29 Nov 2018November 29, 2018, 2015 © BSS. While some cases may be mild and progress slowly, others can cause severe muscle weakness and disability. with instrumentation to the pelvis achieved nice correction [(D) AP and (E) lateral post-op radiographs], and sitting was markedly improved (F). Although large idiopathic curves in adolescence are generally not painful and do not interfere with activities of daily living, severe neuromuscular curves frequently cause impaired posture and discomfort that interfere with basic functions such as sitting (Fig. More often than not, it will be nothing serious and just require monitoring at the hospital. If standing or bending is not possible, the doctors will do the examination in the wheelchair and then on the couch in the clinic. They will be able to assess and see if there is a scoliosis. Common conditions that can result in a neuromuscular scoliosis include: Muscular dystrophy (eg Duchenne’s muscular dystrophy). The neurologic condition may be the patient’s primary diagnosis or may be part of a larger syndrome. Neuromuscular deformity may be classified broadly into two types: the developmental and the acquired. A severe scoliosis compromises respiratory function and makes sitting more difficult. Unfortunately there is no strong evidence that exercise alone stops a scoliosis progressing or improves it. Other types are affected not only by the muscular weakness but also abnormalities of the vertebrae (e.g., myelomeningocele) (Fig. A positive Ober test on the left was noted post-op. Life expectancy in pediatric patients with cerebral palsy and neuromuscular scoliosis who underwent spinal fusion They can develop subsequent spinal deformity from failure of the initial injury procedure as well as the superimposed paralytic factors11 (Fig. The other type could be considered as acquired, and examples of underlying conditions causing acquired deformity would be spinal cord injury, transverse myelitis, and polio. Scoliosis is a complicated spine condition even for those without muscular dystrophy. Having a better understanding of these disorders facilitates the management of their associated spinal deformities (Table 1). She had a two-stage reconstruction with a period of halo-gravity traction between the anterior and posterior procedures. with instrumentation to the pelvis achieved nice correction [(D) AP and (E) lateral post-op radiographs], and sitting was markedly improved (F). The etiology of neuromuscular deformity is primarily that of muscular weakness and/or imbalance and control that affects trunk alignment. Thus, patients with flaccid muscles (e.g., Duchenne’s muscular dystrophy, polio)4–6 (Fig. Revision of the spinal surgery resulted in normalization of spinal alignment and a solid fusion: (C) AP and (D) lateral post-op radiographs. The shape can change as your child grows, particularly at the time of growth spurts. Figure 14–1 This teenage girl had polio with the extensor hallucis longus on one foot as the only functioning lower extremity muscle. Recent advances in the medical treatment of SMA has increased life expectancy and improved functional abilities. 14–3). In his 15 plus years of chiropractic and 13 years of scoliosis-specific chiropractic care, Dr. Alex has seen many patients with neuromuscular scoliosis. 14–5). The scoliosis then progresses with an acute deterioration during the growth spurt somewhere between the ages of 13 and 15 years, such that it becomes difficult or impossible to sit unaided. Though this technique does involve a spinal fusion, its effect on trunk height is less than would occur with a long posterior fusion because many fewer vertebrae are involved in the fusion segment15(Figs. Surgery in a growing child’s spine aims to reduce the risk of the curve worsening at the same time as trying to ensure the spine overall still grows and lengthens with time. Curve progression is especially rapid once the individual becomes non-ambulant (averaging 10° in Cobb angle/year) and usually curves extend to involve most of the thoracic and lumbar spine. The etiology of neuromuscular deformity is primarily that of muscular weakness and/or imbalance and control that affects trunk alignment. A positive Ober test on the left was noted post-op. This does stiffen as well as straighten the spine. Related. 14–4). Types of deformity Scoliosis sitting or standing as straight as before. CLEAR Scoliosis Institute board member Dr. Alex Greaux and Ashley Brewer discuss the tough topic of neuromuscular scoliosis (NMS) during episode 10 of Life Beyond the Curve. If your child is under 10 year of age, neuromuscular scoliosis will be treated like an early onset scoliosis. Figure 14–2 This young girl has myelomeningocele with spotty lower extremity motor function and several neuraxis abnormalities as well as a complex spinal deformity but no sagittal plane malalignment: (A) pre-op AP radiograph. She developed a severe spinal deformity with 90 degrees of pelvic obliquity: (A) anterior/posterior (AP) and (B) bender thoracolumbar (TL) radio-graphs. ♦ Nonoperative Treatment However, deformity in either type has the potential for severe progression because most deformity starts while the patients are skeletally immature. However, it does not appear that braces affect the natural history of these curves. They are usually rigid braces and need to be worn 23 hours a day. Your Spine Surgeon will talk to you about the risks and benefits of this type of an operation. Occasionally, especially if the scoliosis affects someone early in life, it can affect the development and function of the lungs. Additionally, these references have extensive bibliographies that provide the reader with an ample opportunity to peruse the many additional articles that address and expand on the comments in this chapter. Figure 14–5 This nonambulatory teenager with cerebral palsy developed a significant deformity [(A) AP and (B) lateral pre-op radiographs] associated with difficulty sitting (C). This chapter will summarize the collective and traditional wisdom about neuromuscular spine deformity in general and address a few specific conditions to illustrate the concepts and difficulties in reaching the treatment goals of this condition. These are necessary to see if there is a scoliosis and how bad it is. In fact, the goals of surgical treatment are the following: correction of the curve in the coronal plane, normalization of sagittal alignment, leveling of the pelvis, and the achievement of a solid fusion (if in fact the surgical treatment being performed is a definitive fusion)1–3(Fig. ALL Rights Reserved. The aim of the operation is to stop things worsening and to hopefully improve function and appearance. Neuromuscular deformities, also called paralytic spinal deformities, are associated with some type of underlying neurologic condition and may be just one of several musculoskeletal abnormalities caused or exacerbated by the neurologic disease. 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