 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. |
