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Neuromuscular Scoliosis: Changing the Surgical Discussion

(Feb 1, 2009)

Scoliosis is a common occurrence for children with neuromuscular disorders such as cerebral palsy and muscular dystrophy. These curves can progress rapidly and not only cause difficulties with positioning the child and pressure sores, but can create or worsen cardiac and respiratory problems. Many of these children have multiple medical problems and a progressive scoliosis can lead to a rapid deterioration in their health.

With recent advances in care, many children with neuromuscular diseases are living longer, making the decision to treat scoliosis even more critical. Factors used in making the decision to undergo surgery include determining if it will improve the quality of life for the child, decrease the so called burden of care for the child's care providers, and prevent future problems. "We use a much lower threshold (in curve size) to consider surgery for neuromuscular scoliosis (as opposed to idiopathic scoliosis)," explains Benjamin Roye, MD. "In certain conditions even a 20 degree curve can be predicted progress to a life-threatening situation or a situation where a young adult is more compromised than he might have been if treated. We often see patients with very large curves who could have benefitted from an earlier treatment."

While bracing is often a treatment for children with idiopathic scoliosis, it does not prevent the progression of neuromuscular scoliosis. These children are also often unable to tolerate the brace because of their restricted lung functions.

What the pediatric orthopaedic surgeons are finding at the Morgan Stanley Children's Hospital of NewYork-Presbyterian, is that when surgery is indicated for very large curves, performing two smaller surgeries staged a week or two apart are easier for the child to tolerate and can lead to improved curve correction. Helping a family prepare for surgery is a team effort with surgeons, nurses, and child life specialists. Parents are also introduced to other parents to share helpful experiences.

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