Neuromuscular Scoliosis

Indications for Surgery

Unlike idiopathic scoliosis where the cause of scoliosis is unclear, the underlying condition in neuromuscular scoliosis guides treatment strategies. For instance, neurosurgical decompression in patients with syringomyelia (fluid sac within the spinal cord), diastematomyelia (bone or cartilage ingrowth into spinal cord), or tethered cord syndrome may prevent curve progression without spinal stabilization.




Arnold-Chiari Malformation/Syrinx causing Scoliosis A) A young woman with neuromuscular scoliosis related to Arnold-Chiari Malformation (brain stem settling into the neck) and its associated syrinx (spinal fluid accumulation within the spinal cord). B) Xray findings. C) MRI demonstrating cervical spine abnormalities.		Congenital Scoliosis with Diastematomyelia A) An xray of a young girl with congenital scoliosis (malformed, wedged vertebra). The arrow points to the diastematomyelia (bony ingrowth). B) A CT scan image showing a bony spike growing through the spinal canal. C) A photo of the bony spike after it was removed.

The indications for spinal stabilization are less straight-forward than idiopathic scoliosis.

Common indications include:

Curves > 50^o (in patients still growing)
Curve progression > 10^o (after skeletal maturity)
Functional deterioration
Pain
Cardiopulmonary compromise

Pain may be difficult to assess in non-communicative patients.

It is important to maximize nutrition and cardiopulmonary status prior to surgery to minimize the risk of infection and prolonged intubation after surgery. Similarly, skin in the region of the spine and pelvis must be assessed to minimize infection.

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