Neuromuscular Scoliosis

What is Neuromuscular Scoliosis?

Scoliosis is a condition in which the spine bends to the left or right side resulting in an irregular shape. Neuromuscular scoliosis is a common type of scoliosis caused due to neuromuscular disorders affecting the muscles supporting the spine. It usually occurs in children and can worsen into adulthood if left untreated.

Causes of Neuromuscular Scoliosis

Neuromuscular scoliosis may be associated with:

• Spinal muscular atrophy
• Genetic disorder
• Musculoskeletal tumours
• Cerebral palsy
• Spinal injury
• Muscular dystrophy
• Weak pelvic and hip muscles
• Traumatic paralysis
• Spine tumour
• Polio

Scoliosis is more prominent when patients with neuromuscular conditions experience a growth spurt or need to use a wheelchair.

Symptoms of Neuromuscular Scoliosis

Symptoms of neuromuscular scoliosis usually appear in early childhood and include:

• Irregular posture, leaning on one side
• Uneven shoulder blades
• Uneven rib cage
• Tilted pelvis
• Head is not centred over pelvis
• Disproportionate waistline
• Difficulty sitting requiring arm support
• Loss of balance
• Breathing problems in severe cases

The scoliosis becomes more noticeable during periods of rapid growth and involves the entire spine. If left untreated, the condition will continue to worsen into adulthood.

Diagnosis of Neuromuscular Scoliosis

Your doctor will review your child’s symptoms and perform a physical examination of the spine. Diagnostic tests may be performed including:

• Adam’s Forward Bend Test: Your child will be instructed to bend forward at 90 degrees from the waist with the feet together and arms extended forward. This helps to detect spinal asymmetry or any hump formation in the back.
• Cobb Test: This test is used to detect the angle of curvature of the spinal deformity.
• Imaging tests are ordered which include:
  • X-rays: This study uses high electromagnetic energy beams that produce images of the bones to help detect fractures.
  • CT scan: This scan uses special x-rays that produce clear images of any damage present in the internal hard and soft tissue structures of the body.
  • MRI scan: This study helps in detecting damage to soft tissues or ligaments using images created by a computer that analyses radio waves passing through the body in a large magnetic field.
  • EOS imaging:  This test uses radiation of low dose (slit beam x-rays) to produce 3D images of the body while in sitting and standing position.
  • Bone scan: This is a nuclear imaging study that helps your doctor detect hidden stress fractures or any bone disorders.
  • Ultrasound: This test produces images of the internal organs using sound waves of high frequency.
• Pulmonary Function Test: This is a non-invasive test that helps to detect the functional capacity of the lungs.

Treatment for Neuromuscular Scoliosis

Treatments for neuromuscular scoliosis vary based on the severity and type of conditions. A multidisciplinary approach is necessary to address issues caused by the neuromuscular condition including scoliosis.  Scoliosis can be treated by the following methods:

Conservative Method

• Physical Therapy:  Your doctor will instruct your child to perform specific physical exercises to strengthen and balance the muscles.
• Bracing: Bracing can help provide support to the spine while in a seated position so arm support is not required. If your child can walk, bracing is not necessary.
• Wheelchair modification: If your child has a shifted pelvis and uses a wheelchair, a modified wheelchair with a moulded back and side support can be used to improve balance and function while in seating position.

Surgical Method

Surgery aims to reduce the spinal deformity and prevent the curvature from advancing.

• Spinal fusion surgery: In this procedure, a small incision will be made over the spine and metal rods or screws are used to carry out a spinal fusion. This prevents further curvature of the spine.
• Growing rods: For children whose spines are still growing, special rods are placed in the spine to correct spine curvature while allowing the spine to grow. They are removed later to perform spinal fusion after the complete growth of the child.