Published online Apr 18, 2014. doi: 10.5312/wjo.v5.i2.124
Revised: January 8, 2014
Accepted: January 15, 2014
Published online: April 18, 2014
Neuromuscular disorders are a group of diseases affecting the neuro-musculo-skeletal system. Children with neuromuscular disorders frequently develop progressive spinal deformities with cardio-respiratory compromise in the most severe cases. The incidence of neuromuscular scoliosis is variable, inversely correlated with ambulatory abilities and with a reported risk ranging from 80% to 100% in non-ambulatory patients. As surgical and peri-operative techniques have improved, more severely affected children with complex neuromuscular deformities and considerable co-morbidities are now believed to be candidates for extensive surgery for spinal deformity. This article aimed to provide a comprehensive review of how neuromuscular spinal deformities can affect normal spine balance and how these deformities can be treated with segmental instrumentation and sub-laminar devices. Older concepts have been integrated with newer scientific data to provide the reader with a basis for better understanding of how treatment of neuromuscular scoliosis has evolved over the past few decades. Recent advances, as well as challenges that remain to be overcome, in the surgical treatment of neuromuscular curves with sub-laminar devices and in the management of post-operative infections are outlined.
Core tip: In patients with neuromuscular disease, the likelihood and severity of the scoliosis increase with the degree of neuromuscular involvement. There is little doubt that segmental instrumentation techniques have revolutionized the care of patients with neuromuscular scoliosis by providing lasting correction and significant relief of pain and by restoring quality of life and sitting position. The state of knowledge regarding neuromuscular scoliosis is a dynamic process, and a current literature review is mandatory. The somewhat large bibliography for this subject reflects the many opinions and findings currently available.