The first option also has the advantage of allowing an indefinite time between stages if required. Treatment for Neuromuscular Scoliosis requires a multidisciplinary approach and often includes specialists in orthopedics, pediatrics, pulmonology, neurology, urology, nutrition, and gastroenterology. Nonsurgical options for neuromuscular scoliosis. Kotwicki and colleagues15 followed 45 nonambulatory patients with neuromuscular scoliosis treated with a suspension trunk orthosis (STO) and found that the STO slowed curve progression in 23 patients. If the curve progresses over 20 degrees, and your child is still growing, a brace may be recommended to keep the curve from worsening. Posterior approach: The most frequently performed surgery for adolescent idiopathic scoliosis involves posterior spinal fusion with instrumentation and bone grafting. In treating neuromuscular scoliosis, the doctor can choose non-surgical treatment and surgical treatment approaches in line with the patient’s situation. 2012. D, The patient is unable to be comfortably positioned in her wheelchair. FIGURE 24–6 A and B, Clinical photograph (A) and lateral radiograph (B) of a child with severe kyphosis that impedes balanced sitting. Antiepileptic medications such as phenytoin and valproate have been linked to decreased bone turnover and decreased intestinal absorption of calcium resulting in osteopenia, which may affect implant fixation and should be considered in the selection of construct components. Various medications have been tested to improve the musculoskeletal function of patients with neuromuscular disorders. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Nutritional status should be assessed preoperatively with albumin and total blood lymphocyte levels. DMD may be an important exception to this concept: Surgery has been advocated when the deformity reaches 20 degrees because of pulmonary considerations. C, Age 23, curve measures 143 degrees. This is a tremendous advantage because postoperative casting carries the potential for skin and pulmonary complications. Although many patients already have neurologic compromise, they are still at risk for further compromise because of intraoperative spinal column manipulation. Spine was dissected, subperiosteally, only pedicle screw instrumentation is a recent concept, up to the tip of the transverse processes at all levels. Available options may include: 1. Randomized placebo-controlled trials have been conducted investigating the efficacy of several medical treatments for SMA, including creatine, phenylbutyrate, gabapentin, and thyrotropin-releasing hormone.2–5 None of these compounds has proven to be an efficacious drug treatment for SMA.2. Improvement on the Galveston concept has been the focus of many clinical studies.69,72–74 The use of S1 screws alone was investigated, but bone quality is generally not substantial enough for successful use in patients with neuromuscular scoliosis. Patients should have a preoperative anteroposterior and lateral film taken of the entire spine preferably in an upright (sitting or standing) position. 24–1). Treatment for neuromuscular scoliosis The goal of treatment for this type of scoliosis is to maintain the spine in a balanced position and to control the curve of the spine during growth. Olafsson and colleagues18 followed 90 patients with various neuromuscular conditions treated with a soft Boston orthosis for an average of 3 years after brace treatment. The use of iliac screw fixation has become a subject of several more recent articles because of its ease of implantation, avoiding the complex lumbosacral three-dimensional Galveston rod contouring. What are the treatment options for neuromuscular scoliosis? Studies of patient outcomes with unit rod fixation have revealed excellent correction and maintenance of correction.54–56 Bulman and colleagues57 compared the unit rod with double Luque rods and reported superior correction of sagittal and coronal alignment and pelvic obliquity with the unit rod constructs. The difficulty of treating scoliosis in the young is controlling the scoliosis without interfering with growth of the spine. Some authors have argued that the pelvis can be left unfused in patients with slight pelvic obliquity, mild contractures, and little pelvic deformity in the sagittal plane, whereas others have argued that an ambulatory patient should never be fused to the pelvis.69,79 McCall and colleagues60 advocated that patients with less than 15 degrees of L5 tilt should be considered for a fusion to L5. Intrathecal baclofen is a well-established treatment that has been shown to provide significant benefits in controlling spasticity in patients with cerebral palsy. Whether your child has idiopathic, neuromuscular or congenital scoliosis, the primary goal of any treatment is to stop the curve from getting worse. Malnourished patients are more prone to perioperative complications such as wound dehiscence, wound infection, and pulmonary complications. Non-surgicaltreatment Theprimary goal of non-surgical treatment is to prevent the spinal curves from furtherworsening. Many patients with neuromuscular scoliosis are on long-term seizure therapy, which has some important operative ramifications. Conservative and surgical treatment of neuromuscular scoliosis differs from idiopathic scoliosis, being more complex and with a higher complications rate. Surgery is frequently deemed to be the best treatment for scoliosis for adults, children with severe curves, and people of all ages with neuromuscular disorders. Treatment for neuromuscular scoliosis. Various systems have been proposed to provide fixation to the pelvis. In a study of 23 patients, Miller and colleagues17 followed 23 patients with cerebral palsy who wore a rigid Wilmington TLSO for an average of 67 months and concluded that the bracing did not slow progression of their deformity. The dilemma faced by the surgeon is how to stop the progression of a curve without adversely a… Anterior release and fusion has generally been indicated in patients with rigid scoliosis, patients with rigid kyphosis, immature patients at risk for the development of crankshaft growth, and patients at risk for pseudarthrosis owing to incompetent posterior elements (myelomeningocele or severe osteopenia). 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