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Minerva Orthopedics 2021 June;72(3):279-89

DOI: 10.23736/S2784-8469.20.04048-5


lingua: Inglese

Neuromuscular scoliosis

Luca F. COLOMBO 1 , Valentina CARETTI 2, Antonio ANDREACCHIO 3

1 Spinal Unit, Buzzi Children’s Hospital, Milan, Italy; 2 Buzzi Children’s Hospital, Milan, Italy; 3 Department of Pediatric Orthopedics, Buzzi Children’s Hospital, Milan, Italy

Neuromuscular scoliosis indicates a large group of spine deformities which originate from several different pathologies. In this context, it is important to keep in mind that patients with similar spine deformities according to the underlying disease may differ for history, needs and benefits from surgery. All these factors must be carefully considered when choosing a treatment. Conservative treatment is not the solution and does not control the deformity. A common element of neuromuscular scoliosis is that the deformities are progressive in 70-90% of patients and deterioration of the curve as an effect of growth affects their sitting ability. Associated pelvic obliquity affects sitting and standing balance, can lead to pressure sores and can contribute to hip dislocation. If the deformity is located in the thoracic spine, this can lead to thoracic insufficiency syndrome resulting in poor life expectancy and precluding spinal surgery. The majority of the patients affected by neuromuscular scoliosis are unable to walk or stand and they use a wheelchair. When we consider a correction, we have to restore the balance between the pelvis and the shoulders in order to achieve a good position when sitting on the wheelchair, prevent lateral trunk tilt and the development of pressure sores on the ischium. In children with neuromuscular scoliosis, our preference is to use the unit rod system. We use a segmental pedicle screw in patients who are able to walk. In young patients (aged between 5 and 10 years) affected by spinal muscular atrophy and congenital myopathy that often develop thoracic insufficiency syndrome type 2, magnetically growing rods are used. We have different surgical instruments at our disposal, not only pedicle screws, but also hooks and sublaminar wires or bands (although young surgeons never use it and they deem it obsolete): in the treatment of neuromuscular deformity, these instruments can help address many issues. Last but not least, the treatment of children affected by neuromuscular disease can greatly benefit from the establishment of a multidisciplinary team that takes care of all critical aspects in those fragile children.

KEY WORDS: Scoliosis; Cerebral palsy; Spinal muscular atrophies of childhood; Neurosurgical procedures

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