Sobre Neuromuscular Scoliosis 

Neuromuscular scoliosis develops as a result of imbalance in the muscle and nerve pathways of the spine.  This type of scoliosis progresses more frequently than other types of idiopathic scoliosis.  Bracing does not prevent curve progression, and the curves are more severe in patients who are unable to ambulate. 

Underlying disorders that develop neuromuscular scoliosis are:

• Cerebral palsy affects the body’s musculoskeletal system and the ability to move and balance itself.
• Myelodysplasia
• Spinal muscular atrophy
• Freidreich ataxia
• Duchenne muscular dystrophy
• Traumatic paraplegia
• Muscular Dystrophy：There are many different forms of muscular dystrophy (MD) that shape the occurrence of scoliosis within the disorder.
• Spina bifida is one of the most common birth defects. It develops in utero as the embryo’s neural tube (which later develops into the brain and spinal cord) does not close properly.This causes a malformation of the spinal cord, its coverings, and/or the vertebrae of the spine.
• Adults may also develop neuromuscular scoliosis with disorders such as Parkinson’s Disease and Multiple Sclerosis.

Symptoms of Neuromuscular Scoliosis

Any condition that affects the brain and/or spinal cord can produce a wide variety of symptoms as they play a role in virtually every working system within the body.

Cases of NMS can vary greatly as its progressive rate and severity is determined by the amount of muscle and nerve involvement related to the individual’s condition.

While not every person with a neuromuscular disorder is guaranteed to develop scoliosis, it is a common related complication.

The more a person’s neuromuscular condition impairs their movement and balance, the more likely they are to develop scoliosis as a result; people who are wheelchair-bound (non-ambulatory) are more likely to develop scoliosis as a related complication.

The development of neuromuscular scoliosis is more common in children and adolescents than in adults, just as the development of idiopathic scoliosis is far more prevalent in children and adolescents.

Diagnosing Neuromuscular Scoliosis in Children

The process of diagnosing neuromuscular scoliosis in children typically initiates with a thorough physical examination conducted by a healthcare professional.

During this examination, the child’s doctor routinely gathers the family’s medical and genetic history, inquires about the onset and nature of symptoms, and conducts a comprehensive assessment of the child’s spine and back. The examination includes evaluating issues related to balance, movement, skin integrity, and the presence of functional deficits.

For instance, in the case of an adolescent with cerebral palsy who is confined to a wheelchair and exhibits a significant left-bending scoliotic curve, this may lead to a pelvic tilt, contributing to sitting imbalance and the potential development of sitting sores.

X-ray imaging plays a crucial role in the assessment and diagnosis of neuromuscular scoliosis. The Cobb angle, measured during X-rays, serves as the orthopedic gold standard for evaluating scoliosis severity and is categorized on a scale:

• Mild scoliosis: Cobb angle measurement between 10 and 25 degrees
• Moderate scoliosis: Cobb angle measurement between 25 and 40 degrees
• Severe scoliosis: Cobb angle measurement of 40 degrees or more
• Very-severe scoliosis: Cobb angle measurement of 80 degrees or more

Additionally, magnetic resonance imaging (MRI) scans contribute to a comprehensive assessment of neuromuscular scoliosis by providing clear images of soft tissues, aiding in the evaluation of the overall health of the spinal cord.

Neuromuscular Scoliosis Treatment

There are two main treatment approaches when dealing with NMS: nonsurgical (conservative) and surgical.

Nonsurgical Treatment for Neuromuscular Scoliosis

Given that NMS often stems from a brain/spinal cord condition, and with no permanent cure for scoliosis, halting NMS progression permanently is not currently feasible.

At the Scoliosis Reduction Center, our goal in treating NMS patients is to effectively impede its progression and enhance their quality of life. Addressing the underlying neuromuscular condition guiding the scoliosis development, we adapt our treatment plan accordingly.

Our approach involves integrating various treatments, such as bracing and rehabilitation. However, in severe NMS cases, bracing may not always succeed, and scoliosis-specific exercises need modifications for NMS characteristics.

Treating NMS patients is challenging due to the additional limitations imposed by the underlying neuromuscular condition on function, mobility, and overall health. Patients in wheelchairs, with unresponsive conditions to bracing, pose even greater challenges, including complications from immobility and spinal rigidity.

Given the absence of a cure, our treatment focus is on slowing curvature progression as much as possible, for as long as possible, with the aim of improving the patient’s quality of life.

Surgical Treatment for Neuromuscular Scoliosis

In severe instances of NMS, spinal fusion surgery is often recommended, but it should be considered as a last resort after exhausting noninvasive treatments, given the substantial risks and side effects associated, akin to AIS surgery.

Cases suitable for surgery typically involve extreme spinal curvatures exceeding 50 degrees, rapid progression, persistence into adulthood, significant pain, difficulty sitting, or related functional deficits like heart and lung impairment.

For NMS patients, surgical decisions are more intricate due to their underlying condition, necessitating a comprehensive approach that addresses both the neuromuscular condition and scoliosis.

In young individuals with NMS, surgical options are intricate as the growing spine must be considered, as growth triggers curvature progression.

For adult NMS patients, surgery complexity increases with age-related risks and prolonged recovery. Younger patients or those without progression into adulthood generally have more spinal flexibility, facilitating treatment.

A concern with surgical treatment for young NMS patients is potential growth restriction in the fused section. Although growing rods can address this by periodic lengthening, it entails repeated procedures with associated risks.

Innovative Neuromuscular Scoliosis Screening Technologies in Forethought

Forethought Medical excels in neuromuscular scoliosis screening with its innovative technologies. The company, dedicated to intelligent and portable medical devices, boasts a robust research and development team, including medical and clinical experts, electrical engineering PhDs, algorithmic research computer PhDs, and rehabilitation specialists. Leveraging cutting-edge smart optical sensing, precise terrain scanning, multi-sensor data fusion, and digital twin technologies, Forethought has introduced the “Forethought Spinal Data Collection & Analysis System” and “Sapling Spinal Detector.” These advancements simplify and lighten spinal detection, showcasing the company’s technological prowess in the field of neuromuscular scoliosis screening.

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