Severe scoliosis can be disabling. To assess spinal flexibility, supine bending films or traction films are used. The authors based their conclusion on six randomized controlled trials and observed that the most effective prednisolone dose seemed to be 0.75 mg/kg/day, given daily.13 Markham and colleagues14 showed that glucocorticoid therapy provides the added benefit of retarding the anticipated development of ventricular dysfunction if begun before ventricular dysfunction in their series of 14 DMD patients treated with steroids compared with 23 DMD patients treated without steroids. This study was limited by its relatively small sample size and lack of a control group. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. The timing for operative treatment is influenced by curve severity, underlying neuromuscular pathology, and other factors. Because patients with neuromuscular scoliosis are prone to gastrointestinal dysmotility, they are at risk for a postoperative ileus, requiring aggressive hydration, maximized nutritional status, and a rigid daily toilet regimen. Nonoperative treatments can include the following… Botulinum toxin has gained a growing acceptance as a treatment of upper and lower limb spasticity. Several medical therapies have been investigated for the treatment of spasticity in patients with cerebral palsy. For assessment of skeletal maturity, a separate anteroposterior radiograph of the pelvis should be considered because scoliosis films often truncate the anatomy necessary to determine skeletal maturity. In some circumstances, a hybrid system with a combination of hooks, pedicle screws, and sublaminar wires may provide optimal fixation with maximal correction. Children with neuromuscular disorders with a progressive muscle weakness such as Duchenne Muscular Dystrophy and Spinal Muscular Atrophy frequently develop a progressive scoliosis. Neuromuscular scoliosis (NMS) is a type of scoliosis that occurs in individuals with conditions that affect the muscles and / or connective tissues that support the spine. 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. 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 use of a wheelchair affords these patients educational and social opportunities that enrich their lives. Vital capacity that exceeds 500 mL and peak expiratory flow greater than 180 mL/min are associated with decreased perioperative pulmonary complications. Studies indicate that the following treatments for scoliosis are ineffective: 1. Many patients with neuromuscular scoliosis are on long-term seizure therapy, which has some important operative ramifications. Surgical Treatment for Neuromuscular Scoliosis In severe cases of NMS, surgical treatment (spinal fusion), is often recommended. Scoliosis causes abnormal curvature of the spine. 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. 24–1). The treatment options available in neuromuscular scoliosis are limited. Conversely, older patients may be obese, presenting further operative complications associated with their body habitus. 2012. Nutritional status should be assessed preoperatively with albumin and total blood lymphocyte levels. 1. Psychosocial support for patients and parents is also vital. 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. Curves of neuromuscu… DMD may be an important exception to this concept: Surgery has been advocated when the deformity reaches 20 degrees because of pulmonary considerations.25 Patients with severely limited respiratory function have been shown to have good outcomes in spinal surgery, however. The effect of bracing on pulmonary dysfunction seems to depend on the level of muscle spasticity. This clinical course emphasizes that fixation challenges are present in patients with neuromuscular deformity, particular hyperkyphosis. Scoliosis is a condition in which the spine curves sideways in a C- or S-shaped curve. To stop the curve from getting worse and help you go back to doing the things you love, Medtronic developed surgical treatment options for scoliosis. Surgical treatment for scoliosis has developped, and pedicle screw fixation is one of the most widely accepted methods for the treatment of several types of scoliosis. Fusion should be considered as coronal deformity approaches 40 to 60 degrees. Mercado and colleagues31 evaluated 198 publications and graded their results on the concept of Grades of Recommendation introduced in the Journal of Bone and Joint Surgery.32 These authors concluded that the current literature shows there is poor-quality evidence that spinal fusion improves the quality of life in patients with cerebral palsy or DMD.31 In a Cochrane Collaboration review, Cheuk and colleagues33 found that there were no randomized controlled clinical trials available to evaluate the effectiveness of scoliosis surgery in patients with DMD, and so no evidence-based recommendations could be made. Corrective surgery this fusion allows greater mobility and improves the patients ’ lives c and D, instrumentation. 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