Neuromuscular Scoliosis

What is neuromuscular scoliosis?

神经肌病脊柱侧凸is one of three main types of scoliosis that cause an irregular curvature of the spine. It is the second most common form of scoliosis and is associated with disorders of the nerve or muscular systems such as脑瘫,脊柱垫旁观者， 和脊髓损伤.

These types of neuromuscular conditions cause muscles to become weak, spastic, or paralyzed. Without full support from the muscles of the back, the spine can develop anabnormal curve因为它的增长。

What are the symptoms of neuromuscular scoliosis?

神经肌病脊柱侧凸的迹象经常出现在孩子的生命中。您，您孩子的医生或其他照顾者很可能会在整个身体位置的变化或开始坐在椅子上时，最有可能会注意到您孩子的脊柱曲线。症状可能包括：

• leaning or uneven seating posture
• using arms for seating support
• uneven shoulder heights
• 从身体其他部位偏离中心
• 不均匀的臀部或臀部
• 不均匀的肩胛骨
• arms hanging unevenly

How is neuromuscular scoliosis diagnosed?

您的孩子的医生将使用医疗和家庭历史，体检和诊断测试来确定孩子脊柱侧凸的性质，程度和影响。他们还将评估您的孩子的潜在神经肌病，包括他们：

• nutritional status
• lung and heart function
• functional level
• 关节和四肢（挛缩）
• 平衡和行走的能力（也称为车身水平）

Doctors can often predict the likely progression of a child’s scoliosis. They do this by assessing the severity of the existing curve and comparing that to the child’s stage of growth. Mild or moderate curves can become more pronounced during growth spurts. Children at a later stage of growth may be less prone to further spinal deformity.

Diagnostic tests

X射线从前面和边缘拍摄的图像是确认神经肌肉脊柱侧凸和曲线严重程度的主要工具。

Your child’s doctor may also order one or more of the following tests to evaluate the underlying condition associated with the scoliosis:

• 磁共振成像（MRI）
• 计算机断层扫描扫描（CT或CAT扫描）
• EOS成像
• 血液测试
• 超声
• bone scans
• 骨密度扫描（双能X射线吸收术，DEXA，DXA）
• 肌肉活组织检查
• pulmonary function tests
• electromyogram（EMG）和神经传导研究

神经肌病脊柱侧凸的治疗方案是什么？

非手术治疗

非手术治疗如支撑轮椅改性,物理therapy, and environmental adaptation can help your child adapt to everyday environments and improve their mobility. Bracing can prevent your child’s spinal curvature from getting worse during periods of growth, but bracing will not correct the curve.

Spinal fusion surgery

Stabilizing the spine withspinal fusion surgeryis the most common treatment for neuromuscular scoliosis. Using metal rods, hooks, screws, and wires, known as instrumentation, the procedure straightens the spine and solidifies the bone so it will no longer curve abnormally. For 6 to 12 months after surgery, the spine fuses in much the same way that a broken bone heals. The child will need to wear a brace during this time. The instrumentation typically remains in the back without causing any problems.

The goal of aspinal fusion surgeryfor neuromuscular scoliosis is to:

• stabilize the curve and stop its progression
• 平衡脊柱和骨盆（在无法走路的患者中）
• 恢复坐直的能力（在失去这种能力的儿童中）
• 改善/保持肺功能

Spinal fusion for neuromuscular scoliosis is usually necessary by the time a child reaches adolescence - often sooner than with idiopathic scoliosis. Compared to idiopathic scoliosis, it is usually necessary to fuse a larger portion of the spine in order to correct neuromuscular scoliosis.

由于神经肌病患者的儿童具有更高的并发症率，quality and safetyare critical at each stage of the surgery—from preoperative planning all the way through recovery. Research has shown that the involvement of a multidisciplinary team of specialists can reduce the risk of complications.

What is the long-term outlook for children with neuromuscular scoliosis?

A child’s outlook depends less on their scoliosis and more on the nature, severity, and overall impact of their neuromuscular disease. With successful surgery and attentive post-operative care, your child can:

• return to the functional level they had reached before they needed surgery
• have a straighter, more balanced spine
• find it easier to sit up
• 有可能改善肺功能并降低对肺炎的易感性

How we care for neuromuscular scoliosis

TheSpine Divisionat Boston Children’s Hospital is the largest and busiest pediatric spine center in the United States. With a focus on quality and safety, our spine specialists see thousands of spine patients and perform hundreds of spine surgeries each year. We treat all types of scoliosis and other spine conditions, from the most common to the most complex.

We also work closely with Boston Children’sDepartment of Neurologyand the护理医疗复杂程序的儿童to correct complex spine deformities that involve the spinal cord. This multidisciplinary approach to care helps ensure that every patient receives the highest quality care, no matter how complex their surgical, medical, and behavioral needs.