Scoliosis is defined as a curvature of the spine of more than 10 degrees to the side when viewed from the back. Scoliosis can be classified according to the way it develops and the age at which it occurs. They are divided into 3 main groups according to their causes. Structural types of scoliosis;
Neuromuscular scoliosis, which is the second most common type of scoliosis among structural scoliosis types, is a type of scoliosis caused by muscle and nerve diseases. This type, which progresses much faster than idiopathic scoliosis, usually requires surgery.
What is Neuromuscular Scoliosis?
Although scoliosis is generally considered to be a disorder of unknown origin (in most cases of scoliosis, the origin is unknown, it is idiopathic), there may be an underlying disease. After idiopathic scoliosis, which is the most common type of scoliosis, neuromuscular scoliosis, which is the most common type of scoliosis, is a type of scoliosis caused by certain neuromuscular diseases, i.e., as the name suggests, neurological and muscular diseases. These diseases cause rapidly progressive scoliosis by disrupting muscle movements or causing muscle imbalances.
Unlike other types of scoliosis, the fact that it develops due to an underlying cause and disease also differentiates the treatment process. In most cases, patients who do not respond to bracing are treated surgically. Of course, underlying conditions should also be identified and included in the treatment process.
What causes neuromuscular scoliosis?
The answer to the question of what causes neuromuscular scoliosis, one of the structural types of scoliosis, is hidden in the name of the disease. People with underlying neuromuscular diseases, which are conditions that affect the muscular and nervous systems, may also have scoliosis as a result of the physical or functional effects of these diseases. Neuromuscular diseases that cause scoliosis include
- Cerebral palsy
- Hereditary ataxias (Friedreich’s, etc.)
- SMA
- Syringomyelia
- Others (encephalopathy, Rett syndrome)
- Medullary Causes
- Myelodysplasia
- Meningomyelosis
- And some muscle diseases
Symptoms of Neuromuscular Scoliosis
It is not enough to group the symptoms of neuromuscular scoliosis under one umbrella. Unlike other cases of scoliosis, when it develops due to disorders of the nervous and muscular systems, the general condition of the patients will not be similar. Therefore, the symptoms differ in children who can walk and those who cannot.
The symptoms of neuromuscular scoliosis in ambulatory children are similar to those of idiopathic scoliosis. In general, it is characterized by cosmetic defects and pain depending on the magnitude of the angle of curvature, and although pain is a symptom, it is not observed in most cases.
Symptoms of Neuromuscular Scoliosis:
- Irregular ribs and lower back
- Uneven shoulder blades, hunched shoulders
- One leg shorter than the other
- Pain
It is natural for children who use a wheelchair not to notice some cosmetic defects. However, they may have the same symptoms as children who can walk. Curvatures can also cause other problems.
- Often needs help from arms when sitting
- Tilted pelvis (hip bone area)
- Body sores caused by general imbalance
- Difficulty holding the head still
- Reduced facial expression
- Pain
Neuromuscular Scoliosis Treatment
In idiopathic scoliosis, the most common type of scoliosis, progression of the curves tend to stop or slow down after bone development. This is not the case with neuromuscular scoliosis. In most cases, it is more progressive and aggressive than other types of scoliosis. Also, at this point, scoliosis is not a disorder by itself, but a complication of another disease of the muscular and nervous system. Therefore, treatment also includes treatment of the underlying disease. This is a complicating factor in the treatment of neuromuscular scoliosis. Treatment of the underlying disease plays the most important role in the treatment of scoliosis.
As with idiopathic scoliosis, the response rate of patients to bracing and physical therapy is not high. For this reason, a variety of surgical treatments may be used, even at an early age. In addition, the possibility that the disease has caused some deformities in the individual due to underlying causes in most cases makes the procedures difficult.
Neuromuscular Scoliosis Surgery
Although there are bracing and physical therapy options for neuromuscular scoliosis, these treatments often do not provide positive results. Surgery is then the only option. Depending on the child’s age, growth management or fusion surgery may be performed. In general, the goal of fusion surgery is to stop the progression of the disease and correct structural abnormalities. However, in cases of neuromuscular scoliosis, the condition that is causing the scoliosis in the background complicates the situation. Therefore, the neuromuscular disease causing the scoliosis must be treated first. In addition, other complications and limited mobility in wheelchair users also complicate the treatment.
