February 22, 2019ConditionsScoliosis
Overview
It’s less common than Idiopathic scoliosis and can be classified into two main categories as: Neuropathic (Spinal cord and Brain) or Myopathic (Muscle disease)
Neuropathic can further be sub classified as:
- Upper Motor Neuron —
- P.
- Spinocerebellar Deg. (F. Ataxia, CMT)
- Syringomyelia
- Spinal Cord Trauma
- Lower Motor Neuron
- Polio
- Trauma
- SMA
- Dysautonomia
- Myopathic Disorders of the muscle can include
- Muscular Dystrophy
- Limb Girdle
- Fascioscapulohumerla
- Arthrogryposis
- Congenital Hypotonia
- Neuromuscular curves develop very early in life and are frequently progressive
even after skeletal maturity
- Prevalence among common entities include
- Myelodysplasia – 60%
- M.A. – 67%
- Duchenne’s Muscular Dystrophy – 90%
- Traumatic Paralysis – <10 yrs. – 100%
- Syringomyelia – 63 – 87%
Treatment
- Patient evaluation should include the birth and developmental history, medications used during the gestation period
- Clinical assessment should encompass a review of systems, especially the lung and gastrointestinal track function. Swallowing / Aspiration Risk, Reflux assessment should be performed in CP patients
- Surgical Management is reserved for patients with Progressive Collapsing Deformity, Decrease Functional Status, Loss of Sitting Balance, Decrease pulmonary Function and Pain. There is controversy regarding the benefit of surgery in patient with poor cognitive status. Current literature has pointed to the benefits derived from surgical stabilization as reported by caregivers.
- Goals of Surgical treatment: to obtain a solid arthrodesis. Balance spine over the pelvis to improve sitting balance, Solid Arthrodesis, Improve or Maintain Functional Status and Improve Pulmonary Function
- Preoperative interventions should include nutritional optimization nutrition via gastrostomy, and intravenous feeding, fundoplication to manage reflux problems common among cerebral palsy patients.
- Preoperative Halo traction will aid in reducing curve magnitude and contractures of the hips and knees may to be released to facilitate intraoperative positioning for surgery.
Surgical considerations:
- Patients who have failed conservative treatment and or bracing with progressive curves are considered for surgical intervention. Most patients can be treated with posterior spine fusion procedure. Ambulatory patients can be fused above the sacrum. In general patients with long curves to the sacrum, fixed pelvic obliquity and poor sitting balance are suited for long fusions to the sacrum and pelvis. Use of bank bone should be considered. Anterior surgery is indicated in spina bifina patients who lack posterior elements to support a fusion
- Results of surgical treatment has shown that most neuromuscular patients respond well to surgical intervention and improve in their function according to the perspective of their care givers. However, there is a higher complication rate such as infections and pulmonary problem compared to n on neuromuscular patients
Author
CEO, FOCOS Orthopedic Hospital
Orthopedic Surgeon, FOCOS Orthopedic Hospital