The treatment of neuromuscular scoliosis

Neuromuscular scolioses are difficult deformities to treat. A careful assessment and an understanding of the primary disease and its prognosis are essential for planning treatment which is aimed at maximising function. Conservative treatment of these deformities is difficult. Braces may be of short-term value. Surgery is the mainstay of treatment for appropriately selected patients. The goals of surgery are to correct the deformity producing a balanced spine with a level pelvis and a solid spinal fusion to prevent or delay secondary respiratory complications. Improvements in anaesthetic techniques and recognition of the importance of the timing of surgery have reduced the overall complication rate. As deformities involve most of the thoracic and lumbar spine posterior instrumentation is the standard surgical approach. Anterior release is necessary only in severe deformities. The use of pedicle screws improves fixation in the lumbar spine and has reduced the need for instrumentation to the sacrum. Early referral of patients who are candidates for surgery simplifies treatment and may improve its outcome. This can only be achieved by better education of referring physicians on the importance of timing of surgery. (C) 2003 Elsevier Ltd. All rights reserved.