|
The term "neuromuscular
scoliosis" is used to describe curvature of the
spine in children with any disorder of the
neurological system. Common categories include
cerebral palsy, spina bifida, muscular
dystrophies, spinal cord injuries and so forth.
Most of these children have as a unifying
feature weakness of the trunk. As they grow and
their trunk gets weaker, there is a progressive,
collapsing deformity of the spine producing a
long, c-type curve. These curves tend to be
progressive, with the rate of progression
becoming worse during rapid growth. For children
confined to a wheel chair, progressive curves
may affect the child's ability to be seated
comfortably, thereby affecting their quality of
life and function.
The treatment of
neuromuscular scoliosis must be individualized.
Bracing may provide support for the trunk in the
seated position, but is usually not effective at
stopping progression of the curve over time.
Seating modifications such as inserts into
wheelchairs may help with positioning the child,
but are also not corrective in terms of the
scoliosis. Alternative therapies such as
insertion of an Intrathecal Baclophen Pump will
produce a reduction in spasticity but will not
affect the long-term progression of the
scoliosis. Injection of Botox into the
paraspinal musculature will temporarily reduce
the tone in these muscles but has no proven
long-term efficacy in the treatment of
neuromuscular curves.
The fundamental
question to be addressed by families and their
treating doctor is whether the preservation of
the ability to sit by invasive surgery will
maintain or improve the child's quality of life
and function. For some children with cognitive
or visual/sensory impairment, these decisions
are difficult. Parents often struggle with the
fact that they are unable to explain to the
child why they are having surgery and help them
understand that pain accompanying the procedure.
These can be difficult questions to answer given
the risks, costs, and recovery associated with
this type of surgery. These decisions should be
made with great care. Talking with other
families who have been through this decision
process is very helpful. Ultimately, parents
will have to make this difficult decision for
their child.
|
