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Evidence-Based Treatment of Neuromuscular Scoliosis

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Paediatric Orthopaedics

Abstract

Scoliosis is a common clinical entity ubiquitous to most neurologic disorders encountered by the pediatric orthopaedic surgeon and associated care providers. Until recently, though widely performed, the evidence for scoliosis corrective surgery and its impact on patient-specific outcomes was sparse at best. In addition, the choice of surgical techniques applied during surgery for ‘neuromuscular’ scoliosis was based mainly on the results of historic case series with a paucity of higher-level evidence available. Over the last few years, however, the number and quality of relevant studies has increased substantially. The aim of this chapter is to provide a review of the best available evidence and provide recommendations as to most appropriate treatment(s) pertaining to the management of neuromuscular scoliosis. Given the results of this evidence-based review, it would seem that neuromuscular scoliosis correction is a worthwhile procedure with expected improvements in function, quality of life, and patient/caregiver satisfaction, albeit with high surgical risks. The ultimate decision as to whether or not scoliosis surgery is performed should be dependent on a disease-specific assessment of the risks and benefits with appropriate communication to the patient and/or caregiver. With respect to surgical fixation, the use of thoracic/lumbar segmental pedicle screws may offer improved outcomes over other methods but the best choice of pelvic fixation is still controversial. Regarding the use of anterior surgery for neuromuscular scoliosis, its role remains unclear except in the case of spina bifida where it is likely to reduce perioperative risks.

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Authors and Affiliations

  1. Sidra Medical and Research Center, Weill Cornell Medical College, Doha, Qatar

    Jason J. Howard

  2. Sidra Medical and Research Centre, Doha, Qatar

    Jane Farrelly

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  1. Royal Manchester Children’s Hospital, Manchester, United Kingdom

    Sattar Alshryda

  2. Sidra Medical and Research Center, Doha, Qatar

    James S. Huntley

  3. Queen Elizabeth Hospital, Gateshead, United Kingdom

    Paul A. Banaszkiewicz

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Howard, J.J., Farrelly, J. (2017). Evidence-Based Treatment of Neuromuscular Scoliosis. In: Alshryda, S., Huntley, J., Banaszkiewicz, P. (eds) Paediatric Orthopaedics. Springer, Cham. https://doi.org/10.1007/978-3-319-41142-2_24

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