Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 68. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Spinal Deformities and Malformations Section 663 24 Neuromuscular Scoliosis Jean A. Ouellet Vincent Arlet Core Messages Kyphoscoliosis is a synonym for neuromuscular scoliosis in contrast to lordoscoliosis which is a synonym for idiopathic scoliosis Hyperlordosis is also seen in neuromuscular scoliosis Pelvic obliquity is pathognomonic for neuromuscular scoliosis Spinal deformities in neuromuscular patients tend to be severe and progressive in both coronal and sagittal planes Surgical management of patients with neuromuscular scoliosis is associated with greater morbidity as they can have severe comorbid medical problems Duchenne muscular dystrophy and Friedreich s ataxia should always have a preoperative cardiac assessment Preoperative pulmonary function of less than 35 of the predicted value indicates postoperative ventilatory support and dependency which may put the surgical indications in question Maximizing hemostasis with adjuvant controlled hypotension cell savers hemostatic agents and excellent vascular access is imperative since intraoperative bleeding can be significant up to two times blood volume Spinal fixation may be complicated and prone to failure since bone is weakened by disuse osteopenia and antiepileptic drugs Achieving spinal balance in both the coronal and sagittal planes is even more critical as patients with neuromuscular scoliosis typically do not have the innate ability to compensate and balance themselves postoperatively Fusion often extends to the pelvis thus a good understanding of different pelvic-lumbosacral fixations is mandatory Never extend a fusion down to the pelvis in a patient relying on a mobile lumbosacral junction for his or her ambulation even in the presence of pelvic obliquity If the curve 40 and the pelvic obliquity 10 one can stop the fusion at L5 if these are greater then the fusion should be extended to the pelvis Epidemiology Scoliosis in the presence of a neuromuscular disorder NMD behaves entirely differently from
