Paediatric spinal conditions

Tomlinson JE, Gummerson NW, Surgery (2016), doi:10.1016/j.mpsur.2016.10.013

Achieving an upright posture, and balancing the 24 mobile segments of the spine in a vertical column, is clearly no easy task. The neuromuscular control of the spine involves brain, nerve and muscle (including feedback pathways). Problems anywhere in this pathway may lead to a neuromuscular scoliosis. Causes include cerebral palsy, Friedreich’s ataxia, syringomyelia, tumour, trauma, myelodysplasia, spinal muscular atrophy, poliomyelitis, Duchenne muscular dystrophy and arthrogryposis.
The treatment goals in this group of patients are to prevention of significant cardiorespiratory compromise, and maintain function. Function may often be maintenance of sitting balance, use of the upper limbs, the use of a wheelchair, or ease of hygiene and pressure area care rather than walking. Scoliosis surgery in neuromuscular conditions is a significant undertaking and other adaptations such as moulded seating should be considered, with surgery playing a role when other options have been exhausted. Surgery is usually a long posterior instrumented fusion, but unlike idiopathic curves, fixation is often to the pelvis.