Treating Neuromuscular Scoliosis in New Jersey

coliosis is the curvature of the spine, classified into several types, which neuromuscular scoliosis is one of them. This condition often results from a neurological, nerve, or muscular disorder. After idiopathic scoliosis, neuromuscular scoliosis is the second most common type of this condition. Over time, neuromuscular scoliosis will lead to asymmetrical skeletal growth, which causes issues with breathing, sitting, and balance, as well as other conditions.

At Centers for Neurosurgery, Spine & Orthopedics, the surgical and non-surgical team has vast expertise and experience in providing comprehensive care for neuromuscular scoliosis and a range of other spine conditions. Patients throughout northern New Jersey can find personalized treatment plans at multiple convenient locations.

What Is Neuromuscular Scoliosis?

In patients with neuromuscular scoliosis, the spine curves into a C-shape. Several disorders can lead to this condition, such as cerebral palsy and spina bifida. These conditions decrease to eliminate muscle strength and control on the side of the patient which it effects, thereby producing asymmetry, which during development leads to a curved spine as the individual ages.

Unlike idiopathic scoliosis, where the cause is unknown, neuromuscular scoliosis can be traced back to an underlying condition. It also is distinct from degenerative scoliosis, which occurs because of wear and tear and arthritis of the spine.

What Causes Neuromuscular Scoliosis?

Not every patient with a neuromuscular disorder will develop this type of scoliosis, but these conditions can increase the risk because they coincide with muscle weakness, nerve issues, and paralysis. Patients with the following conditions or injuries may be at a heightened risk for neuromuscular scoliosis:

Cerebral palsy: The spine does not develop fully during birth, leaving an opening along the spine that may damage the spinal cord and nerves.
Spina bifida: This is a group of neurological issues affecting the brain and causing difficulties with muscle coordination and motion.
Muscular dystrophy: This group of genetic diseases progressively weakens the skeletal muscles needed for voluntary movement.
Spinal muscle atrophy: This is a group of hereditary conditions that harms skeletal muscle and the cells associated with motor skills.
Friedrich’s ataxia: A rare genetic disease, this is a condition in which nerve fibers in the spinal cord and peripheral nerves become thinner, damaging the nervous system and affecting movement.
Traumatic paralysis: This is the loss of ability to use muscles in part of the body due to a traumatic injury.

What Are the Signs and Symptoms of Neuromuscular Scoliosis?

Symptoms may appear differently in each patient, and some signs may suggest other conditions. For this reason, getting an accurate diagnosis is essential, as it can help physicians pinpoint the most effective treatments. Common symptoms of neuromuscular scoliosis include:

Visible spinal curvature or hunching
Uneven shoulder height and positioning
One shoulder blade appears larger than the other
Uneven hip height and positioning
Head not centered with the rest of the body
Arms hang beside the body differently
Sides of the back appear to be different heights when the patient bends forward
Ribcage appears asymmetrical when observed from the front or back
Poor head, neck, and trunk coordination
Inability to stand or sit upright
Impaired balance and posture
Irregular gait (walking pattern)
Back pain
Radiculopathy
- Dull or sharp pain in the arms and hands
- Numbness or tingling in the buttocks, legs, and feet
- Weakness in leg muscles

Are Wheelchair Users Susceptible to Particular Symptoms?

Many of the conditions that cause neuromuscular scoliosis leave patients in wheelchairs, often during childhood. For these patients, other symptoms may coincide with scoliosis, including:

Leaning to one side of their wheelchair
Slouching posture
Pelvic tilting (abnormality where the pelvic muscles lean to one side)
Decreased ability to sit
Increased need to use hands and arms for seating support
Pressure sores caused by improper seating positions

How Is Neuromuscular Scoliosis Diagnosed?

To diagnose neuromuscular scoliosis, the physician will begin by asking the patient questions about their symptoms and their personal and family medical history. During the physical examination, they will assess the back and spine and observe problems the patient has with everyday functions such as sitting, walking, and maintaining balance.

X-rays are the main imaging procedure used to help diagnose neuromuscular scoliosis. They allow physicians to better view spinal bones and measure the exact degree of curvature. Other tests for evaluating neuromuscular scoliosis include:

Magnetic resonance imaging (MRI): This creates detailed images of organs and soft tissue specifically nerve tissue, which includes the spinal cord.
Computed tomography (CT) scan: This uses computer technology and X-ray to generate images of bones, organs, and muscles.
Ultrasound: This produces images of internal structures in the body using ultrasonic waves.

The physicians at CNSO refer patients to imaging centers who use state-of-the-art diagnostic technology, who will ensure patients are safely protected against radiation.

What Does a Scoliometer Measure?

How much C-curvature of the spine is too much? The Cobb angle refers to the degree of spinal curvature. The scoliometer helps physicians measure this curvature. They place the instrument at different points along the curved spine to gauge the degree of scoliosis. Results indicate:

0 – 10 degrees: Minor asymmetry
10 – 20 degrees: Mild scoliosis
20 – 40 degrees: Moderate scoliosis
Over 40 degrees: Severe scoliosis

Can Neuromuscular Scoliosis Lead to Other Problems?

Neuromuscular scoliosis is progressive, meaning symptoms can worsen if the patient does not receive proper treatment. A common complication of neuromuscular scoliosis is thoracic insufficiency syndrome. This condition reduces the chest’s ability to push air in and out of the lungs, stunting lung growth and leading to breathing and oxygenation difficulties. Common signs of thoracic insufficiency syndrome include heavy breathing, heightened breathing rate, and fatigue.

As neuromuscular scoliosis advances, patients can lose more function and experience a low quality of life. This makes early diagnosis and treatment crucial to ensure better outcomes.

Can Neuromuscular Scoliosis Be Treated Without Surgery?

While surgery is highly effective for treating neuromuscular scoliosis, some patients can experience relief with conservative care. These non-surgical treatments help control spinal curves and can increase a patient’s quality of life. Options include:

Back bracing: Bracing supports the spine, alleviating the pressure and misalignment that causes pain. Braces also help patients achieve more stability when sitting and regain the use of their arms and hands.
Physical therapy: Physical therapists use manual techniques and a range of exercises to help patients enhance their strength, mobility, flexibility, and muscle function.
Wheelchair modifications: In cases where being in a wheelchair compounds the symptoms of neuromuscular scoliosis, modifying the wheelchair with custom features can help with balance and posture.

Patients should be aware that non-surgical treatment cannot prevent the progression of neuromuscular scoliosis. However, it can postpone this progression and help boost function.

What Surgical Treatments Are Used to Treat Neuromuscular Scoliosis?

For some patients, conservative solutions are insufficient for treating neuromuscular scoliosis. Instead, physicians will recommend scoliosis surgery to stabilize the spine and prevent further curvature. The following signs indicate surgical intervention is necessary:

Curvature that exceeds 45 to 50 degrees and is still progressing
Worsening loss of function
Pain significantly affecting the patient’s quality of life
Scoliosis impacting heart and lung function

The two main surgeries suggested for neuromuscular scoliosis are:

Spinal Fusion Surgery

Fusion surgery realigns vertebral bones to achieve a biomechanical position most conducive to functionality. This procedure helps patients regain mobility with little to no pain. It involves trimming or removing vertebrae or the intervertebral discs causing discomfort and then filling in the spinal column with bone graft or a synthetic device to maintain proper spine height.

Laminectomy

The spine features bony arches on both sides called laminae. A laminectomy removes a segment of the laminae to reach the spine or spinal cord. The goal is to alleviate pressure off the spinal cord or surrounding nerves.

The neurosurgeons and orthopedic spine surgeons at CNSO have a track record for performing safe and effective spine surgeries. However, all surgery carries some risk. The following risks of spine surgery have an incidence of 0.5% or less and can be resolved with little to no long-term effects:

Bleeding
Infection
Nerve damage
Leakage of spinal fluid
Adverse reactions to general anesthesia

Recovering From Spinal Surgery

For any type of spine surgery, recovery time will vary depending on the patient’s age, health, and the extent of the procedure. General guidance is to avoid bending, lifting, and twisting for two weeks after surgery, but the CNSO spine surgeons will give more individualized instructions to patients regarding when they can resume normal activities.

The spine surgeon or neurosurgeon may also recommend lifestyle changes to prevent future spine conditions, such as:

Weight management: Maintaining an ideal body weight helps reduce the strain and stress on the spine and its joints both with and without surgery.
Exercise: Working with physical therapists and rehabilitation specialists, a patient can strengthen the spine, improve flexibility and improve mobility.

Will Rehabilitation Involve Physical Therapy?

Most patients also undergo physical therapy or massage therapy to help restore function in the spine. A key aspect of rehabilitation medicine is exercise. Some therapies that can help patients during recovery include:

Physical therapy exercises to help with overall functionality and improve quality of life
Range of motion exercises to regain mobility and flexibility
Strengthening exercises to enhance muscle strength around spinal joints
Pain management techniques to relieve discomfort after spine surgery

Common Follow-Up Care after Scoliosis Treatment

Spine surgeons will schedule follow-up visits with patients to evaluate their progress with recovery and prevent any post-surgical complications. These appointments can include:

Regular check-ups to discuss the patient’s recovery progress and examine the surgery site
X-rays to look confirm placement of any hardware
Potential CT or MRI if any new spinal concerns
EMG/NCV studies if necessary
Compliance with the existing rehabilitation plan or revisiting the existing plan to determine if changes are necessary

Why Choose CNSO for Scoliosis Care?

CNSO is the most comprehensive center in New Jersey, providing surgical and non-surgical treatment for various spine conditions and many brain and nerve concerns. Following medical guidelines and a philosophy that emphasizes conservative care, compassionate physicians expediently determine the best treatments based on each patient’s specific needs, whether it be physical therapy and pain management or if the spine condition is too severe, then spine and back surgery.

The comprehensive care team includes leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists. Care is available at several convenient locations across northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties.

Find Comprehensive Spinal Care at CNSO

Neuromuscular scoliosis causes several painful symptoms and can have a limiting effect on a patient’s quality of life. But treatment is available in northern New Jersey. The vast expertise and comprehensive approach of the team at CNSO help patients realize care tailored to their needs and concerns. Contact CNSO today to request an appointment.