Neuromonitoring in Neuromuscular Scoliosis

Abstract

Neuromuscular disease was first described in 1836 by Conte and is accompanied by spine deformity in 60% to 75% of quadriplegic cerebral palsy children, 90% of spina bifida children (above the sacral level), and nearly 100% of Duchenne muscular dystrophy (DMD) children, who have not been treated with long term deflazacort glucocorticoid. Neuromuscular scoliosis (NMS) presents earlier than idiopathic scoliosis (IS), and is progressive because of the abnormal biomechanical loading of the spine due to muscular imbalance and asymmetrical, Heuter-Volkmann induced growth of immature spinal vertebrae. Anticipation is regarded by DiMeglio as a very successful method of managing NMS scoliosis, and while orthoses may be used indefinitely to treat children with mild cerebral palsy or alternatively to maximize the nonoperative management of sitting ability and postural care in children with severe scoliosis, bracing does not alter progressive neuromuscular deformities that are ≥ 20°. Iatrogenic spinal cord injury remains one of the most devastating complications of neuromuscular spine deformity surgery. The incidence of neurological complications in NMS scoliosis, varies from 0.5% to 4.6%, and is higher than that in IS (0.5% to 0.72%). Higher intraoperative blood loss that compromises spinal cord vascularity, in combination with distraction techniques, that are occasionally adopted to address the severest and stiffest n neuromuscular deformities, may account for this discrepancy.