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Scoliosis in Neuromuscular Disorders

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Neuromuscular Conditions

Patients with the following conditions need careful consideration when being assessed for possible scoliosis surgery:

  • Cerebral palsy
  • Spina bifida
  • Duchenne's muscular dystrophy
  • Spinal muscular atrophy

Consider referral to Respiratory service for review when these patients are:

  • Non-ambulant
  • Have symptoms of sleep disordered breathing
  • Have a history of recurrent pneumonia

Background Respiratory Care


Address Co-morbidities

ECG & echo may be needed, especially in Duchenne's muscular dystrophy or if there is clinical evidence of pulmonary hypertension

Must be optimised for best outcomes. Dietitian input

Respiratory Management of Scoliosis Surgery

If the paediatrician considers surgery for kyphoscoliosis an option referral is made to the orthopaedic service.with spinal x-rays (scoliosis views).

Investigations listed above should be repeated if they have not been done in the last 3 months and results reviewed by the respiratory team. A multidisciplinary team meeting may be required to discuss whether surgery is the best option.

Perioperative care includes optimising nutrition and chest physiotherapy:

Investigations normal
PICU / anaesthetic review & consent
Surgery goes ahead with input from respiratory team if issues arise

Investigations abnormal
Surgery deferred until respiratory review
PICU / anaesthetic review & consent
If surgery goes ahead respiratory team input is needed perioperatively

In some circumstances the multidisciplinary team may decide surgery is too high risk and will not be undertaken.

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Document Control

  • Date last published: 01 July 2012
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Respiratory
  • Author(s): Elizabeth Edwards
  • Editor: Greg Williams
  • Review frequency: 2 years

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