Have you ever felt like your little one's back is a little bent, or that it's heavy on one side? Does it seem like he has a hard time sitting or standing up straight? Sometimes we think that the child is doing it out of boredom. However, behind these things there may be a condition called Neuromuscular Scoliosis . Don't worry, today we will talk about everything in simple terms.
What is Neuromuscular Scoliosis?
Simply put, this is when our child's spine is pulled to one side. Normally, the spine should be straight in the middle. But in this condition, the vertebrae (we call them ``Vertebrae'') of the spine are rotated slightly to the side, causing the spine to curve into a "C" or "S" shape . This is not just a back bend, but also occurs with other underlying conditions that affect the child's nervous system (that is, the brain, spinal cord, and nerves) and muscles.
Now think about it, we tell our children to "keep their back straight" at the dinner table, right? Or we warn them to "not sit like that in bed." But for a child with this condition, sitting up straight is a big challenge. Even if they try, it can be difficult, and sometimes even painful. So it's not that the child is disobeying you, it's just that they really have a hard time doing it.
This scoliosis not only affects your child's posture. You may notice that your child's clothes don't fit properly. One arm may look longer than the other, or the buttons on a shirt may not fit together properly. This is not because the clothes shrunk in the wash or because the seamstress made a mistake. This is a result of a condition called ``Neuromuscular Scoliosis''.
Usually, the symptoms of scoliosis appear during puberty, when the child suddenly gains height. However, in this case, the symptoms can appear even earlier .
Over time, this curvature of the spine can increase. If this happens, pain and other complications can occur. However, these conditions can be controlled with good treatment, and sometimes surgery.
Is this back pain gradually increasing?
Yes, `(Neuromuscular Scoliosis)` is a progressive condition . That is, the curvature of the spine worsens over time. Since this curvature occurs in childhood, it can increase rapidly when the child suddenly grows (what we call a `(growth spurt)`). It is possible that this curvature may continue to increase until adulthood.
How widespread is this situation?
Neuromuscular scoliosis is common with other conditions that affect the nervous system and muscles. For example, it is commonly seen with conditions such as muscular dystrophy, spinal muscular atrophy (SMA), and cerebral palsy (CP) .
Statistically, about 90% of people with Duchenne Muscular Dystrophy and about 80% of people with Spinal Muscular Atrophy develop scoliosis. Between 20% and 70% of people with Cerebral Palsy develop scoliosis.
What are the signs and symptoms of this?
In this situation, there are external signs that you can see from your child, as well as symptoms that the child may feel.
Visible external features:
- Shoulders not being at the same level. It may appear as if one shoulder has gone up and the other has gone down.
- Ribs protruding forward on one side.
- Hips and waist are tilted.
If you have a child who uses a wheelchair, you may see things like:
- Sitting hunched over, leaning to one side.
- Tilting of the pelvis to one side.
- Difficulty sitting (sitting with support on hands or elbows).
- Pressure sores (damage to the skin caused by staying in the same position for too long).
In addition to the spine being pulled to one side, other curvatures of the child's spine may also be seen, for example , forward bending (kyphosis) (like a hunchback) or backward bending (lordosis) (a condition where the stomach protrudes forward and the spine leans back) .
Symptoms felt by the child:
As the curvature of the spine increases, the child may experience the following discomforts:
- Back pain.
- Feeling uncomfortable while sitting.
- Muscle weakness.
- Numbness in the hands and feet.
- Limited range of motion.
- Difficulty keeping the head, trunk, and neck balanced and controlling their movements.
Why is this happening? What are the reasons?
The main cause of ``Neuromuscular Scoliosis`` is an underlying medical condition that affects the child's nervous system and/or muscles . When a child has this type of neuromuscular disease, they are unable to control and move some of the muscles in their body properly. This causes the muscles around the spine to weaken and the spine to start to curve.
Some of the main medical conditions that can be associated with this type of back strain are:
- Cerebral Palsy
- Duchenne Muscular Dystrophy
- Paralysis
- Spina Bifida (a condition of the spinal cord that occurs at birth)
- Spinal Muscular Atrophy
What are the risk factors?
If your child has a neuromuscular disorder and/or uses a wheelchair to get around, there is a higher chance of developing Neuromuscular Scoliosis.
What complications can this cause?
If the curvature of the spine becomes severe due to Neuromuscular Scoliosis, complications such as:
- Respiratory problems: Conditions such as ``Thoracic Insufficiency Syndrome'', which causes difficulty breathing and lack of space in the chest.
- Difficulty functioning independently: For example, difficulty dressing or eating alone.
- Mobility difficulties: Difficulty walking.
- Nerve damage.
- Problems with the cardiovascular system.
In addition to these physical difficulties, the condition `(Neuromuscular Scoliosis)` and the underlying medical condition that causes it can also lead to low self-esteem in the child. Living with several medical conditions at the same time is not easy. This increases the risk of the child becoming depressed, suffering from conditions such as `(Depression)` or `(Anxiety) . Therefore, it is very important to take care of the child's mental health and, if necessary, seek the advice of a mental health professional.
How do you diagnose this?
To diagnose the condition ``Neuromuscular Scoliosis``, a doctor will first perform a physical exam and ask about the symptoms. They will also look at the child's medical history and whether anyone in the family has had similar conditions.
During the examination, the doctor will carefully observe the child's spine, posture, and balance. The skin will also be checked for pressure sores. A device called a scoliometer may be used to measure the curvature of the spine. In addition, imaging tests such as an X-ray or an MRI scan may be performed to clearly see the condition of the spine.
What are the treatments?
A doctor will first try to control this condition with non-surgical treatments.
Nonsurgical treatments
- Wheelchair modifications: If your child uses a wheelchair, a doctor may suggest adding custom seat backing or lateral supports to the wheelchair seat to help them balance more easily.
- Physical therapy: A physical therapist will teach your child exercises to strengthen the affected muscle groups. This can help address balance issues and increase the child's ability to function independently.
- Back brace: This may or may not be recommended depending on the child's condition. For example, a brace worn around the trunk of a child who uses a wheelchair can help them maintain balance while sitting. However, it will not stop the curvature of the spine from increasing. A brace is generally not safe for children who are walking. It can increase the risk of them falling and losing their balance.
Important: Non-surgical treatments can slow or even stop the progression of scoliosis, but they cannot completely straighten the curve of the spine.
Surgery
Surgery for ``Neuromuscular Scoliosis`` can stop the curve from getting worse and stabilize the spine. A doctor may consider surgery in the following cases:
- If the curvature of the spine is more than 40 degrees and continues to worsen.
- If the child is in pain or discomfort.
- If there are complications affecting lung or heart function.
Before deciding on surgery, a doctor will carefully consider the child's overall health, the type of underlying neuromuscular disease, and the severity of the back spasm. The safest treatment option for the child's condition will be chosen.
Types of surgeries performed for neuromuscular dystrophy:
There are two main types of surgery:
1. Spinal Fusion: In this surgery, the surgeon realigns the child's spine and fuses the affected spinal joints. This involves using bone grafts, metal rods, and screws . These are used to hold the bones together until the two bones heal as one. However, after this spinal fusion surgery, the growth of the fused bone stops. This can cause the child to be short in stature.
2. Growing Rods: This surgery is best for children who are still growing. The surgeon inserts a rod along the child's spine. This rod stabilizes the spine and corrects the curve. As the child grows, the rod can be lengthened every 6-8 months, either through a minor surgery or through an in-office magnetic lengthening procedure. When the child reaches skeletal maturity, meaning that they have stopped growing taller, the surgeon removes the rod and performs a spinal fusion.
A child with ``Neuromuscular Scoliosis`` is at higher risk of complications during surgery, such as infections or nerve damage, because they are managing another underlying medical condition. Also, the surgeon has to treat multiple areas of the spine at the same time, which increases the risk of complications .
Your child's medical team will carefully assess whether surgery is safe and will educate you about possible side effects before the procedure, so you can make an informed decision about your child's care.
What is the outlook for this condition? (Prognosis)
The child's outlook depends on several factors:
- The child's overall health.
- The type of underlying medical condition that caused the back pain.
- The severity of the curvature of the spine and the rate at which it increases.
- Treatment methods that are appropriate for the child's condition.
Although surgery can correct a scoliosis, there are risks involved. Your child's medical team will always try to provide the safest treatment for your child's physical and mental well-being. If you have any questions about your child's outlook, talk to your doctor.
What about lifespan?
Neuromuscular Scoliosis may or may not affect your child's life. However, in severe cases, complications can occur that affect the heart and lungs. These can be life-threatening. If your child is at risk for serious complications, your child's medical team will advise you on what to expect.
Can this be prevented?
Unfortunately, there is no way to prevent the development of ``Neuromuscular Scoliosis''. However, if the disease is diagnosed early and treatment begins early , doctors may be able to slow the progression of the curve or even correct it with surgery.
When should I see a doctor?
If you notice signs of a scoliosis in your child, such as difficulty sitting up, shoulder instability, or pressure sores , see a doctor immediately .
If your child has already been diagnosed with Neuromuscular Scoliosis, talk to a doctor if they experience symptoms such as pain, discomfort, difficulty breathing, or other complications.
What questions should you ask the doctor?
You can ask your child's doctor questions like these:
- What kind of treatment do you recommend?
- Does my child need surgery?
- What are the side effects of the treatment?
- How can I keep my baby safe and comfortable?
An important message for you (Take-Home Message)
As a parent, it's normal to feel overwhelmed and anxious when you learn that your child has not one, but two conditions (underlying neuromuscular disease and neuromuscular scoliosis). You may have many thoughts about the future and how to keep your child comfortable. This can be very stressful. But remember, you don't have to deal with these things alone.
Because neuromuscular scoliosis is a progressive condition, you will need to see your child's medical team regularly. During these visits, a doctor will measure the curvature of your child's spine. If the curvature is severe, a surgeon may consider surgery if the risks of surgery outweigh the benefits to your child.
If you have any questions about your child's outlook or how you can help them at home, don't be afraid to talk to your doctor. They will give you the guidance you need. Let's all work together to give your child the best possible outcome.
` Neuromuscular Scoliosis, scoliosis, child health, neurological diseases, musculoskeletal diseases, spine
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