Neuromuscular Disorders: Complications of Paralytic Scoliosis

Mustafa Can KOŞAYa , Rasim Haluk BERKa

aDokuz Eylül University Faculty of Medicine, Department of Orthopedics and Traumatology, İzmir, Türkiye

ABSTRACT
Neuromuscular scoliosis (NMS) is a type of scoliosis that is often associated with underlying neuromuscular disorders of the brain, spinal cord or muscular system such as cerebral palsy, muscular dystrophy, spinal muscular atrophy, and others. Regardless of the aetiology, progressive NMS will lead to pain, pressure sores, pulmonary and cardiac compromise due to the mechanical effects. The treatment of neuromuscular scoliosis can be complex and may involve surgical and non-surgical approaches. Complications can arise at various stages of treatment: pulmonary issues, infection, neurological complications, cardiovascular complications, blood loss, implant failure, wound healing issues. Pulmonary complications are commonly seen in neuromuscular scoliosis surgery at a rate of 22.7% as the patient already has pulmonary dysfunction preoperatively as a natural part of the neurologic or muscular disease causing scoliosis. Wide range of neurological complication varying between neurological compromise with partial or complete recovery, sensory or motor deficits to complete and incomplete spinal cord deficits can be encountered in neuromuscular scoliosis surgery with overall pooled rate of 3%. Superficial or deep wound infections, decubitis ulcers and chronic infection with delayed healing are among infectious wound complications that can be seen in neuromuscular scoliosis surgeries. Surgical site infections frequently require reoperations, prolonged hospital stay and in refractory cases removal of implants. Prevalence of surgical site infections are reported to vary between 5-20%. Factors associated with complications were history of preoperative seizures (48% vs 32%), staged surgery (single vs staged 37% vs 52% respectively), operative time, increased intraoperative blood loss.
Keywords: Neuromuscular scoliosis; complication; implant failure

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