Neuromuscular scoliosis is a very common condition, but it presents the pediatric spine surgeon with many treatment challenges. The patient population is diverse, and the deformities can be complex. Most surgeons have developed their surgical treatment plans and intraoperative techniques through experience.While many different treatmentswork in a given surgeon’s hands, there is currently no one resource to which a younger, inexperienced surgeon or an experienced surgeon presented with a challenging deformity can go to gain knowledge from the vast experience of experts in the field. The purpose of this book is to present some of the experiences of master surgeons, including key aspects of their surgical technique,ways to avoid problems, and advice on dealing with complications. In addition, the authors will provide evidence-based knowledgefrom both the literature and from the studies performed by the Harms Study Group. The authors assume that the reader has a basic knowledge of neuromuscular disease and some experience treating paralytic spine deformities using basic instrumentation. Section I: Surgical and Medical Considerations deals with nonoperative management and indications for surgery. Preoperative planning and intraoperative issues including anesthesia and neuromonitoring are addressed in this section. The managementof subluxed or dislocated hips, which may be very familiar to the pediatric orthopaedist but not to a spine-fellowship trained surgeon, are discussed. The presence of subluxed or dislocated hips in the patient with neuromuscular scoliosis presents particular challenges. The majority of neuromuscular disorders that include subluxed or dislocated hips usually fall into one of three diagnoses, which include 1) spinal cord injury; 2) myelomeningocele; and 3) cerebral palsy. However, the highest prevalence of dislocation is probably caused by sepsis, and it is essential that any relatively acute, radiographically identified dislocated hip have an aspiration and adequate work-up to rule out sepsis.
Hardcover: 206 pages
1 edition (March 9, 2018)