Open Access Highly Accessed Review

A Dutch guideline for the treatment of scoliosis in neuromuscular disorders

MG Mullender1*, NA Blom2, M De Kleuver3, JM Fock4, WMGC Hitters5, AMC Horemans6, CJ Kalkman7, JEH Pruijs8, RR Timmer9, PJ Titarsolej10, NC Van Haasteren11, MJ Van Tol-de Jager12, AJ Van Vught13 and BJ Van Royen1

Author Affiliations

1 Dept. Orthopaedic Surgery, Vrije Universiteit Medical Center (VUmc), Research Institute MOVE, Amsterdam, The Netherlands

2 Department of Pediatric Cardiology, Leiden University Medical Center, The Netherlands

3 Dept. Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands

4 Dept. Neurology, University Hospital Groningen, The Netherlands

5 Revalidatiecentrum Blixembosch, Eindhoven, The Netherlands

6 Vereniging Spierziekten Nederland, Baarn, The Netherlands

7 Dept. Perioperative & Emergency Care, University Medical Centre Utrecht, The Netherlands

8 Department of Paediatric Orthopaedics, University Hospital for Children and Youth Het Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands

9 Dept Anesthesiologie, University Hospital Maastricht, The Netherlands

10 Groot Klimmendaal, Arnhem, The Netherlands

11 Revalidatiecentrum Leijpark, Tilburg, The Netherlands

12 Revalidatiecentrum de Hoogstraat en Wilhelmina Kinderziekenhuis UMC Utrecht, The Netherlands

13 Department of Paediatrics, University Hospital for Children and Youth Het Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands

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Scoliosis 2008, 3:14  doi:10.1186/1748-7161-3-14

Published: 26 September 2008

Abstract

Background

Children with neuromuscular disorders with a progressive muscle weakness such as Duchenne Muscular Dystrophy and Spinal Muscular Atrophy frequently develop a progressive scoliosis. A severe scoliosis compromises respiratory function and makes sitting more difficult. Spinal surgery is considered the primary treatment option for correcting severe scoliosis in neuromuscular disorders. Surgery in this population requires a multidisciplinary approach, careful planning, dedicated surgical procedures, and specialized after care.

Methods

The guideline is based on scientific evidence and expert opinions. A multidisciplinary working group representing experts from all relevant specialties performed the research. A literature search was conducted to collect scientific evidence in answer to specific questions posed by the working group. Literature was classified according to the level of evidence.

Results

For most aspects of the treatment scientific evidence is scarce and only low level cohort studies were found. Nevertheless, a high degree of consensus was reached about the management of patients with scoliosis in neuromuscular disorders. This was translated into a set of recommendations, which are now officially accepted as a general guideline in the Netherlands.

Conclusion

In order to optimize the treatment for scoliosis in neuromuscular disorders a Dutch guideline has been composed. This evidence-based, multidisciplinary guideline addresses conservative treatment, the preoperative, perioperative, and postoperative care of scoliosis in neuromuscular disorders.