Dutch guideline for the treatment of scoliosis in neuromuscular disorders

Authors: M. G. Mullender, N. A. Blom, M. De Kleuver, J. M. Fock, W. M.G.C. Hitters, A. M.C. Horemans, C. J. Kalkman, J. E.H. Pruijs, R. R. Timmer email, P. J. Titarsolej, N. C. Van Haasteren, M J. Van Tol-de Jager, A. J. Van Vught and B. J. Van Royen


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, makes sitting more difficult, and is perceived as unaesthetic. 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 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, preoperative, perioperative, and postoperative care of scoliosis in neuromuscular disorders.

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