Pourquoi s'intéresser à la fonction respiratoire d'un patient porteur d'une scoliose neuromusculaire ? Le point de vue du chirurgien

Scoliosis is a common deformity in many types of neuromuscular diseases. Severe curves of the vertebral column cause difficulties in sitting. Scoliosis treatments in neuromuscular conditions differ from idiopathic scoliosis in being more complex with a higher complication rate. Non-operative measures rarely fully control a progressive scoliosis. The aim of bracing is to prevent spinal deformities secondary to muscular hypotonia or contractures. Day and night time bracing should be readjusted according to the child's growth and could be responsible for functional impairment. Correction surgeries require orthopedic and multi-disciplinary screening and investigations. Pelvic obliquity is commonly associated with neuromuscular scoliosis making sitting difficult and needs to be considered during spinal deformity management. The goal of management of these severe axial deformities is to obtain and maintain a well-balanced spine above a horizontal pelvis. The scheduled multi-disciplinary assessment will anticipate potential peri-operative problems. Respiratory function investigation will guide peri-operative management (non-invasive ventilation). Nutritional status, psychological context, and post-operative functional changes should also be incorporated in this preparation. Careful preoperative planning and surgery can achieve a well-balanced spine over a level pelvis with a good functional result.