Surgical management of neuromuscular scoliosis in paediatric patients: experiences from a tertiary centre multidisciplinary team
Background Management of neuromuscular scoliosis (NMS) is challenging, with both surgical and conservative options involving risks. This study aimed to evaluate multimorbidity in patients with NMS and how this influences multidisciplinary team (MDT) decisions as well as postoperative outcomes.Method...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/9/1/e002456.full |
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| author | James Zhang Faris Khan Theofilos Polychronakis Lucy Chinnery Anas Khan Jake Loveridge |
| author_facet | James Zhang Faris Khan Theofilos Polychronakis Lucy Chinnery Anas Khan Jake Loveridge |
| author_sort | James Zhang |
| collection | DOAJ |
| description | Background Management of neuromuscular scoliosis (NMS) is challenging, with both surgical and conservative options involving risks. This study aimed to evaluate multimorbidity in patients with NMS and how this influences multidisciplinary team (MDT) decisions as well as postoperative outcomes.Methods A retrospective cohort study of patients referred for assessment by the scoliosis MDT in the 8-year period between 2013 and 2021 from a single tertiary centre.Results 84 patients with NMS were referred for assessment to the MDT. The most common underlying cause of NMS was cerebral palsy (51%). The MDT recommended surgery for 60 patients and 24 were conservatively managed. There were no significant differences in age, sex, body mass index or baseline Cobb angle between the two groups. Patients recommended surgery had fewer comorbidities (2.3 vs 3.5, p<0.05) and greater Cobb angle progression in the 18 months prior to MDT decision (22° vs 8°, p<0.05). No single comorbidity significantly influenced the MDT decision. Of the 48 patients that proceeded with surgery, immediate postoperative complications were documented in 54.1%, with no mortality. The most common complications were postoperative anaemia and respiratory infections. Multivariate logistic regression identified the use of non-invasive ventilation, forced vital capacity <70% of predicted and full-time wheelchair use as significant predictors of immediate postoperative complications. Improved posture was the most common long-term outcome (41.7%) and 81.3% of patients reported no complications at 12 months following their surgery.Conclusions Multimorbidity in children with NMS influences scoliosis MDT decisions, alongside factors such as scoliosis curve progression. Immediate postoperative complications were common but longer term outcomes were favourable for most patients. Further research aiming to better inform shared decision-making, improve surgical selection and ultimately enhance the quality of life for patients with NMS is required. |
| format | Article |
| id | doaj-art-0cbcb989c60d4fa498ddec9eb149f67b |
| institution | DOAJ |
| issn | 2399-9772 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj-art-0cbcb989c60d4fa498ddec9eb149f67b2025-08-20T03:01:04ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722025-02-019110.1136/bmjpo-2023-002456Surgical management of neuromuscular scoliosis in paediatric patients: experiences from a tertiary centre multidisciplinary teamJames Zhang0Faris Khan1Theofilos Polychronakis2Lucy Chinnery3Anas Khan4Jake Loveridge5University of Cambridge School of Clinical Medicine, Cambridge, UKSchool of Clinical Medicine, University of Cambridge, Cambridge, UK2Cambridge University Hospitals NHS Foundation Trust, Cambridge, UKSchool of Clinical Medicine, University of Cambridge, Cambridge, UKImperial College Healthcare NHS Trust, London, UKUniversity of Cambridge School of Clinical Medicine, Cambridge, UKBackground Management of neuromuscular scoliosis (NMS) is challenging, with both surgical and conservative options involving risks. This study aimed to evaluate multimorbidity in patients with NMS and how this influences multidisciplinary team (MDT) decisions as well as postoperative outcomes.Methods A retrospective cohort study of patients referred for assessment by the scoliosis MDT in the 8-year period between 2013 and 2021 from a single tertiary centre.Results 84 patients with NMS were referred for assessment to the MDT. The most common underlying cause of NMS was cerebral palsy (51%). The MDT recommended surgery for 60 patients and 24 were conservatively managed. There were no significant differences in age, sex, body mass index or baseline Cobb angle between the two groups. Patients recommended surgery had fewer comorbidities (2.3 vs 3.5, p<0.05) and greater Cobb angle progression in the 18 months prior to MDT decision (22° vs 8°, p<0.05). No single comorbidity significantly influenced the MDT decision. Of the 48 patients that proceeded with surgery, immediate postoperative complications were documented in 54.1%, with no mortality. The most common complications were postoperative anaemia and respiratory infections. Multivariate logistic regression identified the use of non-invasive ventilation, forced vital capacity <70% of predicted and full-time wheelchair use as significant predictors of immediate postoperative complications. Improved posture was the most common long-term outcome (41.7%) and 81.3% of patients reported no complications at 12 months following their surgery.Conclusions Multimorbidity in children with NMS influences scoliosis MDT decisions, alongside factors such as scoliosis curve progression. Immediate postoperative complications were common but longer term outcomes were favourable for most patients. Further research aiming to better inform shared decision-making, improve surgical selection and ultimately enhance the quality of life for patients with NMS is required.https://bmjpaedsopen.bmj.com/content/9/1/e002456.full |
| spellingShingle | James Zhang Faris Khan Theofilos Polychronakis Lucy Chinnery Anas Khan Jake Loveridge Surgical management of neuromuscular scoliosis in paediatric patients: experiences from a tertiary centre multidisciplinary team BMJ Paediatrics Open |
| title | Surgical management of neuromuscular scoliosis in paediatric patients: experiences from a tertiary centre multidisciplinary team |
| title_full | Surgical management of neuromuscular scoliosis in paediatric patients: experiences from a tertiary centre multidisciplinary team |
| title_fullStr | Surgical management of neuromuscular scoliosis in paediatric patients: experiences from a tertiary centre multidisciplinary team |
| title_full_unstemmed | Surgical management of neuromuscular scoliosis in paediatric patients: experiences from a tertiary centre multidisciplinary team |
| title_short | Surgical management of neuromuscular scoliosis in paediatric patients: experiences from a tertiary centre multidisciplinary team |
| title_sort | surgical management of neuromuscular scoliosis in paediatric patients experiences from a tertiary centre multidisciplinary team |
| url | https://bmjpaedsopen.bmj.com/content/9/1/e002456.full |
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