Neuromuscular Scoliosis

What is Neuromuscular Scoliosis (NMS)?

Neuromuscular Scoliosis is the result of any condition that causes weakness of the trunk musculature. This includes muscular dystrophy, cerebral palsy and Marfan’s syndrome. NMS affects balance and alignment of the spine and upper body. The underlying disease causes muscular imbalance and can result in significant spinal deformity as well as pelvic obliquity.

NMS is a complex form of scoliosis, and significantly different from idiopathic scoliosis. The treatment methods are also different than AIS. NMS spinal curves may develop at a young age and progress and worsen during adolescence. Nonsurgical measures rarely control progression. Surgery should usually be done sooner rather than later.

Symptoms of NMS

  • Tilted, uneven shoulders
  • Shoulder blade protrusion
  • Prominent ribs on one side
  • An uneven waistline
  • One hip that is higher than the other.
  • Seating difficulties

How is NMS Diagnosed?

Dr. Shufflebarger will conduct a clinical assessment to identify muscle tone and joint stiffness, including range of motion evaluation of the pelvis and hips. Walking capacity will be tested, as well as the child’s ability to sit, balance, and perform basic functions. Additionally, a respiratory exam, cardiac assessment, and evaluation of digestive and urinary function will be performed. Imaging tests will be ordered to assess the severity of the scoliosis including x-rays, and possibly a CT scan.

Treatment depends on the child’s age, severity of the underlying condition and severity of the spinal curve. The goal of treatment is to prevent spinal deformity with early comprehensive orthopedic management, and, if indicated, to perform surgery at an appropriate age and degree of scoliosis.


The underlying condition guides treatment decisions. Conservative treatment of neuromuscular scoliosis may include bracing for small curves, traction, wheelchair modifications and physical therapy.

Surgery may be recommended based on the child’s age, underlying condition and ability to walk. The goal of surgery is to correct the curve and stop progression, improve sitting or standing balance, and facilitate the caregiver’s functions.

Indications for surgery include:

  • A spinal curvature greater than 500 in children who are still growing or have progressed more than 100 in children who have reached skeletal maturity.
  • Difficulty sitting and functional deterioration.

Spinal deformity surgery has made significant technical advances and innovations and provide real benefits including improved function and reduced pain. Parents are fortunate to have access to a national and internationally recognized expert in the care of NMS. Dr. Shufflebarger was the chief of spinal surgery at the Nicklaus Children’s Hospital in Miami, Florida. In addition to his many accomplishments in research and innovation in pediatric spine conditions, he is a kind and compassionate doctor who is sought out by parents the world over.