Neuromuscular Scoliosis

Neuromuscular scoliosis is a curve of the spine caused by a condition that weakens or tightens the muscles, such as cerebral palsy, spinal muscular atrophy, or muscular dystrophy. Small curves are watched, and seating changes or a brace can keep your child comfortable, but none of these stops a growing curve. When the curve reaches about 50 degrees, spinal fusion is the only treatment that can make it smaller and keep it from growing, and this page sets out the benefits and risks so you can decide with us.

Reviewed by Dr. Kshitij Chaudhary — Last reviewed October 2026

What is neuromuscular scoliosis?

Scoliosis is a sideways curve of the spine. The spine can also twist, which makes the ribs or trunk stick out more on one side. In neuromuscular scoliosis, the curve is caused by a condition with muscle weakness or spasticity (tight muscles), such as:

• Cerebral palsy
• Muscular dystrophy
• Spinal cord injury
• Spina bifida
• Spinal muscular atrophy

The curve follows the underlying condition.

What causes the curve?

• Weak or tight muscles in the spine and upper body pull the spine more to one side than the other, and a curve forms
• Weak or tight muscles around the hips and pelvis shift the trunk, so the head is no longer centred over the pelvis
• The abnormal muscle tone comes from the underlying condition

How do we know how big the curve is?

We measure it on an X-ray, in degrees, as the Cobb angle. The bigger the angle, the worse the curve, and the more likely problems are.

Why is it a problem?

Small curves (under 40 to 50 degrees) don't usually cause problems, and we check them regularly. Once a curve reaches 40 to 50 degrees, it can be expected to grow by at least a degree a year, and sometimes by 10 degrees or more. In one child, a curve went from 45 to 90 degrees in just nine months.

For your child, a big curve can mean:

• Wheelchair transfers get harder
• The pelvis tilts, and your child may lose the balance to sit without help. Sometimes this is also caused by hip dislocation or tight hip muscles, and we check for those
• More skin sores, from pressure on the tilted hips and spine
• Frequent or constant pain
• Breathing problems, mainly with curves over 80 degrees. Weak breathing muscles and trouble clearing secretions can add to this

For you as a parent or carer, bigger curves make dressing, positioning, feeding and wheelchair transfers harder.

What are the options?

There are four: observation, bracing, wheelchair modification and spinal fusion surgery. The three non-surgical options do not stop the curve getting bigger.

• Observation: carrying on as now, with regular checks
• Bracing: a firm moulded plastic brace around the upper body
• Wheelchair modification: seat and trunk supports shaped to your child's curve, made in the wheelchair clinic
• Spinal fusion: rods and bone graft to straighten the spine and fuse it

What do the non-surgical options offer?

When is surgery an option?

• Curves under 50 degrees can usually be watched if your child has no symptoms. Seating changes or a brace can help with symptoms
• At 50 degrees, with or without symptoms, the chance of the curve growing is high and surgery becomes an option. In Duchenne muscular dystrophy, we may offer it at a smaller curve, because lung problems can make surgery unsafe later
• Waiting for problems to appear may not be safe. Curves get harder and riskier to treat as they get bigger. Surgery is less complicated in the early to mid teens, when the spine is more flexible
• Spinal fusion is the only treatment that can make the curve smaller and keep it from growing again
• Surgery usually makes the curve 50 to 75 percent smaller. A 60 degree curve may be 30 degrees or less afterwards

If you're unsure about the advice you've been given, you're welcome to send your scans and reports for a second opinion.

What does surgery involve?

A long cut is made along the back. Anchors (screws, hooks or wires) are attached to the spine and joined to straight rods, which run from just below the neck down to the pelvis, or less often to the lower spine. Bone graft is added so the bones fuse together, which stops the curve coming back. The rods stay in for life and don't need removing.

These are demanding operations that can take several hours or more, because of the long fusion, the large curves and your child's other medical problems. A paediatric anaesthetist looks after your child throughout, and we monitor the spinal cord during surgery. Bleeding is common, so we use medicines to help clotting, and often give your child's own blood back through a cell saver. Some children need a blood transfusion, and donated blood is carefully screened.

What are the benefits of surgery?

• Easier daily activities such as eating, dressing and bathing
• Less time needed for resting
• Better sitting balance
• Better overall health
• Better lung function
• The curve is much less likely to get bigger
• Better sleeping comfort and less pain
• Better appearance and self-esteem

What are the risks of surgery?

These figures come from published studies. Your child's own risk depends on the curve size and on how much the underlying condition affects them.

Correcting the curve also makes your child taller and the trunk straighter, which can make independent transfers and self-catheterisation more difficult.

Most complications can be treated. Even when one happens, about 90 in 100 parents are satisfied with the result because of the benefits.

What is recovery like?

• Straight after surgery: your child goes to the paediatric intensive care unit for at least one night. Some children need breathing support until they are awake and strong enough to have the breathing tube removed
• The first few days: the hospital stay is usually about a week, sometimes longer. We manage pain, restart eating and bowel and bladder routines, and teach you how to care for your child at home. Physiotherapists help with transfers and daily activities
• At home: for the first few weeks, your child needs more help with transfers and bathing than before. About six weeks later, your child moves more and needs less pain medicine. By about 12 weeks, little pain medicine is needed and energy returns to normal. Some children feel the rods in their back at first, and this settles

What should we think about when deciding?

• Your goals as a family, and your child's other medical problems. If these are severe, we'll also talk about whether life expectancy is reduced
• The time in hospital and the extra help your child needs at home afterwards. This can take a heavy toll on families, so plan for it
• It can be hard to operate on a curve that isn't causing symptoms. The reason for surgery is to prevent the problems that come as the curve grows
• Surgery can prevent the problems of a big curve. It will not fix the underlying neuromuscular condition

Think about how much each reason matters to you. If most of your strongest reasons are in one column, that may be the better choice for your child and you. Talk it through with us. You can always take time or ask for a second opinion.

Questions to ask your doctor

• How big is the curve, and how fast is it growing?
• What do you recommend now, and why?
• What are my child's own risks, given their other health problems?
• Which operation, how long will it take, and how long will we be in hospital?
• What help will we need at home?
• What happens if we wait?

Treatments we offer for this

Observation and regular follow-up, advice on seating and wheelchair changes, bracing, physiotherapy and scoliosis correction surgery (posterior spinal fusion with instrumentation).

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About Dr. Kshitij Chaudhary

This page was written by Dr. Kshitij Chaudhary, a fellowship-trained spine surgeon at P.D. Hinduja Hospital, Mumbai, trained in complex spine surgery at Harvard Medical School (Beth Israel Deaconess) and the Twin Cities Spine Center, Minneapolis. 🏃🏾About Dr. Chaudhary

This information is for general education and does not replace a consultation with your doctor.