Neuromuscular Scoliosis

Reviewed by Dr. Kshitij Chaudhary — Last reviewed August 2026

What Is Neuromuscular Scoliosis?

An abnormal curve of the spine is called scoliosis. The twisted spine pushes the ribs outward and creates asymmetry in the trunk. In neuromuscular scoliosis, the curve is caused by conditions that cause muscle weakness or muscle tightness (spasticity). These conditions can affect the brain (cerebral palsy), the spinal cord (spinal cord injury), the nerves (spinal muscular atrophy), or the muscles (muscular dystrophy).

What Causes Neuromuscular Scoliosis?

The muscles that support the spine become too weak or too tight (spasticity). These weak or tight muscles put abnormal forces on the spine. This causes the spine to curve (scoliosis).

How Do We Determine the Severity?

Doctors use X-rays to measure the angle of the curve. This angle is called the Cobb angle. A larger angle means more severe scoliosis. Larger curves tend to cause more problems.

Which Size Curves Can Be a Problem?

• Curves smaller than 40 degrees usually do not cause problems. Your doctor will ask you to return regularly to check the curve size
• Curves larger than 40 to 50 degrees can continue to increase, sometimes as fast as 10 degrees a year
• As curves get larger, your child becomes more likely to develop symptoms and problems

What Problems Can a Large Curve Cause?

For Your Child

• As curves get larger over time, the pelvis starts to tilt. This makes it difficult for your child to sit without help. Hip problems, such as hip dislocation and tight hip muscles, can also cause sitting difficulty
• As the curve worsens, your child can start to use their arms to prop up the trunk. This reduces the use of the hands and arms for daily activities and social interaction
• A tilted pelvis (pelvic obliquity) causes your child to sit more on one side. This puts extra pressure on that side. The skin in this area can break down and form a sore
• Pain in the back or ribs can increase. The ribs can touch the pelvic bone, and this causes pain (costopelvic impingement)
• Breathing problems can develop with large curves over 80 degrees, because the curve compresses the lungs. Muscle weakness can also add to breathing problems
• Nutrition and feeding can get worse, and your child can become malnourished over time

For the Caregiver or Parent

• Feeding problems increase
• Dressing becomes more difficult
• Your child needs frequent repositioning
• Wheelchair transfers become more difficult

What Are the Non-Surgical Treatment Options?

• Observation: Your doctor watches the curve regularly and continues physical therapy
• Bracing: Your child wears an external jacket to support the curve
• Wheelchair modification: The seat and trunk supports of the wheelchair are changed, and sometimes molded, to fit your child's curve

What Are the Benefits of Non-Surgical Options?

• Non-surgical treatment avoids the risks of surgery
• Bracing and wheelchair modification can improve trunk support and sitting posture

What Are the Risks of Non-Surgical Treatment?

• The curve can continue to increase in spite of treatment
• A brace can cause breathing problems
• A brace can cause skin problems
• Pain can increase as the curve size increases
• Care for your child can become more difficult as the curve size increases
• Bracing or wheelchair modification will not straighten the curve
• Bracing does not change the natural course of the curve. Research does not show that external bracing stops a progressive curve from increasing

When Is Surgery Needed?

• If curves increase to more than 50 degrees, or if they cause problems with sitting and balance, surgery becomes an option. In some conditions, such as Duchenne muscular dystrophy, this threshold is lower, and surgery is offered for smaller curves
• There is a window of time in your child's life when surgery can be done with more safety. It is not a good idea to wait for problems to develop before you act
• These curves become bigger and stiffer as your child gets older. Surgery on a very large, stiff curve is more risky than surgery done early, such as in the mid-teens, when the curve is more flexible and easier to correct
• Spinal instrumentation and fusion is the only treatment that can make the curve smaller and stop it from getting bigger
• Surgery can correct the deformity and level the pelvis. This improves sitting balance, and the improvement lasts for the rest of your child's life

What Are the Benefits of Surgery?

• Better posture and sitting balance
• Pain relief
• Better health and nutrition
• Better lung function
• The curve stops getting worse
• A level pelvis spreads body weight evenly. This helps prevent skin breakdown
• Better appearance and self-esteem

What Are the Risks of Surgery?

• Surgery for neuromuscular scoliosis carries some risk
• Complications occur overall in about 1 in 4 patients. 3 out of 4 patients do not have complications
• The risk of complications depends on the severity of the curve and the severity of the underlying neuromuscular condition
• Wound infection can occur in about 4 of 100 children. 96 of 100 children do not get a wound infection. Some infections need repeat surgery to clean out the infection
• Lung problems, such as pneumonia, a prolonged breathing tube, or ventilator support, can occur after surgery
• Urinary tract infection can occur in 5 of 100 children. 95 of 100 children do not get this complication
• Screw loosening or rod breakage can occur in about 16 of 100 children. 84 of 100 children do not have this problem. Repeat surgery to fix this problem is often not necessary
• Back pain can sometimes continue, or can develop as a new problem
• Spinal cord injury and worsening of spasticity, with new bladder and bowel problems, are rare complications. Doctors sometimes use nerve monitoring during surgery to reduce these risks
• The risk of death within 30 days is less than 2 per 100 children. This risk is higher in sicker children with larger curves
• Doctors can successfully treat most complications. Even when complications occur, 90 of 100 parents are satisfied with the results of surgery because of its benefits

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. Learn more about Dr. Chaudhary →

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