A Dutch guideline for the treatment of scoliosis in neuromuscular disorders

The guideline is based on scientific evidence and expert opinions. A multidisciplinary working group representing experts from all relevant specialties performed the research. A literature search was conducted to collect scientific evidence in answer to specific questions posed by the working group. Literature was classified according to the level of evidence.For most aspects of the treatment scientific evidence is scarce and only low level cohort studies were found. Nevertheless, a high degree of consensus was reached about the management of patients with scoliosis in neuromuscular disorders. This was translated into a set of recommendations, which are now officially accepted as a general guideline in the Netherlands.In order to optimize the treatment for scoliosis in neuromuscular disorders a Dutch guideline has been composed. This evidence-based, multidisciplinary guideline addresses conservative treatment, the preoperative, perioperative, and postoperative care of scoliosis in neuromuscular disorders.Neuromuscular disorders comprise a very diverse group of disorders. The most common forms of neuromuscular disorders are Duchenne Muscular Dystrophy (DMD) of the myopathic disorders and Spinal Muscular Atrophy (SMA) of the neurogenic disorders. Despite differences in etiology both forms have a lot of characteristics in common. Both disorders have a genetic origin and have an effect on several systems, requiring a multidisciplinary evaluation and treatment. Typical for both of these disorders is the progressive character of the muscle weakness and as a result ventilatory restriction and a progressive scoliosis. Usually joint contractures, as well as nutritional disorders are present. In dystrophinopathy, cardiac dysfunction and mental retardation can occur as well.Severe scoliosis causes discomfort and compromises respiratory function. Spinal surgery is considered the primary treatment option for correcting severe scoliosis in neuromuscular disorders. It can improve