Neuromuscular scoliosis in children: surgical treatment and lung function (analytical and systematic review)

Objective. To systematically review current publications on surgical correction of neuromuscular scoliosis in children and its relationship with lung function. Material and Methods. A search of scientific sources was conducted in accordance with PRISMA standard. The protocol was developed a priori and was not included in international registries of systematic reviews. The search included PubMed/Medline, Scopus, the Cochrane Library, Google Scholar, eLibrary.ru, CyberLeninka, and Rucont. Of the 938 database entries, 69 studies were included in the review. Results. The most important positive effect of surgical correction of spinal deformity associated with neuromuscular scoliosis on pulmonary function is considered to be stabilization or slowing of the progression rather than regression of respiratory impairment. The main controversy lies in the fact that the method that provides maximum correction and stability (posterior instrumentation and fusion) irreversibly halts the growth of the spine and thorax in growing children, potentially limiting lung development. At the same time, growth-friendly technologies are associated with an expectedly smaller immediate deformity correction and with a higher incidence of planned postoperative complications, which, however, are incomparably less severe than with final fusion. Data on the effectiveness of many growth-preserving systems (Shilla, Luque trolley) in neuromuscular scoliosis remain fragmentary. Conclusion. The analysis of surgical correction techniques in neuromuscular scoliosis and their impact on patients’ respiratory function demonstrates a lack and inconsistence of data; there are no uniform criteria for assessing respiratory function; patient cohorts differ in the nosology and prognosis of the underlying disease, severity of functional status, age, and magnitude of deformity.