Neuromuscular scoliosis: A narrative review on pathophysiologic mechanisms and precision-based management.

Varshasri Degala; Vetha Janane Sashikumar; Disha Vatyani; Alka  Kumari; Sana  Shaik; Nidhi Vadhavekar; Raman Arora; Bisma Bashir  Ahmed

doi:10.51168/sjhrafrica.v7i3.2367

Authors

Varshasri Degala University of Perpetual Help System DALTA Jonelta Foundation School of Medicine
Vetha Janane Sashikumar University of Perpetual Help System DALTA Jonelta Foundation School of Medicine
Disha Vatyani Government Medical College, Nagpur
Alka Kumari Liaquat University of Medical and Health Sciences, Jamshoro.
Sana Shaik Tbilisi State Medical University, Tbilisi, Georgia
Nidhi Vadhavekar Padmashree Dr D Y Patil School of Medicine
Raman Arora Grigol Robakidze University School of Medicine
Bisma Bashir Ahmed People's University of Medical and Health Sciences for Women, Nawabshah, Sindh, Pakistan

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2367

Keywords:

Neuromuscular scoliosis, Spinal deformity, Muscle imbalance, Pelvic obliquity, Multidisciplinary management, Growth-preserving surgery, Minimally invasive spine surgery, Genetic therapy, Pediatric spinal disorders, Precision medicine

Abstract

Scoliosis is a complex, three-dimensional spinal deformity, with Neuromuscular Scoliosis (NMS) representing its second most common and arguably most intricate subtype. Arising from diverse neuropathic and myopathic disorders such as cerebral palsy, Duchenne muscular dystrophy, and spinal muscular atrophy, NMS is characterized by aggressive, multiplanar progression that often results in significant functional decline, pelvic obliquity, and compromised cardiopulmonary reserve. The pathophysiology of NMS is rooted in the failure of dynamic spinal stabilization due to muscular imbalance or denervation. Diagnosis has evolved through advanced imaging, including ultra-low-dose CT and AI-assisted analysis, within a Multidisciplinary Team (MDT) framework. Management strategies are shifting from traditional definitive spinal fusion toward growth-preserving techniques such as magnetically controlled growing rods (MCGR) and minimally invasive bipolar fixation (MIBF) to minimize surgical morbidity and accommodate skeletal growth. Early recognition and individualized, multidisciplinary management are essential, and integration of molecular therapies with precision surgical approaches represents a paradigm shift toward preventive and personalized care in neuromuscular scoliosis. This narrative review aims to synthesize current evidence on neuromuscular scoliosis to enhance understanding of its mechanisms, clinical evaluation, and evolving management strategies. It covers etiology, pathophysiology, diagnosis, multidisciplinary management, surgical and non-surgical treatments, and emerging advances, including minimally invasive techniques and gene-based therapies.

Author Biographies

Varshasri Degala, University of Perpetual Help System DALTA Jonelta Foundation School of Medicine

is a Clinical Intern at the Jonelta Foundation School of Medicine, University of Perpetual Help System. Throughout her undergraduate medical training, she has developed a strong academic foundation and a deep interest in clinical practice and research. She possesses a keen enthusiasm for research and is currently involved in two university-based research projects that are awaiting publication, reflecting her growing engagement with scientific inquiry and evidence-based medicine. Her comprehensive medical education and clinical exposure have cultivated a particular interest in the fields of Neurology, Neurosurgery, and General Surgery. Through continuous learning, clinical observation, and research participation, she aims to further expand her knowledge and skills in these specialties.

Vetha Janane Sashikumar , University of Perpetual Help System DALTA Jonelta Foundation School of Medicine

is a high-achieving clinical clerk at the Jonelta Foundation School of Medicine- University of Perpetual Help System DALTA. With a background in Psychology and a reputable standing in her medical studies, she brings a unique, holistic perspective to her clinical training and evidence-based practice. Her role in this project focused on conducting an extensive literature review to define and describe management strategies. Her further involvement in research- including contributions to pediatric studies, and the development of original clinical protocols- reflects a strong commitment to scientific communication and technical medical writing. Through her clinical experience, leadership activities, and aspiring research efforts, she consistently applies a comprehensive approach to modern medicine, integrating evidence-based practice with practical clinical decision-making.

Disha Vatyani, Government Medical College, Nagpur

is a 2025 graduate of Government Medical College, Nagpur, with a strong aspiration to pursue Neurology. Her interest in the specialty developed through broad academic exposure and active participation in clinical learning during her undergraduate medical training. She has gained experience in core clinical disciplines with a particular focus on neurological sciences, which strengthened her understanding of patient care, diagnostic reasoning, and evidence-based medicine. Her academic engagement and clinical exposure have helped her develop a solid foundation in neurological concepts and reinforced her decision to pursue a career in Neurology. Disha’s dedication to learning and her growing clinical insight reflect her potential to contribute meaningfully to neurological practice and research in the future.

Alka Kumari, Liaquat University of Medical and Health Sciences, Jamshoro.

is a medical graduate from Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. She is currently working as a licensed intern at Liaquat University Hospital. Alongside her clinical work, Dr. Kumari has a strong research background with experience across multiple projects, including case reports, narrative reviews, and a publication(peer-reviewed) in a PubMed-indexed Journal as first author. Dr. Kumari has successfully passed the USMLE Step1 examination and is currently preparing for Step2CK. Her field of interest is Internal Medicine with plans of applying for the upcoming Match Cycle. Her contribution to this project involved an extensive literature review and manuscript preparation, playing an essential role in molding the structure of this article.

Sana Shaik, Tbilisi State Medical University, Tbilisi, Georgia

is a medical graduate of Tbilisi State Medical University, having completed undergraduate training with a strong foundation in clinical medicine and patient care. During medical school, Sana developed robust clinical skills and undertook the CBME surgical training course, which further strengthened exposure to surgical principles and operative care. This early hands-on experience played a key role in shaping a strong interest in cardiology, cardiothoracic surgery, and internal medicine. Alongside clinical training, Sana has been actively involved in research across multiple study designs, including literature reviews, systematic reviews, meta-analyses, case reports, and cross-sectional studies. This combination of clinical competence, structured surgical training, and diverse research experience highlights Sana’s potential to contribute meaningfully to academic medicine and evidence-based clinical practice.

Nidhi Vadhavekar, Padmashree Dr D Y Patil School of Medicine

is a medical professional who earned her MBBS degree from Padmashree Dr. D.Y. Patil School of Medicine in India. She has demonstrated strong leadership skills through her extensive involvement in research, having published over ten articles. As a mentor, Dr. Vadhavekar was instrumental in the research process. Her leadership was evident from the early stages of conceptualization, where she helped shape the study's direction. She continued to lead the effort through the critical phases of revising and finalizing the drafts, ensuring the project's successful completion. This experience highlights her capacity to take initiative and drive a complex scientific undertaking.

Raman Arora, Grigol Robakidze University School of Medicine

is an International Medical Graduate (MD) with structured clinical training across Internal Medicine and allied specialties. He completed his medical education at Grigol Robakidze University, Georgia, and gained comprehensive hands-on experience through university-affiliated hospitals in Internal Medicine, Emergency Medicine, Anesthesiology, Surgery, and Pediatrics. Dr. Arora has a strong academic orientation with experience in clinical literature review, retrospective research workflows, data interpretation, and collaborative academic writing. He is currently preparing for the USMLE examinations and plans to pursue Internal Medicine residency training in the United States, with a strong interest in evidence-based medicine and academic clinical practice.

Bisma Bashir Ahmed, People's University of Medical and Health Sciences for Women, Nawabshah, Sindh, Pakistan

is a final-year MBBS student at People’s University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Sindh, with a clear aspiration to pursue General Surgery. Her interest developed through broad academic exposure and active involvement in clinical and research activities during her undergraduate training. She has contributed to research projects in cardiology, neurology, and pulmonology, which strengthened her foundation in clinical research methodology, including identifying research gaps, manuscript writing, data analysis, and visual presentation. This multidisciplinary exposure helped her make an informed decision to pursue a career in general surgery. Bisma has supported several collaborative research projects, with multiple studies currently in the process of publication. Her analytical skills and research experience highlight her potential to contribute to surgical research and evidence-based practice.

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