Fast Five Quiz: Are You Prepared to Manage Spinal Muscular Atrophy?

Stephen L. Nelson, Jr, MD, PhD

Disclosures

May 16, 2019

Posterior spinal fusion and segmental instrumentation are indicated in patients whose scoliosis is uncontrollable with a brace, and in patients older than 10 years who have a forced vital capacity that is 40% above normal and a spinal curve > 40°.

Patients with SMA may be divided into three functional mobility categories: "sitters," "nonsitters," and "walkers." For sitters and nonsitters, spinal fusion should be performed from thoracic spine to the pelvis; in walkers, the pelvis is typically excluded.

Anterior spinal fusion is generally not recommended for patients with SMA. Surgical correction of hip subluxation and luxation remains controversial owing to high rates of recurrence.

Clinicians should note that spinal fusion can dramatically limit upper-extremity mobility, and many patients are no longer able to feed themselves independently after surgery. Along with surgical interventions, physical and occupational therapies should be used to help maintain physical abilities.

For more on surgical interventions for patients with SMA, read here.

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