Neuromuscular Scoliosis in Children: Causes and Treatment

What Is Neuromuscular Scoliosis?

Neuromuscular scoliosis is a sideways spinal curve that a nerve, cord or muscle condition causes. The muscles that hold the spine upright lose their balance, so the spine leans sideways. In children, it also tends to start early and grow fast.

Doctors also call it neurological or neurogenic scoliosis. Common causes include spina bifida, a tethered cord, a syrinx and cerebral palsy. Muscle diseases, such as spinal muscular atrophy, cause it too.

About 8 in 10 scoliosis cases have no known cause (idiopathic), the NHS notes. This guide, however, covers curves with a nerve or muscle cause. Here, the curve often signals a spinal cord problem that a neurosurgeon can treat.

At a Glance

• What it isA spinal curve from a nerve, spinal cord or muscle condition
• Warning signsA curve that bends left, grows fast or starts before age 10
• Key testMRI of the whole spine, often with a brain MRI
• First stepTreat the spinal cord cause, such as a tethered cord or a syrinx
• ThenSeating, a brace or curve surgery with the orthopedic spine team
• Follow-upX-rays every 6 months while your child grows, then yearly checks

What Brought You Here?

First, pick the line closest to your child's situation. It then takes you to the matching part of this guide.

1. 01A curve that bends left or grows fastOr a curve that started before age 10→
2. 02Back pain, weak legs or bladder changesNerve signs that come with the curve→
3. 03Spina bifida, Chiari or a syrinxHow each condition bends the spine→
4. 04Cerebral palsy or a muscle diseaseWhen muscle tone or weakness drives the curve→
5. 05A surgeon suggested curve surgeryWhy the spinal cord comes first→
6. 06Planning treatment from abroadLength of stay, flights and follow-up at home→

Signs That Point to a Neurological Cause

Uneven shoulders, a tilted waist or a rib hump often come first. The signs that come with the curve, however, point to a nerve cause.

Questions at this stage

When to Get Your Child Checked

Most curves change over months, so families usually have time to plan a visit. Some signs, however, call for a prompt check, and a few need emergency care.

These signs can mean pressure on the cord or a blocked shunt. So go to the nearest hospital first, rather than waiting for a visit abroad.

What Causes Neuromuscular Scoliosis?

Doctors sort the causes into two groups. Some start in the spinal cord itself and often have a treatable cause. Others come from muscle tone or muscle weakness, so care then focuses on the curve.

Spina Bifida and a Tethered Cord

In spina bifida, a curve that suddenly speeds up needs a fresh look. The cord may have stuck to the old repair scar. Our myelomeningocele guide also covers that newborn operation.

In a tethered cord, tissue holds the lower end of the cord in place. So the cord stretches as the child grows; see our tethered cord syndrome guide.

Chiari Malformation and Syringomyelia

A syrinx means a pocket of fluid inside the spinal cord. As it widens, it then presses on the nerve cells that steer the back muscles. In children, a Chiari malformation causes it most often.

Also see our guides to syringomyelia and Chiari malformation.

Spinal Cord Tumors and Injuries

A spinal cord tumor can also bend a child's spine, NIAMS notes. Night pain often comes first; see spinal cord tumors in children. After a cord injury, too, weak trunk muscles let the spine curve.

Cerebral Palsy and Muscle Diseases

In cerebral palsy, stiff and unbalanced muscles pull on the spine. NINDS notes that some children with cerebral palsy develop scoliosis. Also, a baclofen pump or selective dorsal rhizotomy can ease muscle tone; see spasticity surgery.

In spinal muscular atrophy and muscular dystrophy, however, weak trunk muscles cause the curve. So care focuses on the spine itself.

How Doctors Find the Cause: MRI and Nerve Checks

An X-ray measures the curve, but only an MRI shows the spinal cord. So when doctors suspect a neurological cause, an MRI comes before any treatment plan.

First, Prof. Albayrak examines your child standing, bending forward and lying down. He also checks reflexes, strength, the feet and the skin over the lower back.

With spina bifida or a syrinx, the MRI often shows more than one problem. A split cord malformation, for example, can also appear. So the plan follows the whole picture, not a single finding.

Treat the Spinal Cord First, Then the Curve

In neuromuscular scoliosis, the order of treatment matters most. First, the neurosurgeon treats the spinal cord problem that drives the curve. Only then does the team decide whether the curve itself needs treatment.

Straightening the spine around a tethered cord or a large syrinx stretches the cord further. This raises the risk of lasting paralysis. For this reason, Prof. Albayrak treats the cord problem before any decision on curve surgery.

Nerve Monitoring During Surgery

During untethering, Chiari decompression and spina bifida surgery, Prof. Albayrak works with nerve monitoring. It tracks the spinal cord's signals and then warns the surgeon near a nerve. For surgery in children more broadly, see pediatric neurosurgery.

Bracing, Seating and Curve Surgery

Once the cord problem settles, attention turns to the curve itself. The goal, in fact, often means a child who sits without pain and breathes well. These treatments, however, usually belong to the orthopedic spine team.

What the Curve Angle Means

The X-ray report gives the curve as a Cobb angle. Yet age, sitting balance and the cause count just as much.

• 10-20 degrees: find the cause with MRI; X-rays every 6 months
• 20-40 degrees: treat the cause, then seating support or a brace
• 40-50 degrees: surgical planning starts
• Over 50 degrees, or a pelvic tilt over 15 degrees: surgery usually follows

For example, a 35-degree curve may only need watching after an untethering. With a tilted pelvis in a child who cannot walk, however, it may need surgery. MedlinePlus adds that surgery often aims to help a child sit upright or walk better.

What Are the Risks of Surgery?

Surgery for neuromuscular scoliosis carries more risk than many other spine operations. Children often have other problems too, such as fragile bones or poor nutrition. Knowing the risks, however, helps your family prepare.

Risks of the Neurosurgical Step

• A spinal fluid leak, which often settles with rest
• Wound infection
• New weakness, numbness or bladder changes, which remain uncommon
• The cord sticking down again years later (re-tethering)

To lower these risks, Prof. Albayrak operates under the microscope with nerve monitoring. In addition, regular checks catch a returning problem early.

Risks of Curve Surgery

The NHS lists bleeding, wound infection and problems with the rods or bone grafts. Rarely, nerve damage can also cause leg weakness or loss of bladder control. Good preparation, such as better nutrition and treating any urine infection first, lowers these risks.

Recovery and Follow-Up

After an untethering or a Chiari decompression, most children go home within 2-4 days. Follow-up, however, lasts until growth ends, and often beyond.

Severe curves, MedlinePlus also notes, tend to worsen even after growth stops. So keep the yearly checks, even when your child feels well.

Coming to Istanbul from the US, Canada, the UK or Europe

A neurosurgical step, such as an untethering, usually needs one planned trip. Curve surgery, if needed, often comes months later. So plan both stages with your home team.

How Long to Stay in Istanbul

First, add up the consultation, any new MRI, the operation and 2-4 days in hospital. Then rest near the hospital until the check-up before the flight. Overall, many families plan about two weeks.

When Your Child Can Fly Home

After a Chiari decompression, UK aviation guidance advises about 7 days before flying. Air left inside the skull can expand at altitude.

For spine operations, such as an untethering, the CAA gives no separate figure. The US CDC also warns that flying after surgery raises the risk of blood clots. So your surgeon sets the date after a final check.

Follow-Up at Home

First, before you leave, ask for the operation report, discharge summary and scan copies. Then book the 3-6 month MRI and X-ray with your local team.

For insurance and Medicare, see brain surgery in Turkey: planning from the US. For NHS rules and travel insurance, see planning from the UK. From Canada, check with your provincial health plan and private insurer before you book.

Your Child's Neurosurgeon in Istanbul

Prof. Dr. Serdar Baki Albayrak

Neurosurgeon · Full Professor of Neurosurgery

In a child with a curving spine, Prof. Albayrak first looks for a cord cause. He performs tethered cord release, Chiari decompression and spina bifida surgery with nerve monitoring.

Prof. Albayrak completed his neurosurgery training at Istanbul University in 2004. He then took clinical fellowships at the University of Helsinki and Harvard Medical School. At Harvard, he trained at Brigham and Women's Hospital.

27+Years

5,000+Operations

64Countries

33Publications

Figures from Prof. Albayrak's professional profile, September 2026. See his full publication list.

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