Abstract Early-onset neuromuscular scoliosis (EO-NMS) is a complex deformity associated with conditions such as cerebral palsy and spinal muscular atrophy (SMA), often leading to rapid curve progression, pelvic obliquity, impaired sitting balance, and severe pulmonary compromise. In contrast to idiopathic early-onset scoliosis, surgical management in EO-NMS must consider fragile respiratory function, poor bone quality, higher complication rates, and the need to minimize anesthetic exposure. The primary goals are to correct deformity, preserve spinal and thoracic growth, and reduce the cumulative burden on patients and caregivers. Fusionless surgical options form the foundation of EO-NMS treatment. Traditional growing rods, once the standard, require repeated lengthening and induce high complications in neuromuscular patients. Magnetically controlled growing rods prevent open lengthening but are limited by implant size, cost, and failures such as metallosis, while still requiring frequent outpatient distractions. Shilla growth guidance permits spinal growth without the need for repeated procedures and is particularly useful in small or medically fragile children. Segmental sublaminar instrumentation shows efficacy in hypotonic neuromuscular conditions, such as SMA but only in limited studies. Newer innovations like the One-Way Self-Expanding Rod and Spring Distraction System (SDS) allow continuous or passive lengthening through daily activity. Comparative studies suggest SDS achieves greater spinal growth with fewer complications. Other techniques are selective: vertebral body tethering has limited efficacy in neuromuscular scoliosis, while the Vertical Expandable Prosthetic Titanium Rib is beneficial in non-ambulatory patients with thoracic insufficiency. While no single approach is universally optimal, surgical strategy in EO-NMS should be individualized, balancing deformity correction, pulmonary preservation, pelvic stability, and complication risk. Continued innovation and neuromuscular-focused trials are needed to refine outcomes in this vulnerable population.
Garg et al. (Fri,) studied this question.