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

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.