Clinical Practice Guideline for Adolescent and Adult Patients with Spinal Muscular Atrophy – Part 2
Abstract
In recent years, the field of spinal muscular atrophy (SMA) has made progress in multidisciplinary care and disease-modifying therapies. Survival and the quality of life of patients have significantly improved. However, no clinical practice guidelines exist for the management of SMA in adult and adolescent patients. Multidisciplinary experts from a number of tertiary medical centers in China, specializing in the diagnosis and treatment of SMA, came together to remedy this using evidence-based medicine. This guideline serves as an instrumental reference for the standardized care of Chinese SMA patients.
Section
References
- 1. Coratti G, Cutrona C, Pera MC, et al. Motor function in type 2 and 3 SMA patients treated with Nusinersen: a critical review and meta-analysis. Orphanet J Rare Dis. 2021;16(1):817-822.
- 2. Pane M, Palermo C, Messina S, et al. Nusinersen in type 1 SMA infants, children and young adults: Preliminary results on motor function. Neuromuscul Disord. 2018;28(7):582-585.
- 3. Mercuri E, Finkel RS, Muntoni F, et al. Diagnosis and management of spinal muscular atrophy: Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscul Disord. 2018;28(2):103-115.
- 4. Sansone VA, Walter MC, Attarian S, et al. Measuring Outcomes in Adults with Spinal Muscular Atrophy - Challenges and Future Directions - Meeting Report. J Neuromuscul Dis. 2020;7(4):523-534.
- 5. Zizzi CE, Luebbe E, Mongiovi P, et al. The Spinal Muscular Atrophy Health Index: A novel outcome for measuring how a patient feels and functions. Muscle Nerve. 2021;63(6):837-844.
- 6. Chen D, Qiu ZY, Li QY, et al. ICF Based Disability and Rehabilitation Information Standard and Its Applications. Chin J Rehabil Theory Pract. 2006;20(6):501-507.
- 7. Qiu ZY, Li QY, Chen D, et al. Theoretical framework, methods, classification system and applications of ICF-CY. Chin J Rehabil Theory Pract. 2014;20(1):1-6.
- 8. Main M, Kairon H, Mercuri E, et al. The Hammersmith functional motor scale for children with spinal muscular atrophy: a scale to test ability and monitor progress in children with limited ambulation. Eur J Paediatr Neurol. 2003;7(4):155-159.
- 9. O'Hagen JM, Glanzman AM, McDermott MP, et al. An expanded version of the Hammersmith Functional Motor Scale for SMA II and III patients. Neuromuscul Disord. 2007;17(9-10):693-697.
- 10. Krosschell KJ, Scott CB, Maczulski JA, et al. Reliability of the Modified Hammersmith Functional Motor Scale in young children with spinal muscular atrophy. Muscle Nerve. 2011;44(2):246-251.
- 11. Mazzone E, De Sanctis R, Fanelli L, et al. Hammersmith Functional Motor Scale and Motor Function Measure-20 in non ambulant SMA patients. Neuromuscul Disord. 2014;24(4):347-352.
- 12. Mazzone E, Bianco F, Martinelli D, et al. Assessing upper limb function in nonambulant SMA patients: development of a new module. Neuromuscul Disord. 2011;21(5):406-412.
- 13. Sivo S, Mazzone E, Antonaci L, et al. Upper limb module in non-ambulant patients with spinal muscular atrophy: 12 month changes. Neuromuscul Disord. 2015;25(3):212-215.
- 14. Montes J, Glanzman AM, Mazzone ES, et al. Spinal muscular atrophy functional composite score: a functional measure in spinal muscular atrophy. Muscle Nerve. 2015;52(6):942-947.
- 15. Mazzone ES, Mayhew A, Montes J, et al. Revised upper limb module for spinal muscular atrophy: Development of a new module. Muscle Nerve. 2017;55(6):869-874.
- 16. Kichula E, Duong T, Glanzman A, et al. Children’s hospital of Philadelphia infant test of neuromuscular disorders (CHOP INTEND) feasibility for individuals with severe spinal muscular atrophy II. Neurology. 2018;90(15 Suppl):P5.308.
- 17. Berard C, Payan C, Hodgkinson I, et al. A motor function measure for neuromuscular diseases: Construction and validation study. Neuromuscul Disord. 2005;15(7):463-470.
- 18. Vuillerot C, Payan C, Iwaz J, et al. Responsiveness of the motor function measure in patients with spinal muscular atrophy. Arch Phys Med Rehabil. 2013;94(8):1555-1561.
- 19. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil. 1986;67(6):387-389.
- 20. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-148.
- 21. Slayter J, Hodgkinson V, Lounsberry J, et al. A Canadian Adult Spinal Muscular Atrophy Outcome Measures Toolkit: Results of a National Consensus using a Modified Delphi Method. J Neuromuscul Dis. 2021;8(4):579-588.
- 22. Dunaway S, Montes J, Garber CE, et al. Performance of the timed "up & go" test in spinal muscular atrophy. Muscle Nerve. 2014;50(2):273-277.
- 23. Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428-1446.
- 24. Solway S, Brooks D, Lacasse Y, et al. A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest. 2001;119(1):256-270.
- 25. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med. 2002;166(1):111-117.
- 26. Singh SJ, Puhan MA, Andrianopoulos V, et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1447-1478.
- 27. Wang HY, Ju YH, Chen SM, et al. Joint range of motion limitations in children and young adults with spinal muscular atrophy. Arch Phys Med Rehabil. 2004;85(10):1689-1693.
- 28. Salazar R, Montes J, Dunaway Young S, et al. Quantitative evaluation of lower extremity joint contractures in spinal muscular atrophy: Implications for motor function. Pediatr Phys Ther. 2018;30(3):209-215.
- 29. Fujak A, Kopschina C, Gras F, et al. Contractures of the upper extremities in spinal muscular atrophy type II. Descriptive clinical study with retrospective data collection. Ortop Traumatol Rehabil. 2010;12(5):410-419.
- 30. Elsheikh B, Prior T, Zhang X, et al. An analysis of disease severity based on SMN2 copy number in adults with spinal muscular atrophy. Muscle Nerve. 2009;40(4):652-656.
- 31. Elsheikh B, Severyn S, Zhao S, et al. Safety, tolerability, and effect of Nusinersen in non-ambulatory adults with spinal muscular atrophy. Front Neurol. 2021;12:650532.
- 32. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-483.
- 33. Th Kruitwagen-Van Reenen E, Wadman RI, Visser-Meily JMA, et al. Correlates of health related quality of life in adult patients with spinal muscular atrophy. Muscle Nerve. 2016;54(5):850-855.
- 34. Mix L, Winter B, Wurster CD, et al. Quality of life in SMA patients under treatment with Nusinersen. Front Neurol. 2021;12:626787.
- 35. Hodgkinson VL, Oskoui M, Lounsberry J, et al. A National Spinal Muscular Atrophy Registry for Real-World Evidence. Can J Neurol Sci. 2020;47(6):810-815.
- 36. McGraw S, Qian Y, Henne J, et al. A qualitative study of perceptions of meaningful change in spinal muscular atrophy. BMC Neurol. 2017;17:68.
- 37. Qiu ZY. General research on International Classification of Functioning, Disability and Health. Chin J Rehabil Theory Pract. 2003;9(1):2-4.
- 38. Fujak A, Kopschina C, Forst R, et al. Use of orthoses and orthopaedic technical devices in proximal spinal muscular atrophy. Results of survey in 194 SMA patients. Disabil Rehabil Assist Technol. 2011;6(4):305-311.
- 39. Lewelt A, Krosschell KJ, Stoddard GJ, et al. Resistance strength training exercise in children with spinal muscular atrophy. Muscle Nerve. 2015;52(4):559-567.
- 40. Wadman RI, Wijngaarde CA, Stam M, et al. Muscle strength and motor function throughout life in a cross-sectional cohort of 180 patients with spinal muscular atrophy types 1c-4. Eur J Neurol. 2018;25(3):512-518.
- 41. Montes J, Garber CE, Kramer SS, et al. Single-blind, randomized, controlled clinical trial of exercise in ambulatory spinal muscular atrophy: why are the results negative? J Neuromuscul Dis. 2015;2(4):463-470.
- 42. Sansone VA, Racca F, Ottonello G, et al. 1st Italian SMA Family Association Consensus Meeting: Management and recommendations for respiratory involvement in spinal muscular atrophy (SMA) types I-III, Rome, Italy, 30-31 January 2015. Neuromuscul Disord. 2015;25(12):979-989.
- 43. Chinese Medical Doctor Association Pediatric Branch, Pediatric Respiratory Group. Expert consensus on respiratory management of spinal muscular atrophy (2022 edition). Chin J Appl Clin Pediatr. 2022;37(6):401-411.
- 44. Beijing Medical Association Rare Disease Branch, et al. Multidisciplinary management expert consensus on spinal muscular atrophy. Chin Med J. 2019;99(19):1460-1467.
- 45. Trucco F, Ridout D, Scoto M, et al. Respiratory Trajectories in Type 2 and 3 Spinal Muscular Atrophy in the iSMAC Cohort Study. Neurology. 2021;96(4):e587-e599.
- 46. Wijngaarde CA, Veldhoen ES, van Eijk RPA, et al. Natural history of lung function in spinal muscular atrophy. Orphanet J Rare Dis. 2020;15(1):88.
- 47. Veldhoen ES, Wijngaarde CA, Hulzebos EHJ, et al. Natural history of respiratory muscle strength in spinal muscular atrophy: a prospective national cohort study. Orphanet J Rare Dis. 2022;17(1):70.
- 48. Chacko A, Sly PD, Gauld L. Polysomnography findings in pediatric spinal muscular atrophy types 1-3. Sleep Med. 2020;68:124-130.
- 49. Hull J, Aniapravan R, Chan E, et al. British Thoracic Society guideline for respiratory management of children with neuromuscular weakness. Thorax. 2012;67(Suppl 1):i1-i40.
- 50. Bersanini C, Khirani S, Ramirez A, et al. Nocturnal hypoxaemia and hypercapnia in children with neuromuscular disorders. Eur Respir J. 2012;39(5):1206-1212.
- 51. Aboussouan LS. Sleep-disordered Breathing in Neuromuscular Disease. Am J Respir Crit Care Med. 2015;191(9):979-989.
- 52. Berry RB, Chediak A, Brown LK, et al. Best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation (NPPV) in stable chronic alveolar hypoventilation syndromes. J Clin Sleep Med. 2010;6(5):491-509.
- 53. Hermann W, Langner S, Freigang M, et al. Affection of Respiratory Muscles in ALS and SMA. J Clin Med. 2022;11(5):1399.
- 54. Spiesshoefer J, Herkenrath S, Henke C, et al. Evaluation of Respiratory Muscle Strength and Diaphragm Ultrasound: Normative Values, Theoretical Considerations, and Practical Recommendations. Respiration. 2020;99(5):369-381.
- 55. Benditt JO. Respiratory Care of Patients With Neuromuscular Disease. Respir Care. 2019;64(6):679-688.
- 56. Wolfe LF, Benditt JO, Aboussouan L, et al. Optimal NIV Medicare Access Promotion: Patients With Thoracic Restrictive Disorders: A Technical Expert Panel Report From the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society. Chest. 2021;160(5):e399-e408.
- 57. Ward S, Chatwin M, Heather S, et al. Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax. 2005;60(12):1019-1024.
- 58. Chacko A, Sly PD, Ware RS, et al. Effect of nusinersen on respiratory function in paediatric spinal muscular atrophy types 1-3. Thorax. 2022;77(1):40-46.
- 59. Walter MC, Wenninger S, Thiele S, et al. Safety and Treatment Effects of Nusinersen in Longstanding Adult 5q-SMA Type 3 - A Prospective Observational Study. J Neuromuscul Dis. 2019;6(4):453-465.
- 60. Mercuri E, Deconinck N, Mazzone ES, et al. Safety and efficacy of once-daily risdiplam in type 2 and non-ambulant type 3 spinal muscular atrophy (SUNFISH part 2): a phase 3, double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2022;21(1):42-52.
- 61. Wurster CD, Winter B, Wollinsky K, et al. Intrathecal administration of nusinersen in adolescent and adult SMA type 2 and 3 patients. J Neurol. 2019;266(1):183-194.
- 62. Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505.
- 63. Zhang J, Cui XL, Chen S, et al. Ultrasound-guided nusinersen administration for spinal muscular atrophy patients with severe scoliosis: an observational study. Orphanet J Rare Dis. 2021;16(1):274.
- 64. Perlas A, Chaparro LE, Chin KJ. Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia: A Systematic Review and Meta-Analysis. Reg Anesth Pain Med. 2016;41(2):251-260.
- 65. Soh E, Karmakar MK. Assessment of the spine with CT and MRI prior to interspinous/interlaminar spinal procedures: a pictorial review. Br J Radiol. 2013;86(1026):20130066.
- 66. Chu WC, Rasalkar DD, Cheng JC. Asynchronous neuro-osseous growth in adolescent idiopathic scoliosis—MRI-based research. Pediatr Radiol. 2011;41(9):1100-1111.
- 67. Furness G, Reilly MP, Kuchi S. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia. 2002;57(3):277-280.
- 68. Gottlieb M, Holladay D, Peksa GD. Ultrasound-assisted Lumbar Punctures: A Systematic Review and Meta-Analysis. Acad Emerg Med. 2019;26(1):85-96.
- 69. Karmakar MK, Li X, Ho AM, et al. Real-time ultrasound-guided paramedian epidural access: evaluation of a novel in-plane technique. Br J Anaesth. 2009;102(6):845-854.
- 70. Liu Y, Qian W, Ke XJ, et al. Real-time Ultrasound-guided Spinal Anesthesia Using a New Paramedian Transverse Approach. Curr Med Sci. 2018;38(5):910-913.
- 71. Daniels SP, Schweitzer AD, Baidya R, et al. The Lateral C1-C2 Puncture: Indications, Technique, and Potential Complications. AJR Am J Roentgenol. 2019;212(2):431-442.
- 72. Ulbrich EJ, Schraner C, Boesch C, et al. Normative MR cervical spinal canal dimensions. Radiology. 2014;271(1):172-182.
- 73. Li Y, Carandang RA, Ade S, et al. Ultrasound-guided lumbar puncture improves success rate and efficiency in overweight patients. Neurol Clin Pract. 2020;10(4):307-313.
- 74. Coley DB, Shiels EW II, Hogan JM. Diagnostic and interventional ultrasonography in neonatal and infant lumbar puncture. Pediatr Radiol. 2001;31(6):399-402.
- 75. Bogduk N. Clinical Anatomy of Lumbar Spine. 3rd ed. New York: Churchill Livingstone; 1987. p. 63-163.
- 76. Muthusami P, Robinson AJ, Shroff MM. Ultrasound guidance for difficult lumbar puncture in children: pearls and pitfalls. Pediatr Radiol. 2017;47(7):822-830.
- 77. Boon JM, Abrahams PH, Meiring JH, et al. Lumbar puncture: anatomical review of a clinical skill. Clin Anat. 2004;17(7):544-553.
- 78. Shen JH, Wang GL, Wang JK, et al. Anesthetic management of intrathecal nusinersen administration in children with spinal muscular atrophy. J Fujian Med Univ. 2020;44(5):44-48.
- 79. Butson B, Kwa P. Lumbar puncture. Emerg Med Australas. 2014;26(5):500-501.
- 80. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718-729.
- 81. Ma H, Wang GL, Wang JK, et al. Expert consensus on prevention and treatment of complications related to neuraxial block (2017). Chin J Anesthesiol. 2017;37(10):1153-1159.
- 82. Dodd KC, Emsley HCA, Desborough MJR, et al. Periprocedural antithrombotic management for lumbar puncture: Association of British Neurologists clinical guideline. Pract Neurol. 2018;18(6):436-446.
- 83. Shen JX. Diagnosis and treatment of syndromic scoliosis. Chin J Orthop Trauma. 2021;14(5):333-336.
- 84. Rodillo E, Marini ML, Heckmatt JZ, et al. Scoliosis in spinal muscular atrophy: review of 63 cases. J Child Neurol. 1989;4(2):118-123.
- 85. Garg S. Management of scoliosis in patients with Duchenne muscular dystrophy and spinal muscular atrophy: a literature review. J Pediatr Rehabil Med. 2016;9(1):23-29.
- 86. Boulay C, Peltier E, Jouve JL, et al. Functional and surgical treatments in patients with spinal muscular atrophy (SMA). Arch Pediatr. 2020;27(Suppl 1):7S35-7S39.
- 87. Wang Z, Feng E, Jiao Y, et al. Surgical treatment of spinal deformities in spinal muscular atrophy: a single-center experience from China. Eur Spine J. 2022;31(11):3089-3097.
- 88. Islander G. Anesthesia and spinal muscle atrophy. Paediatr Anaesth. 2013;23(9):804-816.
- 89. Förster JG, Schlenzka D, Österman H, et al. Anaesthetic considerations in posterior instrumentation of scoliosis due to spinal muscular atrophy: Case series of 56 operated patients. Acta Anaesthesiol Scand. 2022;66(3):345-353.
- 90. Wijngaarde CA, Brink RC, de Kort FAS, et al. Natural course of scoliosis and lifetime risk of scoliosis surgery in spinal muscular atrophy. Neurology. 2019;93(2):e149-e158.
- 91. Mercuri E, Finkel RS, Muntoni F, et al. Diagnosis and management of spinal muscular atrophy: Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscul Disord. 2018;28(2):103-115.
- 92. Güldner A, Kiss T, Serpa Neto A, et al. Intraoperative mechanical ventilation strategies for obese patients: a systematic review and meta-analysis. Anesthesiology. 2015;123(3):692-713.
- 93. Naylor AJ, Sessler DI, Maheshwari K, et al. Arterial catheters for early detection and treatment of hypotension during major noncardiac surgery: a randomized trial. Anesth Analg. 2020;131(5):1540-1550.
- 94. Teboul JL, Monnet X, Chemla D, et al. Arterial pulse pressure variation with mechanical ventilation. Am J Respir Crit Care Med. 2019;199(1):22-31.
- 95. Okamura M, Saito W, Miyagi M, et al. Incidence of unintentional intraoperative hypothermia in pediatric scoliosis surgery and associated preoperative risk factors. Spine Surg Relat Res. 2020;5(3):154-159.
- 96. Ohrt-Nissen S, Bukhari N, Dragsted C, et al. Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis: a single-center experience of patient blood management in 210 cases. Transfusion. 2017;57(7):1808-1817.
- 97. Sui WY, Ye F, Yang JL. Efficacy of tranexamic acid in reducing allogeneic blood products in adolescent idiopathic scoliosis surgery. BMC Musculoskelet Disord. 2016;17:187.
- 98. Lee CS, Merchant S, Chidambaran V. Postoperative pain management in pediatric spinal fusion surgery for idiopathic scoliosis. Paediatr Drugs. 2020;22(6):575-601.
- 99. Shah SA, Guidry R, Kumar A, et al. Current trends in pediatric spine deformity surgery: multimodal pain management and rapid recovery. Global Spine J. 2020;10(3):346-352.
- 100. Jitpakdee T, Mandee S. Strategies for preventing side effects of systemic opioid in postoperative pediatric patients. Paediatr Anaesth. 2014;24(6):561-568.
- 101. Sheffer BW, Kelly DM, Rhodes LN, et al. Perioperative pain management in pediatric spine surgery. Orthop Clin North Am. 2017;48(4):481-486.
- 102. Phillips DP, Roye DP Jr, Farcy JP, et al. Surgical treatment of scoliosis in a spinal muscular atrophy population. Spine (Phila Pa 1976). 1990;15(9):942-945.
- 103. Fauroux B, Griffon L, Amaddeo A, et al. Respiratory management of children with spinal muscular atrophy (SMA). Arch Pediatr. 2020;27(Suppl 1):7S29-7S34.
- 104. Fujak A, Raab W, Schuh A, et al. Natural course of scoliosis in proximal spinal muscular atrophy type II and IIIa: descriptive clinical study with retrospective data collection of 126 patients. BMC Musculoskelet Disord. 2013;14:283.
- 105. Fujak A, Kopschina C, Forst R, et al. Use of orthoses and orthopaedic technical devices in proximal spinal muscular atrophy. Results of survey in 194 SMA patients. Disabil Rehabil Assist Technol. 2011;6(4):305-311.
- 106. Mesfin A, Sponseller PD, Leet AI. Spinal muscular atrophy: manifestations and management. J Am Acad Orthop Surg. 2012;20(7):393-401.
- 107. Wijngaarde CA, Brink RC, de Kort FAS, et al. Natural course of scoliosis and lifetime risk of scoliosis surgery in spinal muscular atrophy. Neurology. 2019;93(2):e149-e158.
- 108. Khatri IA, Chaudhry US, Seikaly MG, et al. Low bone mineral density in spinal muscular atrophy. J Clin Neuromuscul Dis. 2008;10(1):11-17.
- 109. Wasserman HM, Hornung LN, Stenger PJ, et al. Low bone mineral density and fractures are highly prevalent in pediatric patients with spinal muscular atrophy regardless of disease severity. Neuromuscul Disord. 2017;27(4):331-337.
- 110. Nasomyont N, Hornung LN, Wasserman H. Intravenous bisphosphonate therapy in children with spinal muscular atrophy. Osteoporos Int. 2020;31(5):995-1000.
- 111. McElroy MJ, Shaner AC, Crawford TO, et al. Growing rods for scoliosis in spinal muscular atrophy: structural effects, complications, and hospital stays. Spine (Phila Pa 1976). 2011;36(16):1305-1311.
- 112. Chandran S, McCarthy J, Noonan K, et al. Early treatment of scoliosis with growing rods in children with severe spinal muscular atrophy: a preliminary report. J Pediatr Orthop. 2011;31(4):450-454.
- 113. Swarup I, MacAlpine EM, Mayer OH, et al. Impact of growth friendly interventions on spine and pulmonary outcomes of patients with spinal muscular atrophy. Eur Spine J. 2021;30(3):768-774.
- 114. Lorenz HM, Badwan B, Hecker MM, et al. Magnetically controlled devices parallel to the spine in children with spinal muscular atrophy. JB JS Open Access. 2017;2(3):e0036.
- 115. Sporer SM, Smith BG. Hip dislocation in patients with spinal muscular atrophy. J Pediatr Orthop. 2003;23(1):10-14.
- 116. Zenios M, Sampath J, Cole C, et al. Operative treatment for hip subluxation in spinal muscular atrophy. J Bone Joint Surg Br. 2005;87(11):1541-1544.
- 117. Xu AL, Crawford TO, Sponseller PD. Hip Pain in Patients With Spinal Muscular Atrophy: Prevalence, Intensity, Interference, and Factors Associated With Moderate to Severe Pain. J Pediatr Orthop. 2022;42(5):273-279.
- 118. Thompson CE, Larsen LJ. Recurrent hip dislocation in intermediate spinal atrophy. J Pediatr Orthop. 1990;10(5):638-641.
- 119. Fujak A, Kopschina C, Gras F, et al. Contractures of the lower extremities in spinal muscular atrophy type II. Descriptive clinical study with retrospective data collection. Ortop Traumatol Rehabil. 2011;13(1):27-36.
- 120. Hanna RB, Nahm N, Bent MA, et al. Hip Pain in Nonambulatory Children with Type-I or II Spinal Muscular Atrophy. JB JS Open Access. 2022;7(3):e21.00101.
How to Cite
“Clinical Practice Guideline for Adolescent and Adult Patients With Spinal Muscular Atrophy – Part 2”. Human Brain, vol. 3, no. 3, Mar. 2025, https://doi.org/10.37819/hb.3.2041.
How to Cite
“Clinical Practice Guideline for Adolescent and Adult Patients With Spinal Muscular Atrophy – Part 2”. Human Brain, vol. 3, no. 3, Mar. 2025, https://doi.org/10.37819/hb.3.2041.
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