What is the definition of Spinal Muscular Atrophy?

Spinal muscular atrophy (SMA) is a group of disorders of the motor neurons (motor cells). These disorders are passed down through families (inherited) and can appear at any stage of life. The disorder leads to muscle weakness and atrophy.

What are the alternative names for Spinal Muscular Atrophy?

Werdnig-Hoffmann disease; Kugelberg-Welander disease

What are the causes for Spinal Muscular Atrophy?

SMA is a collection of different motor nerve diseases. Grouped together, it is the second leading cause of hereditary neuromuscular disease, after Duchenne muscular dystrophy.

Most of the time, a person must get the defective gene from both parents to be affected. The most severe form is SMA type I, also called Werdnig-Hoffman disease. Infants with SMA type II have less severe symptoms during early infancy, but they become weaker with time. SMA type III is a less severe form of the disease.

In rare cases, SMA begins in adulthood. This is the mildest form of the disease.

A family history of SMA in an immediate family member (such as brother or sister) is a risk factor for all types of the disorder.

What are the symptoms for Spinal Muscular Atrophy?

Symptoms of SMA are:

  • Infants with SMA type I are born with very little muscle tone, weak muscles, and feeding and breathing problems.
  • With SMA type II, symptoms may not appear until age 6 months to 2 years.
  • Type III SMA is a milder disease that starts in childhood or adolescence and slowly gets worse.
  • Type IV is even milder, with weakness starting in adulthood.

Often, weakness is first felt in the shoulder and leg muscles. Weakness gets worse over time and eventually becomes severe.

Symptoms in an infant:

  • Breathing difficulty with shortness of breath and labored breathing, leading to a lack of oxygen
  • Feeding difficulty (food may go into the windpipe instead of the stomach)
  • Floppy infant (poor muscle tone)
  • Lack of head control
  • Little movement
  • Weakness that gets worse

Symptoms in a child:

  • Frequent, increasingly severe respiratory infections
  • Nasal speech
  • Posture that gets worse

With SMA, the nerves that control feeling (sensory nerves) are not affected. So, a person with the disease can feel things normally.

What are the current treatments for Spinal Muscular Atrophy?

There is no treatment to cure the weakness caused by the disease. Supportive care is important. Breathing complications are common in the more severe forms of SMA. To help with breathing, a device or machine called a ventilator may be needed.

People with SMA also need to be watched for choking. This is because the muscles that control swallowing are weak.

Physical therapy is important to prevent contractions of muscles and tendons and abnormal curvature of the spine (scoliosis). Bracing may be needed. Surgery may be needed to correct skeletal deformities, such as scoliosis.

Two recently approved treatments for SMA areonasemnogene abeparvovec-xioi (Zolgensma) and nusinersen (Spinraza).These medicines are used to treat certain forms of SMA. Talk with your health care provider to see if either of these medicines is right for you or your child.

What is the outlook (prognosis) for Spinal Muscular Atrophy?

Children with SMA type I rarely live longer than 2 to 3 years because of respiratory problems and infections. Survival time with type II is longer, but the disease kills most of those who are affected while they are still children.

Children with type III disease may survive into early adulthood. But, people with all forms of the disease have weakness and debility that gets worse over time. Adults who develop SMA often have a normal life expectancy.

What are the possible complications for Spinal Muscular Atrophy?

Complications that may result from SMA include:

  • Aspiration (food and fluids get into the lungs, causing pneumonia)
  • Contractions of muscles and tendons
  • Heart failure
  • Scoliosis

When should I contact a medical professional for Spinal Muscular Atrophy?

Call your provider if your child:

  • Appears weak
  • Develops any other symptoms of SMA
  • Has difficulty feeding

Breathing difficulty can rapidly become an emergency condition.

How do I prevent Spinal Muscular Atrophy?

Genetic counseling is recommended for people with a family history of SMA who want to have children.

Superficial anterior muscles


Fearon C, Murray B, Mitsumoto H. Disorders of upper and lower motor neurons. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 98.

Haliloglu G. Spinal muscular atrophies. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 630.2.

NIH Genetics Home Reference website. Spinal muscular atrophy. ghr.nlm.nih.gov/condition/spinal-muscular-atrophy. Updated October 15, 2019. Accessed November 5, 2019.

  • Condition: Patients with Spinal Muscular Atrophy (SMA) Undergoing Scoliosis Surgery
  • Journal: BMC musculoskeletal disorders
  • Treatment Used: Hybrid vs. Total Sublaminar Wires
  • Number of Patients: 33
  • Published —
This study compared the surgical outcomes between hybrid constructs involving pedicle screws and sublaminar wire and sublaminar wire alone in the treatment of patients with spinal muscular atrophy (SMA) scoliosis (spinal curvature).
  • Condition: Symptomatic Infantile-Onset Spinal Muscular Atrophy Type 1
  • Journal: The Lancet. Neurology
  • Treatment Used: Onasemnogene Abeparvovec Gene Therapy
  • Number of Patients: 41
  • Published —
This study evaluated the safety and effectiveness of onasemnogene abeparvovec gene replacement therapy in the treatment of infants with spinal muscular atrophy type 1.