Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

Hahn, Frederik; Hauser, D.; Espinosa, Norman; Blumenthal, Stephan; Min, Kan

doi:10.1007/s00586-007-0558-9

Cited by 50 publications

(49 citation statements)

References 47 publications

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“…Pulmonary complications in the peri/postoperative period in DMD patients have been reported to be frequent [1,16,18,21]. Higher pulmonary complications have been reported when the FVC is <30% [7,8,10,19].…”

Section: Discussionmentioning

confidence: 99%

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Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Takaso

Nakazawa

Imura

et al. 2010

International Orthopaedics (SICOT)

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In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients' and parents' satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. The mean rate of %FVC decline after surgery was 3.6% per year. Most patients and parents believed scoliosis surgery improved their function, sitting balance and quality of life even though patients were at high risk for major complications. Their satisfaction was also high.

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Section: Discussionmentioning

confidence: 99%

“…Pneumonia, respiratory arrest, pneumothorax as well as difficulties in weaning from the respirator have been reported [1,8,16,19,21]. Thus, many surgeons have recommended scoliosis surgery only for patients who have a FVC of at least 35-40% [7,18,21].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Takaso

Nakazawa

Imura

et al. 2010

International Orthopaedics (SICOT)

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“…There are few studies on the use of pedicle-screws-alone fixation for scoliosis in DMD. Hahn et al [16] reported excellent results for the coronal deformity with 77% correction, both initially and long-term, using pedicle-screwalone fixation to the pelvis (not segmental pedicle screw instrumentation). The mean preoperative curve size in that study was 44°.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, pelvic fixation has certain disadvantages, including increased blood loss, longer operative time and technical difficulty [5,10,25,36]. In addition, the sacrum and the pelvis in patients with DMD are often small and osteoporotic [4,16].…”

Section: Discussionmentioning

confidence: 99%

Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

et al. 2010

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Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD) and is recommended to correct pelvic obliquity. The caudal extent of instrumentation and fusion in the surgical treatment of scoliosis in DMD has remained a matter of considerable debate, and there have been few studies on the use of segmental pedicle screw instrumentation for this pathology. From 2004 to 2007, a total of 28 patients with DMD underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. All patients had a curve with the apex at L2 or higher preoperatively. Preoperative coronal curve averaged 74°, with a postoperative mean of 14°, and 17°at the last follow-up. The pelvic obliquity improved from 17°pre-operatively to 6°postoperatively, and 6°at the last follow-up. Good sagittal plane alignment was recreated after surgery and maintained long term. In 23 patients with a preoperative L5 tilt of less than 15°, the pelvic obliquity was effectively corrected to less than 10°and maintained by adequately addressing spinal deformity, while five patients with a preoperative L5 tilt of more than 15°had a postoperative pelvic obliquity of more than 15°. Segmental pedicle screw instrumentation and fusion to L5 was effective and safe in patients with DMD scoliosis with a minimal L5 tilt (\15°) and a curve with the apex at L2 or higher, both initially and long term, obviating the need for fixation to the sacrum/pelvis. Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with DMD scoliosis with stable L5/ S1 articulation as evidenced by a minimal L5 tilt of less than 15°, even though pelvic obliquity was significant. There was no major complication. With rigid segmental pedicle screw instrumentation, the caudal extent of fusion in the treatment of DMD scoliosis should be determined by the degree of L5 tilt. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of DMD scoliosis.

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“…Most authors report this technique for the treatment of neuromuscular scoliosis in pediatric patients without additional sacral fixation. Proximal spinal anchorage is done with sublaminar wires [67,71] or with pedicle screws from the L5 level [32,33,72].…”

Section: Iliac Screwsmentioning

confidence: 99%

Pelvic fixation for neuromuscular scoliosis deformity correction

Dayer¹,

Ouellet

Saran

2012

Curr Rev Musculoskelet Med

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Pelvic fixation is most frequently indicated in the pediatric population for the treatment of neuromuscular scoliosis with significant pelvic obliquity. Neuromuscular scoliosis surgery is associated with a high risk of complications, and this is further increased by extension of fusion to the sacrum. Numerous techniques have been described for pelvic fixation associated with a long spine fusion each with its own set of specific benefits and risks. This article reviews the contemporary surgical techniques of pelvic fixation used to extend a spine fusion to the sacrum and pelvis focusing on the management of neuromuscular scoliosis, including their biomechanical rationale, results, and complications.

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Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

Cited by 50 publications

References 47 publications

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

Pelvic fixation for neuromuscular scoliosis deformity correction

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