Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques

Abstract

Study DesignA retrospective matched cohort study.PurposeTo compare the results of combined Luque rod-sublaminar wiring (thoracic) and pedicle (lower lumbar) instrumentation (SLW) versus those with pedicle screw fixation (PS) for scoliosis correction in Duchenne muscular dystrophy (DMD).Overview of LiteraturePS fixation is gaining popularity. Two instrumentation systems were not compared before in a matched cohort of patients.MethodsTwo groups of patients with DMD were matched according to the age at surgery, magnitude of deformity and vital capacity. Indications for surgery included loss of sitting balance, rapid decline of vital capacity and curve progression. In group 1 (22 patients) SLW fixation was used from T2/3 to pelvis or sacrum. In group 2 (18 patients) PS fixation was used from T2/3 to L5. Five patients had all level segmental PS fixations. Minimum follow-up was 2 years (range, 2 to 13 years). Radiographs, lung function tests and subjective/objective assessment were performed at standardized intervals.ResultsMean Cobb angle in group 1 improved from 45.3° (range, 26 to 75°) to 17.7°(range, 0 to 37°) and mean pelvic obliquity improved from 14.5° (range, 8 to 28°) to 5.6° (range, 0 to 15°). Mean Cobb angle in group 2 improved from 42.8° (range, 28 to 80°) to 7.3° (range, 0 to 20°) and mean pelvic obliquity improved from 11.2° (range, 7 to 30°) to 2.0° (range, 0 to 5°) (p < 0.05). Mean operating time and blood loss were less in group 2 (p < 0.05). In group 1, the infection rate and instrumentation failure was higher, and subjective/objective outcomes showed no significant difference between the groups.ConclusionsPS fixation had superior correction and controlled pelvic obliquity without the need for pelvic fixation.

Early limited instrumentation of scoliosis in Duchenne muscular dystrophy: is a single-rod construct sufficient?

“…of fixation in this series compares similarly or favorably with other series 18[5,12,15,18]. All other published series detail dual rod techniques involving 19 sublaminar wiring only, pedicle screws only or a hybrid construct.…”

“…An overall correction to mean of 15.6° signifies that 5 stabilization takes precedence over deformity correction. There was no peri-operative 6 mortality or neurological injury and surgical morbidity, including length of stay, ICU 7 length of stay, intra-operative blood loss and operating time were reduced when 8 compared to other series [5,12,13,14,15]. 9…”

“…operative Cobb angle of 24°, indicates that the decision to operate was taken at a time 4 earlier than other series [6,7,12]. An overall correction to mean of 15.6° signifies that 5 stabilization takes precedence over deformity correction.…”

Determination of the Distal Fusion Level in the Management of Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis Using Pedicle Screw Instrumentation

“…In this method, the LIV was the stable vertebra. In spite of achieving considerable coronal plane correction, it caused flattening of the sagittal contour with long segment fusion and distal adjacent segment degeneration [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ].…”

Accuracy of Free Hand Pedicle Screw Installation in the Thoracic and Lumbar Spine by a Young Surgeon: An Analysis of the First Consecutive 306 Screws Using Computed Tomography

“…Pedicle screws have been commonly used in posterior spinal surgeries since 1959 [ 1 ]. Because pedicle screws can stabilize all three columns of the spine, they are the most popular posterior spinal segmental fixation system, even in the deformed spine [ 2 ]. On the other hand, pedicle screw malposition has the potential risk for permanent neurological deficits.…”