Spinal Fusion in Duchenne's Muscular Dystrophy

Brook, P. D.; Kennedy, J. D.; Stern, L. M.; Sutherland, Andrew D.; Foster, B. K.

doi:10.1097/00004694-199605000-00006

Cited by 13 publications

(11 citation statements)

References 27 publications

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“…However, only six patients out of 20 had pelvic obliquity more than 15°. Brook et al [2] achieved 63% correction in pelvic obliquity in 17 DMD patients with Galveston fixation. We achieved 65% correction in group I (pelvic fixation and pelvic obliquity >15°) and 59% correction in group III (without pelvic fixation and pelvic obliquity <15°), which is comparable to previous reports.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pelvic fixation in neuromuscular scoliosis: a retrospective study in 55 patients

Modi

Suh

Song

et al. 2008

International Orthopaedics (SICOT)

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The literature has described different indications for pelvic fixation in neuromuscular scoliosis. We retrospectively evaluated changes in pelvic obliquity for a minimum of two years among three groups: group I (initial pelvic obliquity >15°; with pelvic fixation), group II (initial pelvic obliquity >15°; without pelvic fixation), and group III (initial pelvic obliquity <15°; without pelvic fixation). We used iliac screws for pelvic fixation in group I. There was significant postoperative improvement (p<0.0001) in Cobb's angle and pelvic obliquity. There was no significant loss of correction in Cobb's angle, thoracic kyphosis, and lumbar lordosis among all three groups; however, group II showed significant correction loss in pelvic obliquity compared to groups I and III at final follow-up (p<0.0001). Our results indicate that patients who have pelvic obliquity >15°require pelvic fixation to maintain the correction and balance over time while obliquity <15°does not require pelvic fixation.

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Section: Discussionmentioning

confidence: 99%

Evaluation of pelvic fixation in neuromuscular scoliosis: a retrospective study in 55 patients

Modi

Suh

Song

et al. 2008

International Orthopaedics (SICOT)

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“…The literature regarding the surgical management of spinal deformity in flaccid neuromuscular disorders (SMA and DMD) suggests that bilateral instrumentation and fusion to either L5 or sacrum is the most effective [1,6,8,12,18,29,30,33,34,42,43] and multiple fixation points such as sublaminar wires are preferred. Marchesi et al [26] selected the modified Galveston technique by inserting two diverging iliac rods over the S1 screw, which subsequently secured tightly with sublaminar wires.…”

Section: Discussionmentioning

confidence: 99%

“…Using pedicle screws is an effective method to correct the rotational component of the deformity. Some authors have advocated the use of pelvic fixation for pelvic obliquity, especially in neuromuscular scoliosis [1,6,8]; however, others have warned about the risk of complications with, it such as screw impingement and ulceration, pain and pressure sores, etc. [5,36,37,40].…”

Section: Introductionmentioning

confidence: 99%

Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

et al. 2009

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Literature has described treatment of flaccid neuromuscular scoliosis using different instrumentation; however, only one article has been published using posterior-only pedicle screw fixation. Complications using pedicle screws in paralytic neuromuscular scoliosis has not been described before. To present results and complications with posterior-only pedicle screws, a retrospective study was carried out in 27 consecutive patients with flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy), who were operated between 2002 and 2006 using posterior-only pedicle screw instrumentation. Immediate postoperative and final followup results were compared using t test for Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis. Perioperative and postoperative complications were noted from the hospital records of each patient. Complications, not described in literature, were discussed in detail. Average follow-up was 32.2 months. Preoperative, immediate postoperative and final follow-up Cobb angle were 79.8°, 30.2°(63.3% correction, p \ 0.0001) and 31.9°, respectively; and pelvic obliquity was 18.3°, 8.9°(52% correction, p \ 0.0001) and 8.9°. Postoperative thoracic kyphosis remained unchanged from 27.6°to 19.9°(p = 0.376); while lumbar lordosis improved significantly from ?15.6°t o -22.4°lordosis (p = 0.0002). Most patients had major to moderate improvement in postoperative functional and ambulatory status compared to the preoperative status. Thirteen (48.1%) perioperative complications were noted with five major complications (four respiratory in the form of hemothorax or respiratory failure that required ventilator support and one death) and eight minor complications (three UTI, two atelectasis, two neurological and one ileus). Postoperatively, we noted complications, such as coccygodynia with subluxation in 7, back sore on the convex side in 4 and dislodging of rod distally in 1 patient making a total of 12 (44.4%) postoperative complications. Of 12 postoperative complications, 6 (50%) required secondary procedure. We conclude that although flaccid neuromuscular scoliosis can be well corrected with posterior-only pedicle screw, there is a high rate of associated complications.

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“…There has been considerable debate in the literature over the need for lumbosacral stabilisation. 8,[21][22][23][24][25][26] The protagonists describe better maintenance of pelvic correction and improved sitting. Lumbosacral fusion also allows greater correction of a curve and better control of sagittal alignment.…”

Section: Discussionmentioning

confidence: 99%

The treatment of scoliosis in muscular dystrophy using modified Luque and Harrington-Luque instrumentation

Bentley

Haddad

Bull

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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We have treated 101 patients with scoliosis secondary to muscular dystrophy over a 13-year period; 64 had Duchenne's muscular dystrophy, 33 spinal muscular atrophy and four congenital muscular dystrophy.The patients underwent a modified Luque (87) or Harrington-Luque instrumentation (14) combined with a limited Moe fusion in all except 27 cases. A mean of 13 levels was instrumented. The mean preoperative sitting Cobb angle was 84° (10 to 150) and the mean postoperative angle 40° (52% correction). Most patients (96%) were able to discard their braces and there was a high level of patient satisfaction (89.6%).Less correction was seen for severe curves, and there was a greater recurrence of postoperative pelvic tilt in those patients not instrumented to the sacrum. Although the incidence of minor or temporary complications was high, these occurred chiefly in the early high-risk patients with very severe curves and considerable pre-existing immobility.

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Spinal Fusion in Duchenne's Muscular Dystrophy

Cited by 13 publications

References 27 publications

Evaluation of pelvic fixation in neuromuscular scoliosis: a retrospective study in 55 patients

Evaluation of pelvic fixation in neuromuscular scoliosis: a retrospective study in 55 patients

Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

The treatment of scoliosis in muscular dystrophy using modified Luque and Harrington-Luque instrumentation

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