The effect of posterior spinal fusion on respiratory function in Duchenne muscular dystrophy

Abstract

Severity of scoliosis was not a key determinant of respiratory dysfunction. Posterior spinal fusion did not reduce the rate of respiratory function decline. These two points suggest that intrinsic respiratory muscle weakness is the main determinant of decline in respiratory function in DMD.

Functional Outcomes in Duchenne Muscular Dystrophy Scoliosis

“…Although most studies did not mention the detailed radiography data, the mean Cobb angle in the surgical group at the initial consultation in our study (65.5°± 18.7°) was similar to that in other studies (56.4°± 20.7°reported by Alexander et al 6 and >50°, by Kinali et al 4 ); however, the mean Cobb angle in the nonsurgical group in the present study (56.9°± 14.6°) was more severe than that in other studies (34.9°± 26.5°reported by Alexander et al 6 and approximately 50°, by Kinali et al 4 ).…”

“…Velasco et al 8 reported that the average rate of decline in forced vital capacity was 4% per year preoperatively, which was reduced to 1.75% per year after surgery. However, other studies 4,6 have not demonstrated any obvious benefits of surgery in terms of respiratory function. The study by Alexander et al 6 had some limitations including the fact that the follow-up period was only one year and the preoperative mean forced vital capacity was significantly lower in the surgical group (36.2%) than in the nonsurgical group (54.3%).…”

“…Because none of those studies were randomized, the heterogeneity of the control group is very important. Galasko et al 7 and Eagle et al 19 only mentioned that there was no difference between the two groups, and Kinali et al 4 and Alexander et al 6 reported only the same age for both groups. Furthermore, the follow-up period in the study by Alexander et al was only one year, and Kinali et al used a very small number of control patients (eleven).…”

“…Nevertheless, the effects of spinal surgery on respiratory function are still controversial. Some studies have noted that spinal arthrodesis had no effects on the natural deterioration of respiratory function associated with Duchenne muscular dystrophy scoliosis [4][5][6] . However, Galasko et al 7 found that, on average, forced vital capacity decreased Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work.…”

“…In addition, the concerns of patients, their relatives, and surgeons often differ. Generally, patients are more concerned with how surgery will help them walk, sit, and perform daily tasks in both the short and long term, a need which most functional outcome measurement tools fail to evaluate [4][5][6][7][8][9][10] . Thus, there is much to be investigated in terms of patient functionality after surgery 1,13 .…”