Correlation of Scoliosis and Pulmonary Function in Duchenne Muscular Dystrophy

Kurz, Lawrence T.; Mubarak, Scott J.; Schultz, Paul; Park, Sung Min; Leach, Judy

doi:10.1097/01241398-198307000-00014

Cited by 148 publications

(62 citation statements)

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“…There are, nevertheless, a few reports that surgery actually slows down the deterioration of pulmonary function. Kurz et al, 32 in their retrospective and longitudinal study of patients with Duchenne muscular dystrophy, demonstrated a slower rate of decline of FVC% in operated patients, and hence recommended early spinal instrumentation and fusion for these patients. Galasko et al 33 analysed 2 groups of scoliotic patients with Duchenne muscular dystrophy, and found that the FVC deteriorated by 8% in the non-operated group while in the operated group, it remained static for 36 months and thereafter diminished slightly; surgical stabilisation also resulted in an improvement in the FEV 1 , and there was significantly improved survival in patients who had undergone spinal stabilisation.…”

Section: Discussionmentioning

confidence: 99%

Spinal Fusion and Instrumentation for Paediatric Neuromuscular Scoliosis: Retrospective Review

Thacker

Hui

Wong

et al. 2002

J Orthop Surg (Hong Kong)

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the follow-up. There were 2 major complications and 2 minor ones; these were pseudarthrosis with rod breakage requiring revision, deep infection necessitating hardware removal, superficial infection that responded to antibiotics, and urinary tract infection requiring 3 weeks of antibiotic treatment. There were no deaths or any neurological complications after instrumentation. Conclusion. Spinal stabilisation and fusion in children with neuromuscular scoliosis is a safe and effective treatment modality. The effect of surgery on long-term pulmonary function, however, remains controversial and needs to be addressed.

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Section: Discussionmentioning

confidence: 99%

Spinal Fusion and Instrumentation for Paediatric Neuromuscular Scoliosis: Retrospective Review

Thacker

Hui

Wong

et al. 2002

J Orthop Surg (Hong Kong)

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“…Respiratory complications are often cited as the most common complication following spine surgery in patients with neuromuscular scoliosis. 23,25 These patients are predisposed to restrictive lung function because of their severe spinal curvature, 16 while other forms of disease impairment predispose to aspiration and pneumonia. Protocols to combat these risk factors have been studied and are likely reasons for the decrease in associated complications.…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database

Cognetti

Keeny

Samdani

et al. 2017

Neurosurgical Focus

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OBJECTIVEPostoperative complications are one of the most significant concerns in surgeries of the spine, especially in higher-risk cases such as neuromuscular scoliosis. Neuromuscular scoliosis is a classification of multiple diseases affecting the neuromotor system or musculature of patients leading to severe degrees of spinal deformation, disability, and comorbidity, all likely contributing to higher rates of postoperative complications. The objective of this study was to evaluate deformity correction of patients with neuromuscular scoliosis over a 12-year period (2004–2015) by looking at changes in postsurgical complications and management.METHODSThe authors queried the Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database for neuromuscular scoliosis cases from 2004 to 2015. The SRS M&M database is an international database with thousands of self-reported cases by fellowship-trained surgeons. The database has previously been validated, but reorganization in 2008 created less-robust data sets from 2008 to 2011. Consequently, the majority of analysis in this report was performed using cohorts that bookend the 12-year period (2004–2007 and 2012–2015). Of the 312 individual fields recorded per patient, demographic analysis was completed for age, sex, diagnosis, and preoperative curvature. Analysis of complications included infection, bleeding, mortality, respiratory, neurological deficit, and management practices.RESULTSFrom 2004 to 2015, a total of 29,019 cases of neuromuscular scoliosis were reported with 1385 complications, equating to a 6.3% complication rate when excluding the less-robust data from 2008 to 2011. This study shows a 3.5-fold decrease in overall complication rates from 2004 to 2015. A closer look at complications shows a significant decrease in wound infections (superficial and deep), respiratory complications, and implant-associated complications. The overall complication rate decreased by approximately 10% from 2004–2007 to 2012–2015.CONCLUSIONSThis study demonstrates a substantial decrease in complication rates from 2004 to 2015 for patients with neuromuscular scoliosis undergoing spine surgery. Decreases in specific complications, such as surgical site infection, allow us to gauge our progress while observing how trends in management affect outcomes. Further study is needed to validate this report, but these results are encouraging, helping to reinforce efforts toward continual improvement in patient care.

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“…This improves the sitting ability and the quality of life [22,28,42]. The pulmonary function deteriorates progressively in the patients with DMD [17,25]. Whether the spinal stabilisation reduces the rate of deterioration in lung function is a subject of controversy [24,30,36].…”

Section: Introductionmentioning

confidence: 99%

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

et al. 2007

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This report describes the spinal fixation with pedicle-screw-alone constructs for the posterior correction of scoliosis in patients suffering from Duchene muscular dystrophy (DMD). Twenty consecutive patients were prospectively followed up for an average of 5.2 years (min 2 years). All patients were instrumented from T3/T4 to the pelvis. Pelvic fixation was done with iliac screws similar to Galveston technique. The combination of L5 pedicle screws and iliac screws provided a stable caudal foundation. An average of 16 pedicle screws was used per patient. The mean total blood loss was 3.7 l, stay at the intensive care unit was 77 h and hospital stay was 19 days. Rigid stabilisation allowed immediate mobilisation of the patient in the wheel chair. Cobb angle improved 77% from 44°to 10°, pelvic tilt improved 65% from 14°to 3°. Lumbar lordosis improved significantly from 20°to 49°, thoracic kyphosis remained unchanged. No problems related to iliac fixation, no pseudarthrosis or implant failures were observed. The average percentage of predicted forced vital capacity (%FVC) of the patients was 55% (22-94%) preoperatively and decreased to 44% at the last follow-up. There were no pulmonary complications. One patient with a known cardiomyopathy died intraoperatively due to a sudden cardiac arrest. The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complications.

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Correlation of Scoliosis and Pulmonary Function in Duchenne Muscular Dystrophy

Cited by 148 publications

References 0 publications

Spinal Fusion and Instrumentation for Paediatric Neuromuscular Scoliosis: Retrospective Review

Spinal Fusion and Instrumentation for Paediatric Neuromuscular Scoliosis: Retrospective Review

Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

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