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

Cawley, Derek; Carmody, Olan; Dodds, M; McCormack, Damian

doi:10.1016/j.spinee.2015.06.008

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…There may be a number of patients where it is valid to use a single rod construct in order to minimize surgical morbidity. Cawley et al[ 6 ] reported 41 patients with DMD, where early correction using limited fixation with one rod proximal to the pelvis allowed adequate sitting posture with low peri-operative morbidity. Unilateral rod fixation is also commonly used in growing rod constructs with good reported outcomes[ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our revision rate was 2% (including a distal junctional kyphosis in a Marfan’s syndrome patient). Cawley et al[ 6 ] recorded 7.3% rod breakage when they used the single rod technique in DMD patients. The use of post-operative immobilization (spinal jacket) may have contributed to our reduced instrumentation failure rates.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical testing of single-rod and double-rod segmental hook fixation constructs with hooks at every level except the apex in a long-segment animal model (calf spines) indicated that over 12 vertebral segments the single rod instrumentation allowed more neutral zone rotation than the double rod construct[ 5 ]. There remains interest in using a single rod technique in high-risk patients, such as children with Duchenne muscular dystrophy (DMD), in order to minimize duration and morbidity of surgery[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Single rod instrumentation in patients with scoliosis and co-morbidities: Indications and outcomes

Loughenbury

2018

WJO

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AIMTo present our results on the use of a single rod instrumentation correction technique in a small number of patients with major medical co-morbidities.METHODSThis study was a prospective single surgeon series. Patients were treated with single rod hybrid constructs and had a minimum 2-year follow-up. Indications included complex underlying co-morbidities, conversion of growing rods to definitive fusion, and moderate adolescent idiopathic primarily thoracic scoliosis with severe eczema and low body mass index (BMI).RESULTSWe included 99 consecutive patients. Mean age at surgery was 12.8 years (SD 3.5 years). Mean scoliosis correction was 62% (SD 15%) from 73° (SD 22°) to 28° (SD 15°). Mean surgical time was 153 min (SD 34 min), and blood loss was 530 mL (SD 327 mL); 20% BV (SD 13%). Mean clinical and radiological follow-up was 3.2 years (range: 2-12) post-operatively. Complications included rod failure, which occurred in three of our complex patients with severe syndromic or congenital kyphoscoliosis (3%). Only one of these three patients required revision surgery to address a non-union. Our revision rate was 2% (including a distal junctional kyphosis in a Marfan’s syndrome patient).CONCLUSIONThe single rod technique has achieved satisfactory deformity correction and a low rate of complications in patients with specific indications and severe underlying medical conditions. In these children with significant co-morbidities, where the risks of scoliosis surgery are significantly increased, this technique has achieved low operative time, blood loss, and associated surgical morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Single rod instrumentation in patients with scoliosis and co-morbidities: Indications and outcomes

Loughenbury

2018

WJO

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Radiographic and Clinical Outcomes of Surgical Correction of Poliomyelitis-Related Spinal Deformities: A Comparison Among Three Types of Pelvic Instrumentations

Tseng

et al. 2019

World Neurosurgery

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Neuromuscular scoliosis: how decision making and treatment are different

Chua

Lau

Hui

et al. 2017

Current Orthopaedic Practice

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Neuromuscular scoliosis is caused by a muscle imbalance as the result of an underlying neuropathic or myopathic cause. This review focuses primarily on recent innovations in the treatment of Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA). The increase in life span of patients with DMD has largely been attributed to the use of steroids and noninvasive ventilator support. Steroids also delay the onset and retard the progression of scoliosis in DMD. The management of NMS requires a multidisciplinary approach, with the involvement of the medical and surgical teams as well as the patient and the caregivers. There is little evidence to support the use of bracing, but appropriate seating strategies can benefit certain patients. Surgery in NMS prevents progression of the scoliosis, improves sitting posture, comfort, and quality of life, and facilitates nursing care. The decision for surgery has to be made before the decrease in respiratory function and increase in scoliosis present significant operative and postoperative risk. The ideal instrumentation system should be inexpensive while allowing the scoliosis and pelvic obliquity to be safely and easily corrected with minimal complications. The choice of surgical technique and implants should allow for efficiency in terms of operative time because there is an increased risk of bleeding with prolonged operative time. Postoperative intensive care usually is required.

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

Cited by 3 publications

References 32 publications

Single rod instrumentation in patients with scoliosis and co-morbidities: Indications and outcomes

Single rod instrumentation in patients with scoliosis and co-morbidities: Indications and outcomes

Radiographic and Clinical Outcomes of Surgical Correction of Poliomyelitis-Related Spinal Deformities: A Comparison Among Three Types of Pelvic Instrumentations

Neuromuscular scoliosis: how decision making and treatment are different

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