Reconstructive Spine Surgery in Pediatric Patients with Major Loss in Vital Capacity

Rawlins, Bernard A.; Winter, Robert B.; Lonstein, John E.; Denis, Francis; Kubic, Paul T.; Wheeler, William Bruce; Ozolins, Andrew L.

doi:10.1097/01241398-199605000-00002

Cited by 55 publications

(28 citation statements)

References 15 publications

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“…This study shows that our patients have been managed successfully with no major complication. Although many studies have reported that the role of scoliosis surgery in patients with DMD is to prevent or retard deterioration of function and sitting balance rather than to improve it because DMD is a progressively deteriorating myopathic disorder [1,[15][16][17][18][19][20][21][22], this study also shows most parents/patients believed that high risk scoliosis surgery improved their function, sitting balance and QOL. The authors were surprised with the strongly positive perceptions of most of the patients/parents with DMD scoliosis and high risk pulmonary dysfunction.…”

Section: Discussionmentioning

confidence: 78%

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Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Takaso

Nakazawa

Imura

et al. 2010

International Orthopaedics (SICOT)

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In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients' and parents' satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. The mean rate of %FVC decline after surgery was 3.6% per year. Most patients and parents believed scoliosis surgery improved their function, sitting balance and quality of life even though patients were at high risk for major complications. Their satisfaction was also high.

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Section: Discussionmentioning

confidence: 78%

“…The majority of studies have reported only data on changes in scoliotic curvature and complications. Irreversible changes in cardiac and pulmonary function pose serious risks to anaesthesia and have been relative contraindications to surgery [7,17,18,20,22,23].…”

Section: Introductionmentioning

confidence: 99%

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Takaso

Nakazawa

Imura

et al. 2010

International Orthopaedics (SICOT)

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“…Spinal deformity is almost universal and progressive in patients with DMD [7,11,19,29,33]. The posterior spinal fusion for neuromuscular scoliosis has been highly effective in stabilizing the spine and maintaining an upright and comfortable sitting balance [5,9,13].…”

Section: Discussionmentioning

confidence: 99%

“…Duchenne muscular dystrophy (DMD) is the most common and severe form of muscular dystrophy and is a flaccid neuromuscular disorder in which gradual deterioration is the hallmark [7,11,19,22,27,29,33]. Spinal deformity such as scoliosis is almost universal in patients with DMD [7,11,19,22,27].…”

Section: Introductionmentioning

confidence: 99%

Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

et al. 2010

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Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD) and is recommended to correct pelvic obliquity. The caudal extent of instrumentation and fusion in the surgical treatment of scoliosis in DMD has remained a matter of considerable debate, and there have been few studies on the use of segmental pedicle screw instrumentation for this pathology. From 2004 to 2007, a total of 28 patients with DMD underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. All patients had a curve with the apex at L2 or higher preoperatively. Preoperative coronal curve averaged 74°, with a postoperative mean of 14°, and 17°at the last follow-up. The pelvic obliquity improved from 17°pre-operatively to 6°postoperatively, and 6°at the last follow-up. Good sagittal plane alignment was recreated after surgery and maintained long term. In 23 patients with a preoperative L5 tilt of less than 15°, the pelvic obliquity was effectively corrected to less than 10°and maintained by adequately addressing spinal deformity, while five patients with a preoperative L5 tilt of more than 15°had a postoperative pelvic obliquity of more than 15°. Segmental pedicle screw instrumentation and fusion to L5 was effective and safe in patients with DMD scoliosis with a minimal L5 tilt (\15°) and a curve with the apex at L2 or higher, both initially and long term, obviating the need for fixation to the sacrum/pelvis. Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with DMD scoliosis with stable L5/ S1 articulation as evidenced by a minimal L5 tilt of less than 15°, even though pelvic obliquity was significant. There was no major complication. With rigid segmental pedicle screw instrumentation, the caudal extent of fusion in the treatment of DMD scoliosis should be determined by the degree of L5 tilt. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of DMD scoliosis.

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“…Die frühe Extubation mit einer adäquaten Schmerzbehandlung, die nicht die Kooperation des Patienten erfordert, und eine rasche Rückverle-gung auf die Normalabteilung sind gerade bei schwer behinderten Kindern äu-ßerst erstrebenswert. Diese Kinder haben in der Regel geringe respiratorische Reserven [17,22]. Sie reagieren sehr empfindlich auf die Gabe systemischer Opioide, sind häufig nicht kooperationsfähig und kön-nen ihre Schmerzen nur in beschränktem Maß ausdrücken [15,19].…”

Section: Hintergrund Und Fragestellungunclassified

Intrathecal opioid medication for perioperative analgesia in severely handicapped children undergoing spinal operations

et al. 2010

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Reconstructive Spine Surgery in Pediatric Patients with Major Loss in Vital Capacity

Cited by 55 publications

References 15 publications

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

Intrathecal opioid medication for perioperative analgesia in severely handicapped children undergoing spinal operations

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