Top

Published in:

01-05-2010 | Original Article

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

Authors: Masashi Takaso, Toshiyuki Nakazawa, Takayuki Imura, Masaki Ueno, Wataru Saito, Ryousuke Shintani, Kazuhisa Takahashi, Masashi Yamazaki, Seiji Ohtori, Makihito Okamoto, Takashi Masaki, Hirotsugu Okamoto, Toshiyuki Okutomi, Kazuhiro Ishii, Yasuhiro Ueda

Published in: European Spine Journal | Issue 5/2010

Abstract

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° preoperatively 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.

Allen B Jr, Ferguson R (1982) The Galveston technique for L rod instrumentation of the scoliotic spine. Spine 10:276–284CrossRef

Askin GN, Hallettv R, Hare N, Webb JK (1997) The outcome of scoliosis surgery in the severely handicapped child: an objective and subjective assessment. Spine 22:44–50CrossRefPubMed

Basobas L, Mardjerko S, Hammerberg K, Lubicky J (2003) Selective anterior fusion and instrumentation for the treatment of neuromuscular scoliosis. Spine 28:S245–S248CrossRefPubMed

Bell DF, Moseley CF, Koreska J (1989) Unit rod segmental spinal instrumentation in the management of patients with progressive neuromuscular spinal deformity. Spine 14:1301–1307CrossRefPubMed

Benson ER, Thomson JD, Smith BG, Banta JV (1998) Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis. Spine 23:2308–2317CrossRefPubMed

Bentley G, Haddad F, Bull TM, Seingry D (2001) The treatment of scoliosis in muscular dystrophy using modified Luque and Harrington-Luque instrumentation. J Bone Joint Surg Br 83:22–28CrossRefPubMed

Bridwell KH, Baldus C, Iffrig TM, Lenke LG, Blanke K (1999) Process measures and patient/parent evaluation of surgical management of spinal deformities in patients with progressive flaccid neuromuscular scoliosis (Duchenne’s muscular dystrophy and spinal muscular atrophy). Spine 24:1300–1309CrossRefPubMed

Daher Y, Lonstein J, Winter R, Bradford D (1985) Spinal surgery in spinal muscular atrophy. J Pediatr Orthop 5:391–395PubMed

Dias RC, Miller F, Dabney K, Lipton G, Thomas TT (1996) Surgical correction of spinal deformity using a unit rod in children with cerebral palsy. J Pediatr Orthop 16:734–740PubMed

10.

Frischut B, Krismer M, Stoeckl B (2000) Pelvic tilt in neuromuscular disorders. J Paediatr Orthop B 9:221–228

11.

Furumasu J, Swank SM, Brown JC, Gilgoff I, Warath SL, Zeller JL (1989) Functional activities in spinal muscular atrophy patients after spine fusion. Spine 14:771–775CrossRefPubMed

12.

Gaine WJ, Lim J, Stephenson W, Galasko CBS (2004) Progression of scoliosis after spinal fusion in Duchenne muscular dystrophy. J Bone Joint Surg Br 86:550–555PubMed

13.

Galasko CBS, Delany C, Morris P (1992) Spinal stabilisation in Duchenne muscular dystrophy. J Bone Joint Surg Br 74:210–220PubMed

14.

Granata C, Merlini L, Cervellati S (1996) Long term results of spine surgery in Duchenne muscular dystrophy. Neuromuscul Disord 6:61–68CrossRefPubMed

15.

Gupta MC, Wijesekera S, Sossan A, Martin L, Vogel LC, Boakes JL, Lerman JA, McDonald CM, Betz RR (2007) Reliability of radiographic parameters in neuromuscular scoliosis. Spine 32:691–695CrossRefPubMed

16.

Hahn F, Hauser D, Espinosa N, Blumenthal S, Min K (2008) Scoliosis correction with pedicle screws in Duchenne muscular dystrophy. Euro Spine J 17:255–261CrossRef

17.

Heller KD, Wirtz DC, Siebert CH, Forst R (2001) Spinal stabilization in Duchenne muscular dystrophy: principles of treatment and record of 31 operative treated cases. J Pediatr Orthop B 10:18–24CrossRefPubMed

18.

Hsu JD (1983) The natural history of spinal curve progression in the nonambulatory Duchenne muscular dystrophy patient. Spine 8:771–775CrossRefPubMed

19.

Kennedy JD, Staples AJ, Brook PD, Parsons DW, Sutherland AD, Martin AJ (1995) Effect of spinal surgery on lung function in Duchenne muscular dystrophy. Thorax 50:1173–1178CrossRefPubMed

20.

Lowenstein JE, Hiroko Matsumoto, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis—a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32:448–452CrossRefPubMed

21.

Luk KD, Ho HC, Leong JC (1986) Iliolumbar ligament. J Bone Joint Surg Br 68:197–200PubMed

22.

Marsh A, Edge G, Lehovsky J (2003) Spinal fusion in patients with Duchenne muscular dystrophy and a low forced vital capacity. Euro Spine J 12:507–512CrossRef

23.

McCall RE, Hayes B (2005) Long-term outcome in neuromuscular scoliuosis fused only to lumbar 5. Spine 30:2056–2060CrossRefPubMed

24.

McCord DH, Cunningham BW, Shono Y (1992) Biomechanical analysis of lumbosacral fixation. Spine 17:S235–S243CrossRefPubMed

25.

Miladi LT, Ghanem TB, Draui MM, Zeller RD, Dubousset JF (1997) Iliosacral screw fixation for pelvic obliquity in neuromuscular scoliosis. Spine 22:1722–1729CrossRefPubMed

26.

Modi HN, Suh SW, Song HR, Fernandez HM, Yang JH (2008) Treatment of neuromuscular scoliosis with posterior-only pedicle screw fixation. J Orthop Surg 3:23CrossRef

27.

Mubarak SJ, Morin WD, Leach J (1993) Spinal fusion in Duchenne muscular dystrophy and fusion to the sacro-pelvis? J Paediatr Orthop 13:752–760

28.

Pehrsson K, Larsson S, Oden A (1992) Long term follow-up of patients untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine 17:1091–1096PubMedCrossRef

29.

Rawlins BA, Winter RB, Lonstein JF, Denis F, Kubic PT, Wheeler WB, Ozolins AL (1996) Reconstructive spinal surgery in pediatric patients with major loss in vital capacity. J Pediatr Orthop 16:284–292PubMed

30.

Sengupta DK, Mehdian SH, McConnell JR, Eisenstein SM, Webb JK (2002) Pelvic or lumbar fixation for the surgical management of scoliosis in Duchenne muscular dystrophy. Spine 27:2072–2079CrossRefPubMed

31.

Shapiro F, Specht L (1993) The diagnosis and orthopaedic treatment of inherited muscular diseases of childhood. J Bone Joint Surg Am 75:439–454PubMed

32.

Sink EL, Newton PO, Mubarak SJ, Wenger DR (2003) Maintenance of sagittal plane alignment after surgical correction of spinal deformity in patients with cerebral palsy. Spine 28:1396–1403CrossRefPubMed

33.

Smith A, Koreska J, Mosley CF (1989) Progression of scoliosis in Duchenne muscular dystrophy. J Bone Joint Surg Am 71:1066–1074PubMed

34.

Smucker JD, Miler F (2001) Crankshaft effect after fusion of and Unit Rod instrumentation in children with cerebral palsy. J Pediatr Orthop 21:108–112PubMed

35.

Sticker U, Moser H, Aebi M (1996) Predominantly posterior instrumentation and fusion in neuromuscular and neurogenic scoliosis in children and adolescents. Euro Spine J 5:101–106CrossRef

36.

Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB (1995) Segmental pedicle screw fixation in the treatment of adolescent idiopathic scoliosis. Spine 20:1399–1405PubMed

37.

Sussman MD (1984) Advantage of early spinal stabilization and fusion in patients with Duchenne muscular dystrophy. J Paediatr Orthop 4:532–538

38.

Whitacker C, Burton D, Asher M (2000) Treatment of selected neuromuscular patients with posterior instrumentation and arthrodesis ending with pedicle screw anchorage. Spine 25:2312–2318CrossRef

39.

Wild A, Haak A, Kumar M (2001) Is sacral instrumentation mandatory neuromuscular thoracolumbar scoliosis due to myelomeningocele? Spine 26:E325–E329CrossRefPubMed

Title: Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?
Authors: Masashi Takaso
Toshiyuki Nakazawa
Takayuki Imura
Masaki Ueno
Wataru Saito
Ryousuke Shintani
Kazuhisa Takahashi
Masashi Yamazaki
Seiji Ohtori
Makihito Okamoto
Takashi Masaki
Hirotsugu Okamoto
Toshiyuki Okutomi
Kazuhiro Ishii
Yasuhiro Ueda
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 5/2010
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-010-1347-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2010

Letter to the Editor concerning “Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise” by Raney N et al. (2009) Eur Spine J 18:382–391

3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers

Free-hand thoracic pedicle screws placed by neurosurgery residents: a CT analysis

Idiopathic scoliosis and balance organisation in seated position on a seesaw

A randomised controlled trial on the effectiveness of bracing patients with idiopathic scoliosis: failure to include patients and lessons to be learnt

Expert’s comment concerning Grand Rounds case entitled “Revision of a lumbar disc arthroplasty following late infection” (by Jeffrey M. Spivak and Anthony M. Petrizzo)