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No difference in postoperative complication rates or cardiopulmonary function for early versus late scoliosis correction in Duchenne muscular dystrophy

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Abstract

Background

Given reduced rates of both pulmonary function decline and scoliosis progression with steroid treatment in Duchenne muscular dystrophy (DMD), the role of early scoliosis surgery has been questioned. The purpose of this study was to compare the postoperative complication rates of early versus late scoliosis correction in DMD.

Methods

This study was a retrospective cohort, conducted at an academic tertiary level children’s hospital. Patients with DMD who underwent posterior scoliosis correction, with preoperative pulmonary function testing [forced vital capacity (FVC)] were included and divided into two groups by preoperative curve angles: ≤ 45° and > 45°. The primary outcome variable was postoperative complications by Clavien–Dindo classification grading. Secondary outcome variables included postoperative complications occurring after the first 90 days, age at surgery, duration of wheelchair dependency preoperatively, pulmonary function, steroid utilization, shortening fraction by echocardiogram, surgery duration, intensive care unit/hospital length of stay, days intubated, infection, and percent curve correction. Two-tailed t-test and Chi-square testing were used for analysis of patient factors and Clavien–Dindo complication grade, respectively.

Results

Thirty-one patients were included with a total follow-up of 8.3 ± 3.2 years, 4.8 ± 2.2 years post-spinal fusion. Steroid treatment (prednisone, deflazacort) was utilized for 21 (67.7%) patients. Primary curve correction was not different between groups (65.0% vs 71.4% [p = 0.37]). There were no significant differences in Clavien–Dindo classification grades between groups (p > 0.05). For the entire cohort, the overall complication rate was higher for patients with steroid treatment (61.9% vs 10.0% [p = 0.008]). Neither forced vital capacity nor fractional shortening on echocardiogram was different between groups at final follow-up (p = 0.6 and p = 0.4, respectively).

Conclusion

The comparable risk of perioperative complications for early and late scoliosis correction supports a “watchful waiting” approach, whereby curves less than 45° can be carefully followed while cardiopulmonary function is maintained. Patients undergoing steroid treatment should be counseled regarding the higher risk of postoperative blood transfusion and deep wound infection.

Level of evidence

III Retrospective cohort.

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Availability of data and materials

Data are available upon reasonable request.

Code availability

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics, Nemours Children’s Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Ali Asma, Armagan Can Ulusaloglu, Michael Wade Shrader, William G. Mackenzie & Jason J. Howard

  2. Division of Pulmonology, Nemours Children’s Hospital, Delaware, Wilmington, USA

    Robert Heinle

  3. Division of Neurology, Nemours Children’s Hospital, Delaware, Wilmington, USA

    Mena Scavina

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  1. Ali Asma
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Contributions

AA and JJH: conception or design of the work. AA, ACU, MWS, WGM, RH, MS, and JJH: acquisition, analysis, or interpretation of data for the work. AA, JJH: drafting the work. AA, ACU, MWS, WGM, RH, MS, and JJH: revising the work critically for important intellectual content. AA, ACU, MWS, WGM, RH, MS, and JJH: final approval of the version to be published. AA, ACU, MWS, WGM, RH, MS, and JJH: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jason J. Howard.

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Conflict of interest

The authors AA, ACU, MWS, WGM, RH, MS, and JJH have no relevant financial or non-financial interests to disclose.

Ethical approval

Approval was obtained from the Nemours Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Ethics approval was provided by our institution’s Office of Human Subjects Protection (IRB# 1770221–1).

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Asma, A., Ulusaloglu, A.C., Shrader, M.W. et al. No difference in postoperative complication rates or cardiopulmonary function for early versus late scoliosis correction in Duchenne muscular dystrophy. Spine Deform 10, 1429–1436 (2022). https://doi.org/10.1007/s43390-022-00532-6

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