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Distal fusion in Duchenne scoliosis: the relevance of preoperative pelvic obliquity. A case series study

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Abstract

Purpose

The aim of this study was to determine clinical and radiographic outcomes for Duchenne Muscular Dystrophy (DMD) patients who underwent posterior spinal fusion from T2/3 to L5 (without pelvic fixation), at this single centre.

Methods

From January 2012 to January 2020, 29 consecutive DMD scoliosis patients underwent posterior spinal fusion using pedicle screws from T2/3 to L5 in a single center with a minimum of 3 years follow-up (FU). Radiologic measurements and chart review were performed.

Results

Twenty nine patients aged 14 ± 1.5 years were included. No patient was lost to FU. All patients had significant correction in Cobb angle, pelvic obliquity (PO) and lumbar lordosis (LL), without loss of correction at last FU. The mean values for preoperative, immediate postoperative and last FU were CA 62o, 15o and 17o, PO: 21o, 8o and 9o; and LL 10o, -41o and -41o respectively. Correction in CA was independent of any variable analysed including implant density, rod diameter, traction, or bone density. Regarding PO, it was inversely related to age and independent of all other variables. Factors associated with postoperative complications were age and respiratory function.

Conclusions

It appears from our results that pelvic fixation might not always be required in DMD scoliosis surgery, when using pedicle screws with lowest instrumented vertebra at L5. However, larger preoperative PO values can be related with residual PO. It seems that probably related to the underlying condition, early surgery may decrease incidence of complications.

Level of evidence

IV.

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Funding

The authors did not received support from any organization for the submitted work.

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Authors and Affiliations

  1. Orthopaedic and Spine Department, Great Ormond Street Hospital, London, WC1N 3JH, UK

    Ruben Alejandro Morales Ciancio, Stewart Tucker, Thomas Ember, Mark Harris, Edel Broomfield & Claudia L. Craven

  2. Division of Neurosurgery, St Michael’s Hospital, University of Toronto, Toronto, Canada

    Martin Julian Gagliardi

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  1. Ruben Alejandro Morales Ciancio
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Contributions

RAMC: made substantial contributions to the conception, design, analysis, and interpretation of data. Made substantial contribution to manuscription major and minor revisions, correction, and edition of final version. Drafted and critically revised the work, approved the final version to be published and agree to be accountable for all aspects of the work. MJG: made substantial contributions to the analysis and interpretation of data. Drafted and revised the work and major and minor revisions’ manuscript, approved the final version to be published and agree to be accountable for all aspects of the work. ST: made substantial contributions to the analysis and interpretation of data. Revised the work and major and minor revision versions, approved the final version to be published and agree to be accountable for all aspects of the work. TE: made substantial contributions to the analysis and interpretation of data. Revised the original work and major and minor revisions’ manuscript, approved the final version to be published and agree to be accountable for all aspects of the work. MH: Made substantial contributions to the analysis and interpretation of data. Revised the original work and major and minor revised version, approved the final version to be published and agree to be accountable for all aspects of the work. EB: made substantial contributions to the design, analysis, and interpretation of data. Made substantial contributions to the manuscript major and minor revisions. Revised the work, approved the final version to be published and agree to be accountable for all aspects of the work. CC: Made substantial contributions to the conception, design, analysis, and interpretation of data. Drafted and critically revised the work and major and minor revisions manuscript, approved the final version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ruben Alejandro Morales Ciancio.

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Conflict interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Great Ormond Street hospital under the number N3323 in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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43390_2023_689_MOESM1_ESM.jpg

Supplementary Online Resource 1 Correlation Matrix demonstrating the Spearman correlation (R value) for key variables. file1 (JPG 790 KB)

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Morales Ciancio, R.A., Gagliardi, M.J., Tucker, S. et al. Distal fusion in Duchenne scoliosis: the relevance of preoperative pelvic obliquity. A case series study. Spine Deform 11, 1261–1270 (2023). https://doi.org/10.1007/s43390-023-00689-8

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