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


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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  1. 1.

    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 22:44–50

    Article  CAS  PubMed  Google Scholar 

  2. 2.

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

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Bonnett C, Brown JC, Perry J, Nickel VL, Walinski T, Brooks L, Hoffer M, Stiles C, Brooks R (1975) Evolution of treatment of paralytic scoliosis at Ranchos Los Amigos Hospital. J Bone Joint Surg Am 57:206–215

    CAS  PubMed  Google Scholar 

  4. 4.

    Braun N, Narinder SA, Rochester DF (1983) Respiratory muscles and pulmonary function in polyositis and other proximal myopathies. Thorax 38:616–623

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Bridwell KH, Baldus C, Iffrig TM (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 24:1300–1309

    Article  CAS  PubMed  Google Scholar 

  6. 6.

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

    CAS  PubMed  Google Scholar 

  7. 7.

    Gill I, Eagle M, Mehta JS, Gibson MJ (2006) Correction of neuromuscular scoliosis in patients with preexisting respiratory failure. Spine 31:2478–2483

    Article  PubMed  Google Scholar 

  8. 8.

    Hahn F, Hauser D, Espinosa N, Blumenthal S, Min K (2005) Scoliosis correction with pedicle screws in Duchnne muscular dystrophy. Euro Spine J 17:255–261

    Article  Google Scholar 

  9. 9.

    Koessler W, Wanke T, Winkler G, Nader A, Toifl K, Kurz H, Zwick H (2001) 2 years’ experience with inspiratory muscle training in patients with neuromuscular disorders. Chest 120:765–769

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Kurz LT, Mubarak SJ, Schultz P, Park SM (1983) Leach J (1983) Correlation of scoliosis and pulmonary function in Duchenne muscular dystrophy. J Pediatr Orthop 3:347–355

    CAS  PubMed  Google Scholar 

  11. 11.

    Leith DE, Bradley M (1976) Ventilatory muscle strength and endurance training. J Appl Physiol 41:508–516

    CAS  PubMed  Google Scholar 

  12. 12.

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

    Article  CAS  Google Scholar 

  13. 13.

    Mercado E, Alman B, Wright G (2007) Does spinal fusion influence quality of life in neuromuscular scoliosis? Spine 19S:120–125

    Article  Google Scholar 

  14. 14.

    Miller RG, Chalmers AC, Dao H, Filler-Katz A (1991) The effects of spine fusion on respiratory function in Duchenne muscular dystrophy. Neurology 41:38–45

    CAS  PubMed  Google Scholar 

  15. 15.

    Oda T, Shimizu N, Yonenobu K, Ono K, Nabeshima T, Kyoh S (1983) Longitudinal study of spinal deformity in Duchenne muscular dystrophy. J Pediatr Orthop 13:478–488

    Google Scholar 

  16. 16.

    Padman R, McNamara R (1990) Postoperative pulmonary complications in children neuromuscular scoliosis who underwent posterior spinal fusion. Del Med J 62:999–1003

    CAS  PubMed  Google Scholar 

  17. 17.

    Rawlins BA, Winter RB, Lonstein JF (1990) Reconstructive spinal surgery in pediatric patients with major loss in vital capacity. J Pediatr Orthop 16:284–292

    Google Scholar 

  18. 18.

    Sakai DN, Hsu JD, Bonnett DA, Bonnett DA, Brown CJ (1997) Stabilizationnof the collapsing spine in Duchenne muscular dystrophy. Clin Orthop 128:256–260

    Google Scholar 

  19. 19.

    Shapiro F, Specht L (1983) The diagnosis and orthopaedic treatment of inherited muscular diseases of childhood. J Bone Joint Surg Am 75:439–445

    Google Scholar 

  20. 20.

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

    Article  Google Scholar 

  21. 21.

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

    CAS  PubMed  Google Scholar 

  22. 22.

    Swank SM, Brown JC, Perry RE (1982) Spinal fusion in Duchenne’s muscular dystrophy. Spine 7:484–491

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Takaso M, Nakazawa T, Imura T, Takahira N, Itoman M, Takahashi K, Yamazaki M, Otori S, Akazawa T, Minami S, Kotani T (2009) Surgical management of severe scoliosis with high-risk pulmonary dysfunction in Duchenne muscular dystrophy. International Orthop. doi:10.1007/s0026400907647

    Google Scholar 

  24. 24.

    Velasco MV, Colin AA, Zurakowski D, Darras BT, Shapiro F (2007) Posterior spinal fusion for scoliosis in Duchenne muscular dystrophy diminishes the rate of respiratory decline. Spine 32:459–465

    Article  PubMed  Google Scholar 

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Correspondence to Masashi Takaso.

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Takaso, M., Nakazawa, T., Imura, T. et al. Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction. International Orthopaedics (SICOT) 34, 695–702 (2010).

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  • Pulmonary Function
  • Force Vital Capacity
  • Duchenne Muscular Dystrophy
  • Spinal Muscular Atrophy
  • Spinal Deformity