Spinal fusion in patients with Duchenne's muscular dystrophy and a low forced vital capacity.
Traditionally, spinal fusion has been denied to patients with scoliosis secondary to Duchenne's muscular dystrophy (DMD) when their forced vital capacity (FVC) is less than 30-40% of predicted values (PFVC). The reasons for this decision are a theoretically increased risk of adverse events from a prolonged anaesthetic and extensive surgery. This paper presents a retrospective analysis of 30 patients with DMD scoliosis who underwent posterior spinal fusion at the Royal National Orthopaedic Hospital. Two subgroups of patients were compared: those with more than 30% PFVC (17 patients) and those with less than 30% PVFC (13 patients). One patient in each group required a temporary tracheotomy and there were nine complications in total. The post-operative stay for patients in each group was similar (24 days in the >30% group, 20 days in the <30% group) and the complication rate was comparable with other published series. We conclude that spinal fusion can be offered to patients with DMD even in the presence of a low FVC.
Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK. Alastairmarsh@doctors.org.uk
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Marsh
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Edge
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Lehovsky
D000293:Adolescent; D000328:Adult; D018681:Anesthetics, General / Q000009:adverse effects; D002648:Child; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology
D018681:Anesthetics, General