title: Surgical treatment of neck hyperextension in duchenne muscular dystrophy by posterior interspinous fusion.
abstract: METHODS
  Seven patients affected by Duchenne muscular dystrophy with neck hyperextension or poor head control in extension have undergone surgery consisting of posterior cervical interspinous fusion.
  
  
  OBJECTIVE
  To report the results of surgical treatment of neck hyperextension executed simultaneously with the correction of the thoracolumbar scoliosis.
  
  
  BACKGROUND
  A severely progressive deformity of the spine in patients affected by DMD can involve also the cervical spine presenting a rigid neck hyperextension or poor head control in extension, forcing the patients to assume awkward compensating postures in order to look straight ahead, worsening significantly their quality of life.
  
  
  METHODS
  The procedure consisted of a posterior approach to the cervical spine, correction of the hyperextension by releasing the fibrotic muscles and ligaments, and stabilization with bone grafts driven into the interspinous spaces, to achieve solid fusion.
  
  
  RESULTS
  No surgical complications were observed, and fusion was achieved in all patients. The mean angle between C2-C7 decreased from an average of 29.8 degrees (7 degrees -56 degrees) before surgery, to an average of 18.5 degrees (6 degrees-30 degrees) at 1 year of follow-up. Range of motion between C1-C2 was preserved.
  
  
  CONCLUSIONS
  Surgical treatment of neck hyperextension in these patients contributes to a better sitting position, to an easier nursing, to a better appearance.
authors.affiliation: Orthopaedic Department, Istituto Ortopedico Rizzoli, Bologna, Italy. giannini@ior.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.forename: Cesare
authors.initials: C
authors.lastname: Faldini
authors.forename: Stavroula
authors.initials: S
authors.lastname: Pagkrati
authors.forename: Gianluca
authors.initials: G
authors.lastname: Grandi
authors.forename: Matteo
authors.initials: M
authors.lastname: Romagnoli
authors.forename: Luciano
authors.initials: L
authors.lastname: Merlini
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000601:surgery; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications*; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011187:Posture; D011859:Radiography; D016059:Range of Motion, Articular; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D012600:Scoliosis / Q000150:complications / Q000209:etiology; D013123:Spinal Fusion / Q000379:methods*; D013131:Spine / Q000503:physiopathology; D016896:Treatment Outcome