title: Surgical management of severe scoliosis with high-risk pulmonary dysfunction in Duchenne muscular dystrophy.
abstract: Between 2005 and 2007, 14 patients who had severe scoliosis in Duchenne muscular dystrophy (DMD) and a poor forced vital capacity (FVC) of <30% at admission underwent scoliosis surgery. FVC on admission was 21.6% (range, 16-27%). The patients were given respiratory muscle training using a pulmonary trainer (Threshold IMT, Philips Respironics, Inc.) for six weeks before operation. FVC increased to 26.2% (range, 22-31%) the day before operation. The mean preoperative scoliosis was 98 degrees (range, 81 degrees-130 degrees). All patients underwent posterior fusion and all-screw construction and were extubated on the operative day. No patients developed any respiratory complications. The postoperative scoliosis was 34 degrees (range, 20 degrees-40 degrees) (65%). FVC remained stable at six weeks after operation. FVC decreased to 19.8% (range, 16-25%) and the mean scoliosis was 35 degrees (range, 23 degrees-40 degrees) (64%) at two years after operation. DMD patients with severe scoliosis and FVC considered too low to permit reasonable surgical risk could undergo surgery and could benefit from surgery.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Kitasato1-15-1, Sagamihara City, Kanagawa, Japan. mtakaso@kitasato-u.ac.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Imura
authors.forename: Naonobu
authors.initials: N
authors.lastname: Takahira
authors.forename: Moritoshi
authors.initials: M
authors.lastname: Itoman
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Seiji
authors.initials: S
authors.lastname: Otori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Akazawa
authors.forename: Shohei
authors.initials: S
authors.lastname: Minami
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kotani