Surgical management of severe scoliosis with high-risk pulmonary dysfunction in Duchenne muscular dystrophy.
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.
Takaso
Masashi
M
Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Kitasato1-15-1, Sagamihara City, Kanagawa, Japan. mtakaso@kitasato-u.ac.jp
Nakazawa
Toshiyuki
T
Imura
Takayuki
T
Takahira
Naonobu
N
Itoman
Moritoshi
M
Takahashi
Kazuhisa
K
Yamazaki
Masashi
M
Otori
Seiji
S
Akazawa
Tsutomu
T
Minami
Shohei
S
Kotani
Toshiaki
T