Pedicle screw-only constructs with lumbar or pelvic fixation for spinal stabilization in patients with Duchenne muscular dystrophy.
METHODS
Retrospective case study.


OBJECTIVE
We present a retrospective clinical study of 36 patients of Duchenne muscular dystrophy (DMD) treated for correction of scoliosis with pedicle screw-only constructs with the objective to analyze our technique, correction and maintenance of spinal and pelvic deformity, spinal fusion, the complications we encountered, and the adequacy of lumbar fixation.


BACKGROUND
Pedicle screw constructs have shown better deformity correction and maintenance as compared with other methods of instrumentation in adolescent idiopathic scoliosis. There are very few reports of pedicle screw-only constructs for DMD patients.


METHODS
Thirty-six patients were followed up for an average period of 37.75 months (min 24 mo). All patients were instrumented from T2, T3, or T4 to L5 and all levels were instrumented. Pelvic fixation was performed only if the pelvic tilt was more than 15 degrees (10 patients).


RESULTS
Cobb angle improved 65% (P<0.001) after surgery from a mean preoperative value of 71 degrees to an average postoperative value of 25.5 degrees. Balanced sitting posture was obtained in all patients. The lumbar lordosis improved significantly (P<0.0001) from an average preoperative value of -21.4 degrees to a mean immediate postoperative value of 23.7 degrees and to 19.5 degrees at final follow-up. In patients where pelvic fixation was performed, pelvic tilt improved 62% (P<0.0001) from an average of 25.8 degrees preoperatively to 9 degrees postoperatively to 11 degrees at final follow-up. In patients where pelvic fixation was not performed, the pelvic obliquity also improved from 10.5 degrees preoperatively to 5.8 degrees postoperatively (41.5% correction) and 8.5 degrees at final follow-up (4.2% correction).


CONCLUSIONS
Pedicle screw-only constructs provide good stability allowing better correction and maintenance of coronal and lumbar deformities, obtaining good sitting balance, and mobilizing patients early after surgery. Longer follow-up is required to adequately comment on the need for pelvic stabilization.
Mehta
Satyen S
SS
Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Seoul 152-703, Korea.
Modi
Hitesh N
HN
Srinivasalu
Santhana
S
Suh
Seung-Woo
SW
Yi
Ju-Won
JW
Cho
Jae-Woo
JW
Song
Hae-Ryong
HR
D000203:Activities of Daily Living; D000293:Adolescent; D001863:Bone Screws / Q000706:statistics & numerical data*; D002648:Child; D006801:Humans; D016268:Internal Fixators / Q000706:statistics & numerical data*; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D020388:Muscular Dystrophy, Duchenne / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D010388:Pelvis / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D004856:Postural Balance / Q000502:physiology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult