title: Functional outcomes in Duchenne muscular dystrophy scoliosis: comparison of the differences between surgical and nonsurgical treatment.
abstract: BACKGROUND
  While most studies of Duchenne muscular dystrophy scoliosis focus on technical and radiographic indices, functional status is a more important factor to consider in the management of Duchenne muscular dystrophy. The objectives of the current study were to compare the pulmonary function, radiographic outcome, and functional recovery, with use of validated questionnaires, in surgically and nonsurgically treated patients with Duchenne muscular dystrophy who have scoliosis.
  
  
  METHODS
  Sixty-six patients (forty treated surgically and twenty-six treated nonsurgically) with a minimum follow-up of two years were included in this study. Forced vital capacity, radiographic parameters (the Cobb angle, lordosis, and pelvic obliquity), and functional status, according to the modified Rancho scale and manual muscle test, were measured preoperatively and at the time of the final follow-up. The Muscular Dystrophy Spine Questionnaire (MDSQ) was completed at the final follow-up evaluation.
  
  
  RESULTS
  Pulmonary function, functional scores (manual muscle test and modified Rancho scale), and radiographic measurements, except for lordosis, were similar for both groups at the time of the initial consultation (p > 0.05). At the time of the final follow-up, all radiographic parameters were significantly improved in the surgical group compared with the nonsurgical group. The mean score (and standard deviation) on the manual muscle test was not significantly different between the surgical and nonsurgical groups (23.2 ± 8.3 versus 22.8 ± 6.3; p = 0.828). The mean score on the modified Rancho scale also showed similar results in the groups (3.9 ± 0.3 and 4.04 ± 0.3, respectively; p = 0.088). The surgical group had higher mean MDSQ scores than the nonsurgical group (35.1 ± 14.7 and 26.9 ± 9.9, respectively; p = 0.008). Both groups showed a decrease in forced vital capacity at the time of the final follow-up, but the deterioration of forced vital capacity was significantly slower (p = 0.035) in the surgical group (268 ± 361 mL) than in the nonsurgical group (536 ± 323 mL).
  
  
  CONCLUSIONS
  Surgery in patients who had Duchenne muscular dystrophy with scoliosis improved function and decreased the rate of deterioration of forced vital capacity compared with patients treated conservatively. However, the muscle power and forced vital capacity decreased in both groups.
authors.affiliation: Department of Orthopaedic Surgery, Kyung-Hee University College of Medicine, Dongdamun-ku, Seoul, Republic of Korea. E-mail address for K.S. Suk: Sks111@khmc.or.kr.
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Suk
authors.affiliation: Department of Orthopaedic Surgery, Gangnam Severance Hospital (B.H.L., HM.L., S.H.M., K.M.S., and H.S.K.), and Department of Neurology, Brain Korea 21 Project for Medical Science (Y.C.C.), Yonsei University College of Medicine, Unjuro 211, Gangnam-Gu, Seo.
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Gangnam Severance Hospital (B.H.L., HM.L., S.H.M., K.M.S., and H.S.K.), and Department of Neurology, Brain Korea 21 Project for Medical Science (Y.C.C.), Yonsei University College of Medicine, Unjuro 211, Gangnam-Gu, Seo.
authors.forename: Hwan Mo
authors.initials: HM
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Gangnam Severance Hospital (B.H.L., HM.L., S.H.M., K.M.S., and H.S.K.), and Department of Neurology, Brain Korea 21 Project for Medical Science (Y.C.C.), Yonsei University College of Medicine, Unjuro 211, Gangnam-Gu, Seo.
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Moon
authors.affiliation: Department of Orthopaedic Surgery, Gangnam Severance Hospital (B.H.L., HM.L., S.H.M., K.M.S., and H.S.K.), and Department of Neurology, Brain Korea 21 Project for Medical Science (Y.C.C.), Yonsei University College of Medicine, Unjuro 211, Gangnam-Gu, Seo.
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Choi
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Yatap-ro 59,Seongnam 463-070, Republic of Korea. E-mail address for D.E. Shin: shinde@cha.ac.kr.
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Shin
authors.affiliation: Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital, Koyang 410-719, Republic of Korea. E-mail address for J.W. Ha: jwha@nhimc.or.kr.
authors.forename: Jung Won
authors.initials: JW
authors.lastname: Ha
authors.affiliation: Department of Orthopaedic Surgery, Gangnam Severance Hospital (B.H.L., HM.L., S.H.M., K.M.S., and H.S.K.), and Department of Neurology, Brain Korea 21 Project for Medical Science (Y.C.C.), Yonsei University College of Medicine, Unjuro 211, Gangnam-Gu, Seo.
authors.forename: Kwang Min
authors.initials: KM
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, Gangnam Severance Hospital (B.H.L., HM.L., S.H.M., K.M.S., and H.S.K.), and Department of Neurology, Brain Korea 21 Project for Medical Science (Y.C.C.), Yonsei University College of Medicine, Unjuro 211, Gangnam-Gu, Seo.
authors.forename: Hak Sun
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications* / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D012129:Respiratory Function Tests; D012600:Scoliosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult