title: Surgery for scoliosis in Duchenne muscular dystrophy.
abstract: BACKGROUND
  Scoliosis in patients with Duchenne muscular dystrophy (DMD) is usually progressive and is treated with surgery. However, it is unclear whether the existing evidence is sufficiently scientifically rigorous to support a recommendation for spinal surgery for most patients with DMD and scoliosis. This is an updated review, and an updated search was undertaken in which no new studies were found for inclusion.
  
  
  OBJECTIVE
  To determine the effectiveness and safety of spinal surgery in patients with DMD with scoliosis. We intended to test whether spinal surgery is effective in increasing survival and improving respiratory function, quality of life, and overall functioning, and whether spinal surgery is associated with severe adverse effects.
  
  
  METHODS
  On 16 June 2015 we searched the Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL Plus. We also searched ProQuest Dissertation and Thesis database (January 1980 to June 2015), the National Institutes of Health Clinical Trials Database (6 January 2015), and the WHO International Clinical Trials Registry Platform (17 June 2015), and checked references. We imposed no language restrictions.
  
  
  METHODS
  We planned to include controlled clinical trials using random or quasi-random allocation of treatment evaluating all forms of spinal surgery for scoliosis in patients with DMD in the review. The control interventions would have been no treatment, non-operative treatment, or a different form of spinal surgery.
  
  
  METHODS
  We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors independently examined the search results and evaluated the study characteristics against inclusion criteria in order to decide which studies to include in the review.
  
  
  RESULTS
  Of the 49 relevant studies we found, none met the inclusion criteria for the review because they were not clinical trials, but prospective or retrospective reviews of case series.
  
  
  CONCLUSIONS
  Since no randomized controlled clinical trials were available to evaluate the effectiveness of scoliosis surgery in patients with DMD, we can make no good evidence-based conclusion to guide clinical practice. Patients with scoliosis should be informed as to the uncertainty of benefits and potential risks of surgery for scoliosis. Randomized controlled trials are needed to investigate the effectiveness of scoliosis surgery, in terms of quality of life, functional status, respiratory function, and life expectancy.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
authors.forename: Daniel K L
authors.initials: DK
authors.lastname: Cheuk
authors.forename: Virginia
authors.initials: V
authors.lastname: Wong
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wraige
authors.forename: Peter
authors.initials: P
authors.lastname: Baxter
authors.forename: Ashley
authors.initials: A
authors.lastname: Cole
mesh_terms: D006801:Humans; D020388:Muscular Dystrophy, Duchenne / Q000150:complications*; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013131:Spine / Q000601:surgery