title: Impact of a Comparative Study on the Management of Scoliosis in Duchenne Muscular Dystrophy: Are Corticosteroids Decreasing the Rate of Scoliosis Surgery in the United States?
abstract: METHODS
  A cross-sectional analysis.
  
  
  OBJECTIVE
  The aim of this study was to determine whether the surgical treatment for scoliosis due to Duchenne muscular dystrophy (DMD) has decreased over a recent 11-year period, specifically, after the wide acceptance of glucocorticoid treatment for DMD.
  
  
  BACKGROUND
  DMD can result in a flaccid neuromuscular scoliosis that has been traditionally treated surgically. In 2004, a comparative study demonstrated that glucocorticoid treatment decreased the progression of scoliosis in DMD.
  
  
  METHODS
  We used the Nationwide Inpatient Sample from 2001 to 2012 to identify patients with DMD undergoing spinal fusion. Demographic information (age, hospital size, location, geographic status) was collected. We examined the distribution of patient and hospital characteristics among cohorts undergoing spinal fusion from 2001 to 2004 (period 1; before publication of the comparative study), 2005 to 2008 (period 2; immediately following publication of the comparative study), and 2009 to 2012 (period 3; moderate duration following publication of the comparative study).
  
  
  RESULTS
  We identified 1874 males undergoing spinal fusion. During this period, the overall rate of DMD surgeries declined by 48%-from 1.87 surgeries in 2001 to 0.97 surgeries in 2012 per million US males per year. This decline was significantly pronounced following the publication of the comparative study [periods 2 and 3; For period 2 vs. period 1: incidence rate ratio (IRR) = 0.71, 95% confidence interval (95% CI) = 0.56-0.91, P = 0.01; For period 3 vs. period 1: IRR = 0.77, 95% CI = 0.61-0.97, P = 0.03].
  
  
  CONCLUSIONS
  Our study demonstrates a significant decrease in the rate of scoliosis surgery for DMD from 2001 to 2012. It appears that the decline in surgical treatment could be related to the publication and landmark study demonstrating decreased progression of scoliosis with glucocorticoid treatment.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Brandon L
authors.initials: BL
authors.lastname: Raudenbush
authors.affiliation: Department of Public Health Science, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Caroline P
authors.initials: CP
authors.lastname: Thirukumaran
authors.affiliation: Department of Public Health Science, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY.|Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: James O
authors.initials: JO
authors.lastname: Sanders
authors.affiliation: Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY.|Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Rubery
authors.affiliation: Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Addisu
authors.initials: A
authors.lastname: Mesfin
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications*; D019635:Neurosurgical Procedures; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids