Table 5.
Clinical and radiographic outcomes of surgical correction of scoliosis in patients with Duchenne muscular dystrophy, the current and previous studies reporting clinical and radiographic outcomes are summarized
|
Study
|
Current
|
Heller
|
Sengupta
|
Marsh
|
Cervellati
|
Hahn
|
Mehta
|
Modi
|
Takaso
|
Debnath
|
Alexander
|
Duckworth
|
Suk
|
Nedelcu
|
Scannell
|
Takaso
|
Yang
|
|||
| Year | 2022 | 2001 | 2002 | 2003 | 2004 | 2008 | 2009 | 2010 | 2010 | 2011 | 2013 | 2014 | 2014 | 2016 | 2017 | 2018 | 2020 | |||
| Patients (n) | 43 | 31 | 50 | 30 | 20 | 20 | 36 | 18 | 28 | 22 | 18 | 28 | 26 | 40 | 13 | 47 | 13 | 271 | 99 | |
| Instrumentation (n) | PH/PS/SL or PS | I | L/G or L-rod | L/G or L-rod | C/HL/USS/S | L/CD | PS/G | PS | PS | PS | SL | PS | L/G and/or PS | SL or PS | CD | UR | L | PS | PS | CD |
| Distal instrumented level [n = (if subset)] | L4 (21), L5 (4), P (18) | SP | P (31) | L5 (19) | P | SP | P | L5 (26); P (10) | L5 (7); SP (11) | L5 | P | L5 | NA | L4/5 (14); SP (12) | LL (5); P (40) | SP | P | P | L5 | LL (5); P (94) |
| Age at surgery (yr) | 14.4 | 14.1 | 14 | 11.7 | 14.7 | 13 | 14 | 13.5 | 14.4 | 13 | 12.5 | 11.8 | 14.2 | 14.2 | 14.9 | 12.7 | 13 | 14 | 13.5 | 15.1 |
| Pre-op FVC% | NA | 54.3 | 44 | 58 | 33 | NA | 55 | NA | NA | NA | 57 | 53 | NA | NA | NA | NA | 59 | 48 | NA | NA |
| Post-op FVC% | NA | NA | NA | NA | NA | NA | 54 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| FVC% at final F/U | NA | 52.7 | NA | NA | NA | NA | 47 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Pre-op scoliosis (°) | 57.5 | 48.6 | 48.4 | 19.8 | 61 | 48 | 44 | 71 | 76.4 | 74 | 45.3 | 42.8 | 56.4 | 59 | 65.5 | 30 | 31 | 43 | 70 | 65.8 |
| Scoliosis (initial post-op) (°) | NA | 12.5 | 16.7 | 3.2 | 24.2 | 22 | 10 | 25.5 | 30.1 | 14 | NA | NA | 21.6 | 13 | NA | 2 | 16 | 12 | 15 | NA |
| Correction of scoliosis (%) | 79.2 | 74.3 | 66 | 80 | 60.3 | 54.2 | 77 | 65 | 63.3 | 81 | NA | NA | 61.7 | 78 | NA | 93.3 | NA | NA | 78.6 | 50.6 |
| Scoliosis at final F/U (°) | 15.6 | 12.5 | 22 | 5.2 | NA | 28 | 9 | 28.5 | 31.3 | 17 | 17.7 | 7.3 | NA | NA | 36.2 | 4.2 | 21 | 12 | 17 | 32.5 |
| Scoliosis loss of correction (°) | NA | 0 | 5.2 | 2 | NA | 6 | 1 | 3 | 1.2 | 3 | NA | NA | NA | NA | NA | 2.2 | 5 | 0 | 2 | NA |
| Pre-op pelvic obliquity (°) | 16.3 | 18.2 | 19.8 | 8.9 | 18.1 | 19.8 | 14 | 14.8 | 18.1 | 9 | 14.5 | 11.2 | NA | 21 | 20.7 | 7.7 | 7 | 6 | 15 | 21 |
| Pelvic obliquity (initial post-op) (°) | NA | 3.8 | 7.2 | 2.2 | NA | 10 | 3 | 6.7 | 8.6 | 3 | NA | NA | NA | 3 | NA | 0.6 | 5 | 3 | 5 | NA |
| Correction of pelvic obliquity (%) | 80.8 | 79.1 | 63.6 | 76 | NA | 49.5 | 65 | 54.7 | 52 | 66.7 | NA | NA | NA | 85.7 | NA | 92.2 | 66.7 | 53.8 | ||
| Pelvic obliquity at final F/U (°) | 4.6 | 5.1 | 11.6 | 2.9 | NA | NA | 3 | 9.3 | 8.8 | 6 | 5.6 | 2 | NA | NA | 11.4 | 1.5 | 5 | 2 | 6 | 9.7 |
| Fusion to sacropelvis (%) | 41.9 | 100 | 100 | 0 | 100 | 100 | 100 | 27.8 | 66.7 | 0 | 100 | 0 | NA | 46.2 | 89.9 | 100 | 100 | 100 | 0 | 94.9 |
| Duration of surgery (min) | 352.1 | 363 | 310 | 240 | 212 | 180 | 307 | 332 | 348 | 282 | 260 | 216 | NA | 260 | NA | 170 | 227 | 332 | 270 | NA |
| Blood loss (mL or % TBV) | 36% | 3373 | 4100 | 3300 | 4900 | 1200 | 2642 | 2955 | 2561 | 950 | 3400 | 2000 | NA | 1882 | NA | 2553 | 1327 | 1596 | 910 | NA |
| F/U (yr) | 10.9 | 1.8 | 4.6 | 3.5 | Until discharge | 5 | 5.2 | 1.6 | 1.4 | 3.3 | 4.5 | 2.3 | 1 | 2 | 3.86 | 6.9 | 4 | 4 | 3 | 6.6 |
| MDSQ score at F/U | 38.1 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 35.1 | NA | NA | NA | NA | NA |
This cohort included 20 Duchenne muscular dystrophy patients and 7 patients with spinal muscular atrophy.
C: Colorado; CD: Cotrel-Dubousset; FVC: Forced vital capacity; F/U: Follow-up; G: Galveston technique; H: Harrington; HL: Harrington-Luque; L: Luque sublaminar wires; LL: Lower lumbar; MDSQ: Muscular Dystrophy Spinal Questionnaire; P: Pelvis; PH: Pedicle hooks; PS: Pedicle screws; S: Synergies; SL: Sublaminar instrumentation; SP: Sacropelvis; USS: AO universal spine system; NA: Not available; TBV: Total blood volume; NA: Not available.