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Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques

STUDY DESIGN: A retrospective matched cohort study. PURPOSE: To compare the results of combined Luque rod-sublaminar wiring (thoracic) and pedicle (lower lumbar) instrumentation (SLW) versus those with pedicle screw fixation (PS) for scoliosis correction in Duchenne muscular dystrophy (DMD). OVERVIE...

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Autores principales: Debnath, Ujjwal Kanti, Mehdian, Syed M. Hossein, Webb, John K.
Formato: Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047897/
https://www.ncbi.nlm.nih.gov/pubmed/21386945
http://dx.doi.org/10.4184/asj.2011.5.1.43
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author Debnath, Ujjwal Kanti
Mehdian, Syed M. Hossein
Webb, John K.
author_facet Debnath, Ujjwal Kanti
Mehdian, Syed M. Hossein
Webb, John K.
author_sort Debnath, Ujjwal Kanti
collection PubMed
description STUDY DESIGN: A retrospective matched cohort study. PURPOSE: To compare the results of combined Luque rod-sublaminar wiring (thoracic) and pedicle (lower lumbar) instrumentation (SLW) versus those with pedicle screw fixation (PS) for scoliosis correction in Duchenne muscular dystrophy (DMD). OVERVIEW OF LITERATURE: PS fixation is gaining popularity. Two instrumentation systems were not compared before in a matched cohort of patients. METHODS: Two groups of patients with DMD were matched according to the age at surgery, magnitude of deformity and vital capacity. Indications for surgery included loss of sitting balance, rapid decline of vital capacity and curve progression. In group 1 (22 patients) SLW fixation was used from T2/3 to pelvis or sacrum. In group 2 (18 patients) PS fixation was used from T2/3 to L5. Five patients had all level segmental PS fixations. Minimum follow-up was 2 years (range, 2 to 13 years). Radiographs, lung function tests and subjective/objective assessment were performed at standardized intervals. RESULTS: Mean Cobb angle in group 1 improved from 45.3° (range, 26 to 75°) to 17.7°(range, 0 to 37°) and mean pelvic obliquity improved from 14.5° (range, 8 to 28°) to 5.6° (range, 0 to 15°). Mean Cobb angle in group 2 improved from 42.8° (range, 28 to 80°) to 7.3° (range, 0 to 20°) and mean pelvic obliquity improved from 11.2° (range, 7 to 30°) to 2.0° (range, 0 to 5°) (p < 0.05). Mean operating time and blood loss were less in group 2 (p < 0.05). In group 1, the infection rate and instrumentation failure was higher, and subjective/objective outcomes showed no significant difference between the groups. CONCLUSIONS: PS fixation had superior correction and controlled pelvic obliquity without the need for pelvic fixation.
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spelling pubmed-30478972011-03-08 Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques Debnath, Ujjwal Kanti Mehdian, Syed M. Hossein Webb, John K. Asian Spine J Clinical Study STUDY DESIGN: A retrospective matched cohort study. PURPOSE: To compare the results of combined Luque rod-sublaminar wiring (thoracic) and pedicle (lower lumbar) instrumentation (SLW) versus those with pedicle screw fixation (PS) for scoliosis correction in Duchenne muscular dystrophy (DMD). OVERVIEW OF LITERATURE: PS fixation is gaining popularity. Two instrumentation systems were not compared before in a matched cohort of patients. METHODS: Two groups of patients with DMD were matched according to the age at surgery, magnitude of deformity and vital capacity. Indications for surgery included loss of sitting balance, rapid decline of vital capacity and curve progression. In group 1 (22 patients) SLW fixation was used from T2/3 to pelvis or sacrum. In group 2 (18 patients) PS fixation was used from T2/3 to L5. Five patients had all level segmental PS fixations. Minimum follow-up was 2 years (range, 2 to 13 years). Radiographs, lung function tests and subjective/objective assessment were performed at standardized intervals. RESULTS: Mean Cobb angle in group 1 improved from 45.3° (range, 26 to 75°) to 17.7°(range, 0 to 37°) and mean pelvic obliquity improved from 14.5° (range, 8 to 28°) to 5.6° (range, 0 to 15°). Mean Cobb angle in group 2 improved from 42.8° (range, 28 to 80°) to 7.3° (range, 0 to 20°) and mean pelvic obliquity improved from 11.2° (range, 7 to 30°) to 2.0° (range, 0 to 5°) (p < 0.05). Mean operating time and blood loss were less in group 2 (p < 0.05). In group 1, the infection rate and instrumentation failure was higher, and subjective/objective outcomes showed no significant difference between the groups. CONCLUSIONS: PS fixation had superior correction and controlled pelvic obliquity without the need for pelvic fixation. Korean Society of Spine Surgery 2011-03 2011-03-02 /pmc/articles/PMC3047897/ /pubmed/21386945 http://dx.doi.org/10.4184/asj.2011.5.1.43 Text en Copyright © 2011 by Korean Society of Spine Surgery http://creativecommons.org/licenses/by-nc/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Debnath, Ujjwal Kanti
Mehdian, Syed M. Hossein
Webb, John K.
Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques
title Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques
title_full Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques
title_fullStr Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques
title_full_unstemmed Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques
title_short Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques
title_sort spinal deformity correction in duchenne muscular dystrophy (dmd): comparing the outcome of two instrumentation techniques
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047897/
https://www.ncbi.nlm.nih.gov/pubmed/21386945
http://dx.doi.org/10.4184/asj.2011.5.1.43
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