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Functional Outcomes in Duchenne Muscular Dystrophy Scoliosis: Comparison of the Differences Between Surgical and Nonsurgical Treatment

Suk, Kyung Soo MD; Lee, Byung Ho MD; Lee, Hwan Mo MD; Moon, Seong Hwan MD; Choi, Young Chul MD; Shin, Dong Eun MD; Ha, Jung Won MD; Song, Kwang Min MD; Kim, Hak Sun MD

Journal of Bone & Joint Surgery - American Volume: 5 March 2014 - Volume 96 - Issue 5 - p 409–415
doi: 10.2106/JBJS.M.00777
Scientific Articles
Supplementary Content

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.

Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

1Department 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

2Department 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, Seoul 135-720, Republic of Korea. E-mail address for B.H. Lee: bhlee96@yuhs.ac. E-mail address for H.M. Lee: hwanlee@yuhs.ac. E-mail address for S.H. Moon: shmoon@yuhs.ac. E-mail address for Y.C. Choi: ycchoi@yuhs.ac. E-mail address for K.M. Song: sycuos@yuhs.ac. E-mail address for H.S. Kim: haksunkim@yuhs.ac

3Department 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

4Department 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

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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