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

Authors
 Kyung Soo Suk  ;  Byung Ho Lee  ;  Hwan Mo Lee  ;  Seong Hwan Moon  ;  Young Chul Choi  ;  Dong Eun Shin  ;  Jung Won Ha  ;  Kwang Min Song  ;  Hak Sun Kim 
Citation
 Journal of Bone and Joint Surgery - American Volume, Vol.96(5) : 409-415, 2014 
Journal Title
 Journal of Bone and Joint Surgery - American Volume 
ISSN
 0021-9355 
Issue Date
2014
MeSH
Activities of Daily Living ; Adolescent ; Follow-Up Studies ; Humans ; Male ; Muscular Dystrophy, Duchenne/complications* ; Muscular Dystrophy, Duchenne/physiopathology ; Prospective Studies ; Recovery of Function ; Respiratory Function Tests ; Scoliosis/etiology* ; Scoliosis/physiopathology ; Scoliosis/surgery ; Scoliosis/therapy* ; Surveys and Questionnaires ; Treatment Outcome ; Young Adult
Abstract
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.
Full Text
http://jbjs.org/content/96/5/409.long
DOI
10.2106/JBJS.M.00777
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hak Sun(김학선) ORCID logo https://orcid.org/0000-0002-8330-4688
Moon, Seong Hwan(문성환)
Suk, Kyung Soo(석경수) ORCID logo https://orcid.org/0000-0003-0633-2658
Shin, Dong Eun(신동은)
Lee, Byung Ho(이병호) ORCID logo https://orcid.org/0000-0001-7235-4981
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
Choi, Young Chul(최영철) ORCID logo https://orcid.org/0000-0001-5525-6861
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98372
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