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Patients with Duchenne's muscular dystrophy, scoliosis may see benefits from one-rod correction
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LYON, France — Placement of a single rod with hybrid fixation to correct scoliosis in 41 children with Duchenne’s muscular dystrophy proved safe and durable, according to a presenter at the EuroSpine Annual Meeting, here.
Derek T. Cawley presented results of the single-surgeon series carried out in Ireland from 2000 to present. All patients completed a minimum 1-year follow-up with a mean follow-up of 5 years. He also discussed the senior investigator’s results with two-rod constructs in an earlier, but similar group of patients treated, as a point of comparison.
“In terms of radiographic outcomes, our Cobb angle improved in both groups…On the single rod side, it improved from 24º to 15º Cobb angle, and while we did not fix to the pelvis, we still had an improvement in pelvic obliquity also,” Cawley said.
He emphasized that the goals of surgery in patients with Duchenne’s muscular dystrophy and scoliosis are to improve seating and breathing rather than spinal curve correction.
The surgeon performed usual perioperative optimization and a standard surgical work-up, according to Cawley. During surgery, the physician used a typical 5.5-mm diameter stainless steel rod. The surgery was done without drains, starting at the lumbar aspect, and extended to the facets on both sides, sequentially working along the midline and extending the incision proximally. The incision was closed in layers.
“It was a bilateral facetectomy and bone grafting,” Cawley said.
A goal of the technique was to have patients be extubated by the time they left the operating room, he said.
In the single-rod series, there were three rod breakages, one of which was associated with deep infection; two patients with broken rods were asymptomatic. The length of stay was 11 days in the series and there tended to be a shorter operative time in patients treated with one rod compared to patients treated with a two-rod construct, Cawley said. – by Susan M. Rapp
Reference:
Cawley DT. Paper #60. Presented at: EuroSpine Annual Meeting; Oct. 1-3, 2014; Lyon, France.