Surgical stabilization of the spine in Duchenne muscular dystrophy.

The problem of real distress from the discomfort of collapsing scoliosis is predictable in Duchenne muscular dystrophy (DMD). Once the lumbar curve has exceeded 35 degrees, further progression is inevitable. A vital capacity, then, of 35% or more permits consideration of spinal surgery. Using these indications, 24 patients with DMD had long Harrington instrumentations and spinal fusions from S1 up to the upper thoracic spine (T4, 5, or 6). After two weeks recumbent, they were mobilized wearing a light spinal support in their wheelchairs. The complications encountered are described in detail. One patient died two years after his operation from dystrophic cardiomyopathy. With a follow-up period of four months to 42 months, the rest of these patients are well and sitting with comfort. The authors think that this experience indicates that prophylactic spinal fusion deserves consideration in the care planned for these patients.