Spinal fusion in Duchenne muscular dystrophy--fixation and fusion to the sacropelvis?

Twenty-two wheelchair-bound patients with Duchenne muscular dystrophy (DMD) underwent Luque segmental instrumentation and fusion. Twelve patients were instrumented to the sacropelvis, and 10 were instrumented to L5. Mean preoperative and postoperative curves were nearly identical in both groups. The mild degree of trunk shift and pelvic obliquity was similar between the two groups. The recommendation for operation in such patients should be made when their curve is > 20 degrees and if their forced vital capacity is > 40%. If treatment is initiated early, Luque instrumentation and fusion from high thoracic (T2 or T3) to the fifth lumbar vertebra should be sufficient.