What is included in spinal care of patients with Duchenne muscular dystrophy (DMD)?

Updated: Aug 17, 2020
  • Author: Twee T Do, MD; Chief Editor: Jeffrey D Thomson, MD  more...
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Answer

Daily glucocorticoid treatment reduces the risk of scoliosis, but increases the risk of vertebral fracture. Spinal care by an experienced spinal surgeon comprises the following:

  • In the ambulatory phase, scoliosis monitoring by clinical assessment, with spinal radiography only if scoliosis is observed
  • In the non-ambulatory phase, clinical assessment for scoliosis at each visit; spinal radiography is indicated as a baseline assessment for all patients and should consist of a sitting anteroposterior (AP) full-spine radiograph and lateral projection film
  • An AP spinal radiograph is warranted annually for curves of less than 15-20° and every 6 months for curves of more than 20°, irrespective of glucocorticoid treatment, until skeletal maturity
  • Support of spinal/pelvic symmetry and spinal extension by the wheelchair seating system
  • Monitoring for painful vertebral body fractures
  • Spinal fusion to straighten the spine, prevent further worsening of deformity, eliminate pain due to vertebral fracture with osteoporosis, and slow the rate of respiratory decline
  • Anterior spinal fusion is inappropriate in DMD
  • Posterior spinal fusion is warranted only in nonambulatory patients who have spinal curvature of more than 20°, are not taking glucocorticoids, and have yet to reach skeletal maturity
  • In patients on glucocorticoids, surgery may be warranted if curve progression continues and is associated with vertebral fractures and pain after optimization of medical therapy to strengthen the bones, irrespective of skeletal maturation

Internal fixation is warranted for severe lower-limb fractures in ambulatory patients, to allow prompt rehabilitation and the greatest possible chance of maintaining ambulation. In the nonambulatory patient, the requirement for internal fixation is less acute. Splinting or casting of a fracture is necessary for the nonambulatory patient, and is appropriate in an ambulatory patient if it is the fastest and safest way to promote healing and does not compromise ambulation during healing.


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