Abstract / Summary
Abstract Introduction Whether posterior spinal fusion (PSF) alters pulmonary decline in patients with Duchenne muscular dystrophy (DMD) remains uncertain. This study evaluated longitudinal changes in pulmonary function and respiratory muscle strength after PSF and examined whether the magnitude of scoliosis correction was associated with postoperative pulmonary outcomes. Methods We retrospectively reviewed patients with DMD who underwent PSF and had pulmonary function testing before and after surgery. Pulmonary measures were assessed preoperatively, at approximately 5 to 6 months postoperatively, and at final follow-up of approximately 2 years. Results Sixteen nonambulatory male patients were included at a mean age of 17.9 ± 2.9 years. The mean Cobb angle improved from 63.6° ± 15.4° preoperatively to 19.1° ± 13.3° postoperatively. Mean FVC percent predicted remained stable from the preoperative to early postoperative assessment (41.0% ± 15.5% vs 41.1% ± 18.0%) but decreased to 34.4% ± 13.7% at final follow-up. MEP decreased significantly during the early postoperative period (P = 0.010), whereas maximal inspiratory pressure remained unchanged. Greater absolute curve correction was associated with greater reductions in measured FVC at early postoperative assessment (ρ = −0.62, P = 0.019) and final follow-up (ρ = −0.65, P = 0.012). Conclusions In nonambulatory patients with DMD, FVC percent predicted did not change significantly during early follow-up but declined significantly by approximately 2 years. In our cohort, greater absolute curve correction was associated with greater measured FVC loss. These findings do not support pulmonary preservation as an expected benefit of greater deformity correction and reinforce the functional, postural, and quality-of-life goals of PSF.