Résumé :
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Concerning multidisciplinary care of Duchenne Muscular Dystophy (DMD), the prevention of scoliosis remains a priority. Spinal surgery is considered as the treatment of choice and early instrumentation and fusion are widely proposed. The objectives of surgery are to improve the comfort and quality of life of the patient and to prevent the degradation of their respiratory function. Nevertheless, the effect of spinal surgery on respiratory function is still controversial. We intended then to study, retrospectively, the loss of forced vital capacity in 64 DMD patients born between 1970 and 1990, and we followed up on average 9 years after they lost deambulation. The average time before the onset of arthrodesis was 4 years for the surgery group comprising 52 patients. Our study (which covered 4 french departments) did not show any improvement in the lung function arising from surgery. The annual forced vital capacity decrease was the same in the 52 patients operated before (5,12%/year) and after the spinal fusion (5,89%/year) on as for the 12 patients not operated on. Consequently, our study showed that no improvement in respiratory function could be expected from surgery. There is therefore no argument in favour of advising patients to accept surgery. Our results are consistent with other recent studies, which consider the question of whether systematic and early spinal surgery should still be widely proposed. Furthermore, recent studies report that 25% of patients with DMD would suffer from a moderate and non progressive scoliosis, that is likely to be improved by the early introduction of corticosteroids.
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