At some point, surgery may be necessary to lengthen heel cords, despite other treatments. Some investigators suggest waiting until the fixed deformity is greater than 20 degrees, whereas other investigators suggest doing early prophylactic muscle/tendon lengthening procedures. There are several reasons to proceed with surgery:
- Heel cord lengthening may prolong walking; and
- Preventing foot deformities after wheelchair confinement may help with positioning, and allow continued shoe wearing.
- 90-95% of boys with DMD exhibit scoliosis; the age of onset is variable;
- A spine exam and spine X-rays (sitting anteroposterior spine) as necessary should be performed on a routine basis after the age of 10 years or when patients become non-ambulatory;
- The trunk muscles progressively weaken, leading to collapse of the spine into a long C-shaped curve;
- In addition to seating problems and discomfort, scoliosis can lead to respiratory compromise due to decreased lung volume; and
- Scoliosis surgery is recommended when the curvature measures 20 to 30 degrees; bracing is not thought to be helpful and is poorly tolerated.
- Scoliosis correction is major surgery and needs to be performed before pulmonary function is too compromised, when pulmonary function has decreased to less than 35% of normal;
- The blood loss in this type of surgery tends to be significant and blood transfusions are almost always required;
- Post-operatively, the child will be in the intensive care for several days, with total hospitalization time usually 7 to 10 days; and
- Following correction, the child can sit in the wheelchair more comfortably and for longer periods, and respiratory function is improved.
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