Pelvic obliquity after fusion of the spine in Duchenne muscular dystrophy

Spinal fusion, ending caudally at L5 rather than at the sacrum, is recommen ded for selected patients with scoliosis due to Duchenne muscular dystrophy , We present a retrospective review of 48 patients operated on for this con dition, Patients having spinal curvature with a Cobb angle of less than 40 degrees and with less than 10 degrees between a line tangential to the supe rior margins of both iliac crests and a line perpendicular to the spinous p rocesses of L4 and L5, were fused to L5 (38 patients); patients not meeting these criteria were fused to the sacrum (10 patients), Spinal and sitting obliquity increased in patients fused to L5, rather than to the sacrum, but the severity of the worsening obliquity was significant ly greater in patients in whom the apex of the curve was below L1, Two of t he ten latter patients required revision procedures for worsening obliquity when their pulmonary function deteriorated to less than 25% of predicted v alues. We recommend fusion to the sacrum for scoliosis in Duchenne muscular dystro phy, especially for patients with an apex to their curve below L1.