In some people with muscular dystrophy (MD), surgical procedures are an option to help relieve several of the complications common to the condition.
Surgery for scoliosis
Scoliosis is an unnatural sideways twisting curvature of the spine. It often occurs in MD because the muscles on either side of the spinal column are weak and cannot effectively support the spine in the upright position.
With time, as the scoliosis worsens, there’s progressive tilting of the pelvis. This causes increasing difficulty and discomfort in sitting, as weight is no longer distributed evenly between the buttocks. Scoliosis also often alters the shape of the chest and reduces lung capacity, making breathing less efficient.
Having spinal surgery can help with breathing function, lessen back pain and discomfort, and improve sitting balance. It should eliminate the long-term need for a brace or support in people using wheelchairs.
However, this is major surgery that carries risks (as does all surgery), and has potential drawbacks. The surgery involves a spinal fusion using metal rods to hold the back in a straighter position. Rigid stabilising of the spine from just below the neck to the pelvis does restrict mobility of the trunk.
Surgery restricts further growth of the spine, so as far as possible it is postponed in very young children unless the spinal curvature is severe. There are also new procedures that allow the spine to grow even after spinal surgery, although these require repeated surgical interventions.
Surgery for contractures
As muscle deteriorates, a person with muscular dystrophy often develops contractures, which are basically shortening of the muscle and tendons. These can become severe, causing discomfort and restricting mobility and flexibility. Contractures can cause joint “fixation”, affecting the knees, hips, feet, elbows, wrists and fingers.
Range-of-motion exercises, and braces on the lower legs can help keep the limbs stretched and flexible and delay the development of contractures by keeping tendons from shortening prematurely.
When contractures have advanced, however, tendon-release surgery may be performed to relieve them. A tendon-release procedure called heel-cord surgery is often done to treat ankle and other contractures while the child is still walking. This may allow the child to continue to walk afterwards, usually with the addition of lower leg braces.
Cataract and ptosis surgery
A cataract is a clouding of the lens that eventually causes vision impairment, and occurs with higher incidence in some types of MD, and earlier than with common, age-associated cataracts. Cataract surgery is a highly effective procedure commonly performed also in the general population, to remove the cataract and restore vision.
Drooping eyelids may occur in some MD patients, to the extent that the lid needs to be held open. In some cases, surgery may be able to correct this.
Pacemakers
Some people who have heart problems related to MD may be helped by the insertion of a pacemaker, which prompts the heart to beat more regularly.
Sources:
– Muscular Dystrophy Australia. Information: Scoliosis. Official website www.mda.org.au
– National Institute of Neurological Disorders and Stroke (NINDS). (2011). Muscular dystrophy: Hope through research.
