Spinal muscular atrophy: clinical features and treatment of spinal and limb deformities. Interstate Consensus Protocol
Objective. To substantiate the protocol for the diagnosis and treatment of deformities of the spine and limbs in patients with spinal muscular atrophy basing on an assessment of the level of evidence of published data. Material and Methods. Data on foreign protocols and their adaptation for use in...
Main Authors: | , , , , , , , , |
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Format: | Article |
Language: | English |
Published: |
Ministry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan"
2020-06-01
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Series: | Хирургия позвоночника |
Subjects: | |
Online Access: | https://www.spinesurgery.ru/jour/article/view/1695/1684 |
Summary: | Objective. To substantiate the protocol for the diagnosis and treatment of deformities of the spine and limbs in patients with spinal muscular atrophy basing on an assessment of the level of evidence of published data.
Material and Methods. Data on foreign protocols and their adaptation for use in Russia and CIS countries were analyzed and summarized.
The main platform was the evidence-based systematization of studies reflecting modern approaches to the diagnosis and treatment (including surgery) of spinal and limb deformities in patients with spinal muscular atrophy. The formulated recommendations are based on
literature data and the authors’ own experience. Literature was searched in online databases of Medline, Embase, Web of Science, and Cochrane Library information platforms. Preference was given to studies that could be classified as evidence level 2+ and higher according to
the ASMOK system. References are given in the order of their mention in the text. Search depth was 5 years. Methods used to assess the
quality and strength of evidence were expert consensus and significance assessment in accordance with the rating scheme. Methods used
to analyze evidence were reviews of published meta-analyzes and systematic reviews with evidence tables.
Results. Various aspects of clinical examination, respiratory support and postural control, conservative and surgical treatment of spinal
and limb deformities, preoperative, intraoperative and postoperative management, and anesthetic risk assessment in patients with spinal
muscular atrophy are highlighted.
Conclusion. Secondary orthopedic pathology in patients with spinal muscular atrophy causes not only severe violation of the musculo-
skeletal system functions (support, movement, and verticalization), but also pathological changes in the vital functions of internal organs
and systems (respiratory, digestive, cardiovascular). A thorough analysis of the patient’s condition (assessment of general somatic, neurological, and orthopedic statuses) based on the data of preoperative multidisciplinary examination allows assessing the risks of complications and developing individual program of surgical rehabilitation of the patient. Surgical correction of orthopedic pathology in spinal
muscular atrophy improves the functional status of the patient, improves the quality of life and the level of self-care, and optimizes the
function of external respiration. |
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ISSN: | 1810-8997 2313-1497 |