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...

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Main Authors: Sergey O. Ryabykh, Dmitry M. Savin, Egor Yu. Filatov, Svetlana N. Medvedeva, Anastasia N. Tretjakova, Dmitry A. Popkov, Tatyana V. Ryabykh, Elena N. Shchurova, Marat S. Saifutdinov
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
Series:Хирургия позвоночника
Subjects:
Online Access:https://www.spinesurgery.ru/jour/article/view/1695/1684
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author Sergey O. Ryabykh
Dmitry M. Savin
Egor Yu. Filatov
Svetlana N. Medvedeva
Anastasia N. Tretjakova
Dmitry A. Popkov
Tatyana V. Ryabykh
Elena N. Shchurova
Marat S. Saifutdinov
author_facet Sergey O. Ryabykh
Dmitry M. Savin
Egor Yu. Filatov
Svetlana N. Medvedeva
Anastasia N. Tretjakova
Dmitry A. Popkov
Tatyana V. Ryabykh
Elena N. Shchurova
Marat S. Saifutdinov
author_sort Sergey O. Ryabykh
collection DOAJ
description 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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spelling doaj.art-a5e842e307b54f46b638c16c6fc1db542023-09-02T20:09:17ZengMinistry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan"Хирургия позвоночника1810-89972313-14972020-06-01172799410.14531/ss2020.2.79-94Spinal muscular atrophy: clinical features and treatment of spinal and limb deformities. Interstate Consensus ProtocolSergey O. Ryabykh0https://orcid.org/0000-0002-8293-0521Dmitry M. Savin1https://orcid.org/0000-0001-6284-2850Egor Yu. Filatov2https://orcid.org/0000-0002-3390-807XSvetlana N. Medvedeva3https://orcid.org/0000-0002-1398-960XAnastasia N. Tretjakova4https://orcid.org/0000-0002-1094-4502Dmitry A. Popkov5https://orcid.org/0000-0002-8996-867XTatyana V. Ryabykh6https://orcid.org/0000-0002-9315-3035Elena N. Shchurova7https://orcid.org/0000-0003-0816-1004Marat S. Saifutdinov8https://orcid.org/0000-0002-7477-5250Russian Ilizarov Scientific Center for Restor- ative Traumatology and Orthopaedics, Kurgan, RussiaRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, RussiaRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, RussiaRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, RussiaRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, RussiaRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, RussiaRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, RussiaRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, RussiaRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, RussiaObjective. 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.https://www.spinesurgery.ru/jour/article/view/1695/1684spinal muscular atrophyspinal deformitieslimb deformitiesorthopedic syndromespine surgeryconservative treatmentsurgical treatment
spellingShingle Sergey O. Ryabykh
Dmitry M. Savin
Egor Yu. Filatov
Svetlana N. Medvedeva
Anastasia N. Tretjakova
Dmitry A. Popkov
Tatyana V. Ryabykh
Elena N. Shchurova
Marat S. Saifutdinov
Spinal muscular atrophy: clinical features and treatment of spinal and limb deformities. Interstate Consensus Protocol
Хирургия позвоночника
spinal muscular atrophy
spinal deformities
limb deformities
orthopedic syndrome
spine surgery
conservative treatment
surgical treatment
title Spinal muscular atrophy: clinical features and treatment of spinal and limb deformities. Interstate Consensus Protocol
title_full Spinal muscular atrophy: clinical features and treatment of spinal and limb deformities. Interstate Consensus Protocol
title_fullStr Spinal muscular atrophy: clinical features and treatment of spinal and limb deformities. Interstate Consensus Protocol
title_full_unstemmed Spinal muscular atrophy: clinical features and treatment of spinal and limb deformities. Interstate Consensus Protocol
title_short Spinal muscular atrophy: clinical features and treatment of spinal and limb deformities. Interstate Consensus Protocol
title_sort spinal muscular atrophy clinical features and treatment of spinal and limb deformities interstate consensus protocol
topic spinal muscular atrophy
spinal deformities
limb deformities
orthopedic syndrome
spine surgery
conservative treatment
surgical treatment
url https://www.spinesurgery.ru/jour/article/view/1695/1684
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