Muscular dystrophy refers to a group of genetic diseases all characterized by progressive muscle weakness and degeneration. Muscular dystrophy can affect the muscles in the arms, legs, face, neck, shoulders, hips, and heart. If the disease affects the diaphragm, it can cause breathing problems.
There are several types of surgery that may be required to diagnose the type of muscular dystrophy a patient has, to monitor disease progression, or to treat complications. They are summarized here.
A muscle biopsy is a minor surgical procedure in which a small sample of muscle tissue is collected. This sample can be used to diagnose some types of muscular dystrophy, as well as to gauge disease progression.
Depending on the location of the biopsy and the age of the patient, general anesthesia is sometimes required. The procedure is very brief, and patients are usually able to leave the hospital on the same day.
Scoliosis corrective surgery
The progressive muscle weakness caused by muscular dystrophy often means that patients have insufficient muscle support for the spine. This can lead to abnormal curvature of the spine, called scoliosis. It usually can be corrected through a surgical procedure called spinal fusion, in which the vertebrae — the bones of the spine — are fused so that they heal into a single bone. This may be accomplished by surgically affixing rods to the vertebrae with metal pins.
Scoliosis surgery also generally means that patients will not be able to receive medications by injection into the cerebrospinal fluid, which surrounds the spinal cord.
Gastrostomy tube insertion
Some people with muscular dystrophy may need the assistance of a feeding tube (also called a gastrostomy tube or G-tube) to ensure they are taking in enough nutrients.
This surgery is usually performed under general anesthesia. It takes about 30 minutes and recovery is very quick, with most patients able to leave the hospital a day or two after the surgery.
During the surgery, a tube is inserted down the patient’s throat to guide the G-tube. Most commonly, a small incision is made in the abdomen near the stomach, and a needle is used to insert the G-tube into the stomach.
Some patients may need a slightly more complex procedure, called open gastrostomy. In these cases, a slightly larger incision is made in the wall of the abdomen, and the G-tube is inserted into the stomach. The stomach is then secured to the G-tube and to the abdomen.
Physicians work with patients and their caregivers to ensure that the right G-tube and procedure are chosen for the patient’s needs.
In some patients, the muscles that control breathing can be affected. The patient might struggle to breathe, especially at night. For some, this can be treated with oxygen; for others, a tracheostomy might be necessary. It involves cutting a hole in the neck to allow the insertion of a tube directly into the windpipe (trachea). A ventilator or breathing machine is attached to the opening using a tube and controls breathing.
Some types of muscular dystrophy can affect heart muscles, requiring the patient to undergo surgery to have a pacemaker implanted. This device controls the rhythm of the heart to correct for abnormalities so that the heart beats normally.
Some types of muscular dystrophy can cause cataracts (milky occlusions) to form in the lens of the eye, preventing patients from seeing. This can be treated with cataract surgery — the lens of the eye is surgically removed and replaced with an artificial lens.
The surgery is brief and most patients are able to return home the same day.
The muscle weakness and atrophy that occur as a result of the disease can cause tendons to become painfully short as the muscles shrink.
The Achilles tendon — the tendon at the back of the ankle that controls the extension of the foot — is commonly affected in some types of muscular dystrophy. As a result, the foot remains curled, and patients can experience difficulty walking.
There is a surgical procedure to lengthen this or other tendons, if necessary. It involves the surgeon making small incisions in the tendon, allowing it to stretch or extend. The procedure is normally performed under general anesthesia. Patients generally need a cast for about three weeks after the surgery and work with their physical therapist before and after the procedure to ensure that they maintain flexibility and range of motion in the tendons that have been treated.
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