Surgery to fuse spine in DMD is needed for how large of a contracture?

• A. 0-5°
• B. 5-15°
• C. 10-30°
• D. 30-45°

Answer: (C)

In Duchenne muscular dystrophy, the spine often deteriorates as trunk muscles weaken, and braces are less reliable because the muscles that brace the spine are also weak. Fusion is considered when the spinal contracture has progressed to a mild-to-moderate range, around 10–30 degrees, because at this point the curve is likely to progress and begin affecting seating balance and respiratory function, while still being manageable surgically with a durable stabilization. Early fusion at this range helps prevent further deformity, preserves sitting control, and offers a more reliable, long-term solution than bracing alone. Below about 10 degrees, conservative management is typically pursued, and explanations for larger curves (greater than 30 degrees) are that the need for fusion becomes even more evident as the curve advances and risks to function and ventilation increase.