Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment

Abstract

Background-Pulmonary function in patients with adolescent idiopathic scoliosis many years after posterior spinal surgery or brace treatment has not been documented. Methods-A consecutive group of patients treated by posterior fusion or a brace at least 20 years previously was investigated. 90% attended a clinical follow up. Lung volumes were determined before treatment in 251 patients, 1.4 years after surgery in 141 patients, and 25 years after surgery or start of brace treatment in 110 patients. Vital capacity (VC) was calculated as percentage predicted according to height and age and the results were corrected for loss of height due to scoliosis. Scoliosis angles were measured and smoking habits were recorded. An age and sex matched control group was also examined with the same questionnaire and pulmonary function tests. Results-VC increased from 67% predicted immediately before surgery to 73% (p<0.001) after surgery and to 84% (p<0.001) at the present follow up, mean change 10.8% (95% CI 9.5 to 12.1). In the brace treated patients VC increased from 77% predicted before treatment to 89% (p<0.001) 25 years after start of treatment, mean change 12.3% (95% CI 10.5 to 14.1). The mean Cobb angle at the present follow up study was 40°in both surgically and brace treated patients. The present results of lung volumes did not correlate with pretreatment or post-treatment Cobb angles or smoking habits.

Severe restrictive lung disease and vertebral surgery in a pediatric population

“…Whereas in idiopathic scoliosis the deformity itself is the cause of functional deterioration, in patients with neuromuscular disease the underlying disease persists even after the deformity is corrected. As to the status of lung function at long-term, some studies have provided evidence of improved pulmonary function at 1-2 years following surgery [5,8], whereas in others this improvement was not observed [4,10,12]. In the present study, FVC was 26% (range 13-39%) of the theoretical value preoperatively.…”

Pulmonary Function in Adolescent Idiopathic Scoliosis Relative to the Surgical Procedure

“…The controversies could perhaps be attributed to the fact that these studies were done on nonhomogeneous populations with different treatment modalities, age distribution, gender, curve patterns, curve severity, and etiology of the scoliosis and with various measurement techniques and parameters of pulmonary function evaluation such as the use of absolute versus percent-predicted values. Only one study that we know of has described the long-term effect of pulmonary function changes relative to the types of surgical procedure used for spinal arthrodesis in patients with adolescent idiopathic scoliosis 10 . The purpose of the present study was to evaluate pro-T spectively, at regular intervals for a minimum of five years postoperatively, the changes in pulmonary function after surgical correction of adolescent idiopathic scoliosis.…”

“…The effect of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis is controversial. Although some investigators have shown that surgical correction of scoliosis substantially improves measured pulmonary functions such as vital capacity [4][5][6][7][8][9][10][11] , others have demonstrated no major improvement in pulmonary function after operative correction [11][12][13][14][15] or have reported loss of pulmonary function postoperatively [15][16][17][18][19] . The controversies could perhaps be attributed to the fact that these studies were done on nonhomogeneous populations with different treatment modalities, age distribution, gender, curve patterns, curve severity, and etiology of the scoliosis and with various measurement techniques and parameters of pulmonary function evaluation such as the use of absolute versus percent-predicted values.…”

Measuring outcomes in adult spinal deformity surgery: a systematic review to identify current strengths, weaknesses and gaps in patient-reported outcome measures

“…are currently most frequently reported in ASD research (Table 3). It is beyond the scope of this paper to discuss the appropriateness of the identified outcome domains, whether they should be included in a core outcome set and whether the currently used PROMs adequately represent all relevant aspects of functioning and quality of life for patients with ASD, but it is remarkable that outcome domains related to 'neurological function' (e.g., muscle power function, bladder or bowel functions) and 'pulmonary function,' both observed to be affected before and after ASD surgery [43][44][45], are not evaluated by PROMs in the current literature (Table 3). Lenke et al [44] and Lehman et al [45] demonstrated that both these outcome domains are significantly affected in ASD patients.…”