Pulmonary Function in Adolescent Idiopathic Scoliosis Relative to the Surgical Procedure

Kim, Yongjung J.

doi:10.2106/jbjs.c.00978

Cited by 136 publications

(96 citation statements)

References 35 publications

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“…Kim et al [25] recently reported that an open anterior approach may have a deleterious effect on pulmonary function for as long as 5 years postoperatively, after surgical treatment of adolescent idiopathic scoliosis. Video-assisted thoracoscopy (VAT), used for the anterior release, followed by posterior instrumentation for scoliosis treatment [2,29,36,37] can minimize, but not eliminate, the negative effect on pulmonary function, as reported by Newton et al [36].…”

Section: Introductionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

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Section: Introductionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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“…Pulmonary function was also not examined. Several studies have reported a postoperative decrease in pulmonary function, which may persist for as long as 2 years [19,20,36]. However, any procedure in which the rib cage is opened-e.g., for rib hump resection in posterior instrumentation-can lead to similar negative effects.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, anterior fusion provides better curve correction and can save fusion levels distally [4,18]. However, some studies have reported a postoperative decrease in pulmonary function [19,20].…”

Section: Introductionmentioning

confidence: 99%

Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation

et al. 2011

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Posterior pedicle screw fixation is now the standard treatment for surgical correction of idiopathic scoliosis and has largely replaced anterior techniques, but there have been reports describing a lordogenic effect of segmental pedicle screw instrumentation in the thoracic spine. This clinical study compared anterior dual rod instrumentation with posterior pedicle screw fixation for idiopathic thoracic lordoscoliosis, including 42 patients (7 male, 35 female; average age 16 years, range 12-34) who underwent posterior pedicle screw fixation (n = 20) or anterior dual rod instrumentation (n = 22) at two centers. The average follow-up period was 33 months (24-108 months). Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis with a structural thoracic curve (Lenke 1-3) and thoracic hypokyphosis (T4-T12 \ 20°). The main thoracic curve magnitude and sagittal profile on standing radiographs were evaluated. Thoracic kyphosis was significantly restored from preoperatively 10.2°to 23.4°postoperatively in the anterior group and from 7.6°to 12.9°in the posterior group (P \ 0.005). Kyphosis improved significantly better in the anterior group than in the posterior group (P \ 0.005). The preoperative and postoperative main thoracic curve values were 63°(48-80°) and 25.2°in the anterior group and 60.6°(50-88°) and 23.6°in the posterior group, with no significant differences between the groups. No neurological or other severe complications were observed. Anterior dual rod instrumentation in patients with thoracic lordoscoliosis allows significantly better restoration of thoracic kyphosis than posterior pedicle screw instrumentation.

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“…Similar findings were confirmed by Johnston et al [23], who also noticed that patients having a preoperative brace treatment had significantly lower lung volumes than patients not having any brace treatment, although preoperative major curves were similar in the two groups. In 2005, Kim et al [24] reported changes in the pulmonary function after different surgical approaches for AIS in 118 patients with a minimum 5 years of follow-up. Patients undergoing posterior spinal instrumentation with thoracoplasty, anterior open spinal instrumentation or combined anterior and posterior approach all had a significant decrease in their percentage-predicted forced vital capacity and forced expiratory volume in 1 s. In contrast, patients with posterior spinal instrumentation without thoracoplasty demonstrated a slight increase in the absolute lug volumes and no significant changes in the percentage predicted lung volumes [25].…”

Section: Anterior Thoracoscopic Proceduresmentioning

confidence: 99%

Anterior surgery for adolescent idiopathic scoliosis

Helenius

2013

Journal of Children's Orthopaedics

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Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50-60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pullout, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of[70°have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS ([90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3.

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Pulmonary Function in Adolescent Idiopathic Scoliosis Relative to the Surgical Procedure

Abstract: Kim, Yongjung J.; Lenke, Lawrence G.; Bridwell, Keith H.; Kim, Kyoungnam L.; and Steger-May, Karen, ,"Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure

Cited by 136 publications

References 35 publications

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation

Anterior surgery for adolescent idiopathic scoliosis

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