Results of Preoperative Pulmonary Function Testing of Adolescents with Idiopathic Scoliosis

Newton, Peter O.; Faro, Frances D.; Gollogly, Sohrab; Betz, Randal R.; Lenke, Lawrence G.; Lowe, Thomas G.

doi:10.2106/jbjs.d.02209

Cited by 157 publications

(138 citation statements)

References 28 publications

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“…Some of these reports have concluded that the former is the main cause of the latter [8,9]. Other authors, by contrast, obtained similar results to those found in the present study and have been unable to establish a direct link between the severity of spinal deformity and lung function [35][36][37]. These discrepancies can be explained by the heterogeneity of the populations included in the different studies, where idiopathic scoliosis was frequently mixed with secondary scoliosis, and clinical subtypes, severity of chest deformities and smoking histories were very diverse.…”

Section: Lung Functionsupporting

(Expert classified)

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Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis

Martínez‐Llorens¹,

Ramírez²,

Colomina³

et al. 2009

Eur Respir J

104

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Adolescent idiopathic scoliosis (AIS) can lead to ventilatory restriction, respiratory muscle weakness and exercise limitation. However, both the causes and the extent of muscle dysfunction remain unclear. The aim of our study is to describe muscle weakness and its relationship to lung function and tolerance to exercise in AIS patients.Lung and muscle function, together with exercise capacity, were assessed in 60 patients with pronounced spinal deformity (.40u) and in 25 healthy volunteers.Patients with AIS had only mild to moderate abnormal ventilatory patterns, the most frequent of which were restrictive abnormalities. The function of respiratory and limb muscles and exercise capacity were below normal limits in AIS patients, and were significantly lower than in controls. Exercise capacity was found to correlate with the function of inspiratory, expiratory, upper limb and lower limb muscles which, in addition, were reciprocally interrelated. Multivariate analysis showed that lower limb muscle function is the main contributor to exercise intolerance. There appeared to be no connection between spinal deformity and lung function, muscle function or exercise capacity.We conclude that AIS patients show generalised muscle dysfunction which contributes to the reduction in their exercise capacity, even in the absence of severe ventilatory impairment.

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Section: Lung Functionsupporting

(Expert classified)

“…Many studies have already investigated lung function in patients with scoliosis, exploring, in particular, the relationships between the chest deformity and ventilatory impairment [5,8,9,[35][36][37]. Some of these reports have concluded that the former is the main cause of the latter [8,9].…”

Section: Lung Functionmentioning

confidence: 99%

Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis

Martínez‐Llorens¹,

Ramírez²,

Colomina³

et al. 2009

Eur Respir J

104

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show abstract

“…Once documented, the progression of scoliosis needs to be addressed to arrest thoracic cage deformity and concomitant pulmonary compromise. (5) Thoracic cage deformity can arise intrinsically from fused ribs and/or secondarily from the curvature, rotation and shortening of the thoracic spine. Severe thoracic cage distortion leads to extrinsic restrictive lung disease from the diminution of lung volume under the convex rib hump and on the concave side, where the ribs impinge on the lung.…”

Section: Introductionmentioning

confidence: 99%

“…(7) Previous studies have indicated that severe scoliosis leads to poor pulmonary function. (2)(3)(4)(5)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) Since poor pulmonary function may lead to a higher incidence of postoperative pulmonary complications, preoperative pulmonary function tests (PFTs) have commonly been used to predict postoperative pulmonary complications. (14) However, there have been no detailed analyses of preoperative pulmonary function in relation to the Cobb angle, location of apical vertebrae and age in AIS.…”

Section: Introductionmentioning

confidence: 99%

Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients

Johari¹,

Sharifudin²,

Rahman³

et al. 2016

smedj

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RESULTSThe mean age of the patients was 16.68 ± 6.04 years. An inverse relationship was found between the degree of the Cobb angle and FVC as well as FEV1; however, the relationships were not statistically significant (p = 0.057 and p = 0.072, respectively). There was also a trend towards a significant negative correlation between the thoracic curve and FVC (p = 0.014). Patients with larger thoracic curves had lower pulmonary function. A one-year increase in age significantly decreased FVC by 1.092 units (p = 0.044). No significant relationship between age and preoperative FEV1 was found. The median FVC was significantly higher in patients with affected apical vertebrae located at levels L1-L3 than at T6-T8 or T9-T12 (p = 0.006).CONCLUSION Lung function impairment was seen in more severe spinal deformities, proximally-located curvature and older patients.

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“…Spinal surgeons are waiting for future studies on this promising new technique. Pulmonary function in patients with AIS related to surgical approaches Newton et al [22] evaluated preoperative pulmonary function data in 631 patients with AIS. In this group, the mean percentage of the predicted forced vital capacity fell below the American Thoracic Society threshold for normal pulmonary function (80 %) once the magnitude of the main thoracic curve exceeded 70°.…”

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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Results of Preoperative Pulmonary Function Testing of Adolescents with Idiopathic Scoliosis

Cited by 157 publications

References 28 publications

Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis

Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis

Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients

Anterior surgery for adolescent idiopathic scoliosis

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