Severe restrictive lung disease and vertebral surgery in a pediatric population

Abstract

The aim of this study is to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC) \40% and severe vertebral deformity. Few studies have examined surgical treatment in these patients, who are considered to be at a high risk because of their pulmonary disease, and in whom preoperative tracheostomy is sometimes recommended. Inclusion criteria include FVC \40%, age \19 years and diagnosis of scoliosis. The retrospective study of 24 patients with severe restrictive lung disease, who underwent spinal surgery. Variables studied were age and gender, pre-and postoperative spirometry (FVC, FEV1, FEV1/FVC), preoperative, postoperative and late use of non-invasive ventilation (BiPAP) or mechanical ventilation, associated multidisciplinary treatment, type and location of the curve, pre-and postoperative curve values, type of vertebral fusion, intraand postoperative complications, duration of intensive care unit (ICU) stay and length of postoperative hospitalization. Mean age was 13 years (9-19) of which 13 were males and 11 females. Mean follow-up was 32 months (24-45). The etiology was neuromuscular in 17 patients and other etiologies in 7 patients. Mean preoperative FVC was 26%

The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature

“…In our sample, 79% of the patients had moderate or severe pulmonary impairment preoperatively; 30% of the patients improved slightly, 40% maintained their preoperative level and 30% showed a decline at follow-up. Our results echo those of prior studies on patients with severe pulmonary impairment: Payo [31] reported on 17 neuromuscular scolioses, with FVC \40% and mean patient age of 13 years. The preoperative Cobb angle was 88°and was corrected to 37°.…”

“…To include continuous variables and binary outcome parameters, we performed correlation analyses between radiographic and pulmonary parameters and risk factor identification for adverse events, such as revision surgery, major complications, an FVC% \40% [30,31] and nonunion. Descriptive statistics included an analysis of means ± 1 standard deviation and ranges.…”

“…Rawlins [30] reported on 32 patients with a mean age of 13 years, kyphosis of 79°, scoliosis of 87°and preop-FVC% of \40%; 19% experienced pulmonary complications, and 9% needed tracheostomies. In Rizzi's study [5], 40% of the patients experienced postoperative respiratory complications, and in Payo's [31] study of 17 patients with an FVC \40%, postoperative complications occurred in 58%, and 24% experienced respiratory failure. In Wazeka's study [20] of 21 patients with an FVC% of 32%, 19% required prolonged ventilation, and 40% experienced respiratory complications.…”

Spirometrically-defined restrictive ventilatory defect: population variability and individual determinants

“…The full version of this paper, with online appendices, is available online at www.thepcrj.org PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org number of factors have been associated with a restrictive ventilatory defect 3 including overweight/obesity, posttuberculous lung damage, 4 ethnic inhalation of tobacco, 5 occupational exposures, 6,7 vertebral spine and other bone problems, 8 and some have even hypothesised an association with the future development of diabetes 9 and lung cancer. 10 There is growing evidence to suggest that a restrictive spirometric ventilatory defect is relatively common, yet the morbidity and mortality related to this lung function impairment and its relative impact in comparison with the better known obstructive patterns -i.e.…”

Section 9: Home mechanical ventilation in children with kyphoscoliosis

“…We found 11 retrospective studies reporting on 592 pediatric patients undergoing spinal fusion surgery, of whom 134/558 (24%) required prolonged mechanical ventilation, defined as !36 hours (see Table 2). [16][17][18][19][20][21][22][23][24][25][26] It was unclear how many of the patients in the paper by Mills et al remained extubated at !36 hours. 16 Twenty-three (2.5%) of the patients received HMV preoperatively.…”