Thoracic mobility and its relation to pulmonary function and rib-cage deformity in patients with early onset idiopathic scoliosis: a long-term follow-up

Abstract

Study design A group of adult patients with idiopathic scoliosis, diagnosed before the age of ten, at a mean of 26.5 years after treatment with either brace or surgery during childhood and adolescence attended a clinical follow-up. Objectives To evaluate the relation between thoracic mobility, rib-cage deformity, and pulmonary function. Summary of background data Long-term studies of pulmonary function in relation to thoracic mobility after treatment in this patient group have not been published. Methods A total of 106 patients, 57 braced and 49 operated patients, attended the follow-up. We examined thoracic mobility (range of motion of the thoracic spine, thorax expansion, and breathing movements) and rib-cage deformity (curve size and trunk deformity) as well as pulmonary function, especially total lung capacity (TLC). Respiratory muscle strength was evaluated in a subgroup. Results Thoracic range of motion was significantly less among the surgically treated patients compared with both the bracetreated and comparison group. Thorax expansion and breathing movements during maximal breathing were significantly reduced in the scoliotic patients compared with the reference values, with no significant differences between the treatment groups. The brace-treated group had better pulmonary function than the operated group, as measured by the TLC, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) (percentage of predicted values). The respiratory muscle strength was significantly lower only in the surgically treated patients when compared with reference values. The results of a multivariate analysis revealed that the strongest factors explaining TLC percentage of predicted were gender, brace model, and smoking habits. Conclusions Thoracic mobility was significantly reduced at mean 26.5 years after completed treatment in both brace-treated and surgically treated patients with early onset scoliosis, compared with the reference values, which did not influence TLC as strongly as gender, brace model, and smoking habits. Levels of evidence Level III.

Effect of chest mobilization on intercostal muscle stiffness

“…For this reason, this study was limited to male participants. In addition, healthy young participants were included because reduced thoracic mobility is influenced by disease and aging ( Moll and Wright, 1972 ; Rehman et al, 2020 ; Romberg et al, 2020 ), and skeletal muscle stiffness varies with age ( Hirata et al, 2020 ; Kelly et al, 1993 ). Therefore, the results may differ in women, patients, and the elderly.…”

“…The thorax is composed of the thoracic vertebrae, ribs, and sternum and has the mobility to expand its antero-posterior and lateral diameters with inspiration during respiration ( Moll and Wright, 1972 ). Thoracic mobility has been reported to be reduced in respiratory diseases such as chronic obstructive pulmonary disease ( Reddy et al, 2019 ), ankylosing spondylitis (AS) ( Hsieh et al, 2016 ), and scoliosis ( Romberg et al, 2020 ). Hsieh et al (2016) showed that AS patients with reduced thoracic mobility had reduced lung capacity compared with healthy participants.…”

The sternum reconstruction: Present and future perspectives

“…Reduction of thorax expansion may compromise the volume of the chest, with 20% loss of its normal capacity ( 6 ). The type of prosthesis is also critical because most of the patches are non-absorbable and synthetic and the patients are often young, with a long-life expectancy ( 10 – 14 ).…”

Preliminary study of the characteristics of rib fractures and their impact on pulmonary ventilatory function

“…The larger the movement of the ribs, the larger the change in thoracic volume. Therefore, greater changes in gas pressure inside the thorax will lead to larger amounts of gas being exchanged to achieve pulmonary ventilation [ 5 , 6 ]. Therefore, once rib fractures happen, it will cause some degree of decline in pulmonary ventilation function.…”