Background:The long-term pulmonary function of patients with
adolescent idiopathic scoliosis undergoing surgical correction is uncertain.
To our knowledge, no report has demonstrated the changes in pulmonary function
five years or more following spinal arthrodesis with use of modern segmental
spinal instrumentation techniques for the treatment of all types of adolescent
idiopathic scoliosis in a similar adolescent population.
Methods:One hundred and eighteen patients with adolescent idiopathic
scoliosis undergoing surgical treatment at a single institution were evaluated
with pulmonary function tests to assess the absolute and percent-predicted
value of forced vital capacity and forced expiratory volume in one second at
the preoperative examination and at regular intervals postoperatively. The
patients were divided into four groups depending upon the surgical procedure:
Group 1 comprised forty-nine patients who had posterior spinal arthrodesis
with iliac crest bone graft; Group 2, forty-one patients who had posterior
spinal arthrodesis with thoracoplasty; Group 3, sixteen patients who had open
anterior spinal arthrodesis with a rib resection thoracotomy; and Group 4,
twelve patients who had combined anterior and posterior spinal arthrodesis
with a rib resection thoracotomy and iliac crest bone graft, respectively.
Results:A comparison of absolute pulmonary function values from the
preoperative and final follow-up evaluations demonstrated a significant (p
< 0.0001) increase in both the forced vital capacity and the forced
expiratory volume in one second for Group 1, whereas no change was seen in
those values for Groups 2, 3, and 4. A comparison of the changes in the
percent-predicted pulmonary function values demonstrated significant (p <
0.05) decreases in forced vital capacity and forced expiratory volume in one
second for Groups 2, 3, and 4, except for the latter value for Group 4,
whereas Group 1 had no change.
Conclusions:Patients who have had any type of chest cage disruption
during the surgical treatment of adolescent idiopathic scoliosis demonstrate
no change in the absolute value and a significant decline in the
percent-predicted value of pulmonary functions at five years following
surgery. Chest cage preservation is recommended to maximize both absolute and
percent-predicted pulmonary function values after surgical treatment of
adolescent idiopathic scoliosis.
Level of Evidence:Therapeutic Level III. See Instructions
to Authors for a complete description of levels of evidence.