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Results of Preoperative Pulmonary Function Testing of Adolescents with Idiopathic ScoliosisA Study of Six Hundred and Thirty-one Patients
Peter O. Newton, MD1; Frances D. Faro, MD1; Sohrab Gollogly, MD1; Randal R. Betz, MD2; Lawrence G. Lenke, MD3; Thomas G. Lowe, MD4
1 Department of Orthopedics, Children's Hospital San Diego, 3030 Children's Hospital, Suite 410, San Diego, CA 92123. E-mail address for P.O. Newton: pnewton@chsd.org
2 Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140. E-mail address: rbetz@shrinenet.org
3 Washington University School of Medicine, 1 Barnes-Jewish Plaza, Suite 11300, West Pavilion, St. Louis, MO 63110. E-mail address: lenkel@msnotes.wustl.edu
4 Woodridge Spine Center, 3550 Lutheran Parkway West, Suite 201, Wheat Ridge, CO 80033. E-mail address: woodridgespine@aol.com
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A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the DePuy-Spine Harms Study Group. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy-Spine). Also, a commercial entity (DePuy-Spine) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Children's Hospital San Diego, San Diego, California

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Sep 01;87(9):1937-1946. doi: 10.2106/JBJS.D.02209
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Background: Previous research has suggested a correlation between pulmonary impairment and thoracic spinal deformity. The curve magnitude, number of involved vertebrae, curve location, and decrease in thoracic kyphosis independently contribute to pulmonary impairment, but the strength of these associations has been variable. The objectives of this study were to test the hypothesis that increased thoracic deformity is associated with decreased pulmonary function and to determine which, if any, radiographic measurements of deformity predict pulmonary impairment.

Methods: Preoperative pulmonary function testing and radiographic examination were performed on 631 patients with adolescent idiopathic scoliosis. Correlation analysis and subsequent stepwise multiple regression analysis were carried out to assess the associations between radiographic measurements of deformity and the results of pulmonary function testing.

Results: The magnitude of the thoracic curve, the number of vertebrae involved in the thoracic curve, the thoracic hypokyphosis, and coronal imbalance had a minimal but significant effect on pulmonary function. While these four factors were associated with an increased risk of moderate or severe pulmonary impairment, they explained only 19.7%, 18.0%, and 8.8% of the observed variability in forced vital capacity, forced expiratory volume in one second, and total lung capacity, respectively. The degrees of scoliosis that were associated with clinically relevant decreases in pulmonary function were much smaller than previously described, but the majority of the observed variability in pulmonary function was not explained by the radiographic characteristics of the deformity.

Conclusions: Some patients with adolescent idiopathic scoliosis may have clinically relevant pulmonary impairment that is out of proportion with the severity of the scoliosis, and this may alter the decision-making process regarding which fusion technique will produce an acceptable clinical result with the least additional effect on pulmonary function.

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