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Machida M, Rocos B, Machida M, Nomura K, Nemoto N, Oikawa N, Taira K. The Prevalence of Scoliosis after Fontan Circulation Surgery Followed-Up to Adolescence. Spine Surg Relat Res 2024; 8:212-217. [PMID: 38618220 PMCID: PMC11007251 DOI: 10.22603/ssrr.2023-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/10/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction The advancement of surgical techniques and perioperative management for congenital heart disease (CHD) has increased life expectancy. The surgical creation of the Fontan circulation maintains pulmonary blood flow without relying on an effective pump from the abnormal heart, relying on peripheral vascular resistance to maintain effective flow through the lungs. Unfortunately, this delicate mechanism is compromised when scoliosis restricts ventilation, leading to Fontan failure and a poor prognosis for life. This report describes the prevalence of scoliosis with Fontan completion surgery and the role of screening and surgical correction. Methods Ninety-six consecutive Japanese patients undergoing Fontan completion surgery for CHD between 2000 and 2017 were identified in our institutional records. The inclusion criterion was at least 7 years of follow-up after Fontan completion surgery, while the exclusion criteria were congenital, syndromic, and neuromuscular scoliosis. Radiographic and clinical parameters, including cardio-thoracic ratio (CTR) for cardiomegaly and cyanosis saturation, were compared between with and without scoliosis. Results There were 23 and 40 patients in the scoliosis and no scoliosis groups, respectively. The mean age at the final follow-up was 18.5 and 16.7 years in the scoliosis and no scoliosis groups, respectively (p=0.02). Mean CTR was 43.7% and 39.4% in the scoliosis and no scoliosis groups (p=0.016), and the mean saturation in room air at the final follow-up was 88.8% and 93.2%, respectively (p=0.036). There were no significant differences to clarify the risk factors with multivariate logistic regression analysis. Conclusions The prevalence of scoliosis with Fontan completion surgery was 36.5%. Screening for scoliosis is important for children with Fontan circulation surgery as part of their routine follow-up at least until they reach adolescence. Evidence Level: 4.
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Affiliation(s)
- Masayoshi Machida
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Brett Rocos
- Division of Spine Surgery, Duke Orthopedic Surgery, Durham, USA
| | - Masafumi Machida
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Koji Nomura
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Naho Nemoto
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Noboru Oikawa
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Katsuaki Taira
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
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Manzak Dursun AS, Ozyilmaz S, Ucgun H, Elmadag NM. The effect of Pilates-based exercise applied with hybrid telerehabilitation method in children with adolescent idiopathic scoliosis: A randomized clinical trial. Eur J Pediatr 2024; 183:759-767. [PMID: 37993666 DOI: 10.1007/s00431-023-05340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
This study aimed to investigate the effect of Pilates-based exercise training applied with hybrid telerehabilitation on Cobb angle, respiratory function, respiratory muscle strength, and functional capacity in patients with adolescent idiopathic scoliosis (AIS). This is an evaluator-blinded, randomized, controlled trial. For the study, 32 patients were randomly allocated into two groups: a hybrid telerehabilitation group (training group), provided with modified Pilates-based exercises with synchronous sessions; and a home-based group (control group), doing the same exercises in their home. The Pilates-based exercise program consists of stretching and strengthening exercises combined with postural corrections and breathing exercises modified according to the curve type and localization of the patients, done every day of the week for 12 weeks. Analyses were made based on the comparison between the angle of trunk rotation, Cobb angle, spirometry, maximal inspiratory (MIP) and expiratory pressures (MEP), and incremental shuttle walk tests done at the beginning and end of the study. The training group showed statistically significant improvements in Cobb angle, PEF%, MIP, and MEP values compared with the control group (p < 0.05). CONCLUSION Pilates-based exercises applied with the hybrid telerehabilitation method can improve Cobb angle and respiratory muscle strength in patients with AIS. The hybrid telerehabilitation method can be used as an alternative to home-based programs, especially in locations and times where there may be limited access to supervised training. Also, the nature of the disease that requires long-term follow-up is another factor where hybrid telerehabilitation may be an advantage. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05761236. WHAT IS KNOWN • Exercise training is one of the main approaches to treating scoliosis. WHAT IS NEW • Application of exercises via telerehabilitation method may contribute more to the improvement of scoliosis-related parameters than home-based programs. • Telerehabilitation may be a preferable alternative exercise method in scoliosis, considering the advantages of accessibility and long-term follow-up.
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Affiliation(s)
- Ayse Sena Manzak Dursun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, 34050, Istanbul, Turkey
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
| | - Semiramis Ozyilmaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, 34050, Istanbul, Turkey.
| | - Hikmet Ucgun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Nuh Mehmet Elmadag
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Roggio F, Trovato B, Sortino M, Onesta MP, Petrigna L, Musumeci G. The Role of Muscle Biomarkers in Adolescent Idiopathic Scoliosis. J Clin Med 2023; 12:7616. [PMID: 38137689 PMCID: PMC10743897 DOI: 10.3390/jcm12247616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the predominant orthopedic disorder in children, affecting 1-3% of the global population. Research in this field has tried to delineate the genetic factors behind scoliosis and its association with heredity since AIS is considered a polygenic disease and has different genetic and epigenetic factors. The current study conducted a narrative review of the literature, focusing on biomarkers in the pathophysiology of muscle in AIS patients. Articles were collected from Scopus, Pubmed, and Web of Science. The key screening parameters were scoliosis classification, sampling, and the biomarkers evaluated. This review emphasizes potential key mechanisms and molecular regulators in muscle tissue. While there has been limited focus on the proteins contributing to muscle changes in AIS, significant attention has been given to genomic studies of single-nucleotide polymorphisms, particularly in LBX1. Despite these efforts, the exact causes of AIS remain elusive, with several theories suggesting genetic and hormonal factors. This review identified critical protein biomarkers such as Gi-protein alpha subunits, fibrillin-1 and -2, and various differentially expressed proteins, which may be linked to muscle alterations in AIS. This field of research is still limited due to a lack of homogeneity in the distinction of patients by groups and curve severity. Although the pathophysiology of AIS is still unclear, molecular research is important to guide the treatment of AIS before achieving skeletal maturity, thus avoiding serious problems associated with posture changes and low quality of life. In the future, a more comprehensive synergy between orthopedic and molecular research might ameliorate the diagnosis and treatment of AIS patients.
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Affiliation(s)
- Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy
| | - Bruno Trovato
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | - Martina Sortino
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | | | - Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n 97, 95123 Catania, Italy
- Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
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Miyagi M, Saito W, Mimura Y, Nakazawa T, Imura T, Shirasawa E, Uchida K, Ikeda S, Kuroda A, Inoue S, Yokozeki Y, Tanaka Y, Akazawa T, Takaso M, Inoue G. Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1090. [PMID: 37374294 DOI: 10.3390/medicina59061090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Background and objectives: Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and pre- or intraoperative traction would be effective for severe spinal deformities but would be invasive. This study aimed to evaluate the outcomes of PSF-only surgery for patients with severe NMS with a Cobb angle > 100°. Materials and Methods: Thirty NMS patients (13 boys and 17 girls; mean age 13.8 years) who underwent PSF-only surgery for scoliosis with a Cobb angle > 100° were included. We reviewed the lower instrumented vertebra (LIV), duration of surgery, blood loss, perioperative complications, preoperative clinical findings, and radiographic findings, including Cobb angle and pelvic obliquity (PO) in the sitting position pre- and postoperatively. The correction rate and correction loss of the Cobb angle and PO were also calculated. Results: The mean duration of surgery was 338 min, intraoperative blood loss was 1440 mL, preoperative %VC was 34.1%, FEV1.0 (%) was 91.5%, and EF was 66.1%. There were eight cases of perioperative complications. The Cobb angle and PO correction rates were 48.5% and 42.0%, respectively. We divided the patients into two groups: the L5 group, in which the LIV was L5, and the pelvis group, in which the LIV was the pelvis. The duration of surgery and PO correction rate in the pelvis group were significantly higher than those in the L5 group. Conclusions: Patients with severe NMS demonstrated severe preoperative restrictive ventilatory impairments. PSF surgery without anterior release or any intra-/preoperative traction showed satisfactory outcomes, including acceptable scoliosis correction and improved clinical findings, even in patients with extremely severe NMS. Instrumentation and fusion to the pelvis for severe scoliosis in patients with NMS showed good PO correction and low correction loss of Cobb angle and PO, but a longer duration of surgery.
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Affiliation(s)
- Masayuki Miyagi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Yusuke Mimura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Shinsuke Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Akiyoshi Kuroda
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Sho Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Yuji Yokozeki
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Yoshihide Tanaka
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
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Is impaired lung function related to spinal deformities in patients with adolescent idiopathic scoliosis? A systematic review and meta-analysis-SOSORT 2019 award paper. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:118-139. [PMID: 36509885 DOI: 10.1007/s00586-022-07371-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/08/2022] [Accepted: 08/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Some teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients remains unclear, which affects clinical management. This systematic review and meta-analysis aimed to summarize the associations between various lung function parameters and radiographic features in teenagers with AIS. METHODS A search of PubMed, Embase, PEDro, SPORTDiscus, CINAHL, Cochrane Library, and PsycINFO (from inception to March 14, 2022) without language restriction. Original studies reporting the associations between lung function and spinal deformity in patients with AIS were selected. Independent reviewers extracted data and evaluated the methodological quality of the included studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pearson correlation and 95% confidence intervals were calculated using random-effects meta-analysis. RESULTS Twenty-seven studies involving 3162 participants were included. Limited-quality evidence supported that several spinal parameters were significantly related to lung function parameters (e.g., absolute value and percent of the predicted forced vital capacity (FVC; %FVC), forced expiratory volume in one second (FEV1; %FEV1), and total lung capacity (TLC; %TLC)) in AIS patients. Specifically, meta-analyses showed that main thoracic Cobb angles in the coronal plane were significantly and negatively related to FVC (r = - 0.245), %FVC (r = - 0.302), FEV1 (r = - 0.232), %FEV1 (r = - 0.348), FEV1/FVC ratio (r = - 0.166), TLC (r = - 0.302), %TLC (r = - 0.183), and percent predicted vital capacity (r = - 0.272) (p < 0.001). Similarly, thoracic apical vertebral rotation was negatively associated with %FVC (r = - 0.215) and %TLC (r = - 0.126) (p < 0.05). Conversely, thoracic kyphosis angles were positively related to %FVC (r = 0.180) and %FEV1 (r = 0.193) (p < 0.05). CONCLUSION Larger thoracic Cobb angles, greater apical vertebral rotation angle, or hypokyphosis were significantly associated with greater pulmonary impairments in patients with AIS, although the evidence was limited. From a clinical perspective, the results highlight the importance of minimizing the three-dimensional spinal deformity in preserving lung function in these patients. More research is warranted to confirm these results.
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Vergari C, Skalli W, Abelin-Genevois K, Bernard JC, Hu Z, Cheng JCY, Chu WCW, Assi A, Karam M, Ghanem I, Bassani T, Galbusera F, Sconfienza LM, Brayda-Bruno M, Courtois I, Ebermeyer E, Vialle R, Langlais T, Dubousset J. Spine slenderness is not an early sign of progression in adolescent idiopathic scoliosis. Med Eng Phys 2022; 108:103879. [DOI: 10.1016/j.medengphy.2022.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
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Politarczyk K, Popowicz-Mieloch W, Kotwicki T. Pulmonary Parameters in Adolescents with Severe Thoracic Idiopathic Scoliosis: Comparison Girls versus Boys. Healthcare (Basel) 2022; 10:healthcare10081574. [PMID: 36011232 PMCID: PMC9408572 DOI: 10.3390/healthcare10081574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
The study compared pulmonary parameters, registered at the preoperative examination, in adolescent boys versus girls, both with severe thoracic idiopathic scoliosis. Thirty consecutive boys and 30 consecutive girls with Lenke 1 or 3 type, in the age range 14−18 years, with a Cobb angle of >50° and Risser sign ≥ 3 were enrolled. Corrected body height was used to calculate pulmonary parameters according to the Global Lung Function (GLI 2012) reference values. Significantly higher values of the calculated predicted pulmonary parameters and the upper and lower limit of normal (ULN and LLN), as well as significantly higher absolute values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), were observed in boys than girls; however, the registered FVC and FEV1, expressed as percentages of the predicted values, tended to be lower in boys. The FEV1 z-score difference between boys and girls may suggest a need for more intensive preoperative pulmonary rehabilitation in boys.
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Affiliation(s)
- Katarzyna Politarczyk
- Department of Spine Disorders and Pediatric Orthopaedics, University of Medical Sciences, 61-545 Poznan, Poland
- Correspondence: ; Tel.: +48-661-078-278
| | | | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopaedics, University of Medical Sciences, 61-545 Poznan, Poland
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The Influence of Surgical Correction of Idiopathic Scoliosis on the Function of Respiratory Muscles. J Clin Med 2022; 11:jcm11051305. [PMID: 35268396 PMCID: PMC8911023 DOI: 10.3390/jcm11051305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objective: It is important to introduce respiratory exercises to the therapy of patients after the surgical treatment of adolescent idiopathic scoliosis. Surgical correction is the best way to prevent hypoxia in scoliosis, but whether pulmonary rehabilitation increases the effectiveness of scoliosis surgery has not yet been confirmed. Therefore, the aim of the study was to evaluate the function of respiratory muscles after surgical correction of idiopathic scoliosis. Methods: The study involved 24 patients, aged 13.6 ± 0.6. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured using the Mikro RPM. In all patients, before the procedure, 7 days after and 3 months after the procedure, the MIP and MEP were measured. Results: MIP was the lowest 7 days after the procedure; it was 45.28 cmH2O and was statistically significantly lower compared to the measurement before the procedure (p < 0.001) and 3 months after the procedure (p < 0.001). Conclusions: The degree of curvature of the spine before the procedure does not significantly affect initial values of the strength of respiratory muscles. The level of MIP is not dependent on the type of surgery.
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Rafferty A, Fleming N, Kiely P, Mockler D, Dockrell S. Does exercise therapy improve pulmonary function in patients with Adolescent Idiopathic Scoliosis? Physiother Theory Pract 2022; 39:1095-1105. [PMID: 35176949 DOI: 10.1080/09593985.2022.2034198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Exercise therapy is frequently used for treating patients with Adolescent Idiopathic Scoliosis (AIS) however no previous review has evaluated the effect of exercise therapy on pulmonary function in this population. OBJECTIVE To systematically analyze the literature on the effect of exercise therapy on pulmonary function in patients with AIS. METHODS A systematic electronic database search (CINAHL, Embase, Medline, Web of Science) was conducted. Manual searches of key reviews and studies were also conducted. Studies that included exercise-based interventions to improve pulmonary function in patients with AIS and reported pre- and post-intervention pulmonary function test scores were included. Test scores were compared using standardized mean difference (SMD) between intervention and control groups in randomized control trials (RCT) and mean ± SD between pre- and post-intervention in prospective intervention studies (PI). Methodological quality was assessed using a modified Downs and Black checklist. RESULTS Fifteen studies met the inclusion criteria (six RCTs and nine PIs). Results indicated the positive effect of exercise-based therapy on lung volumes (FVC/VC) and FEV1 in patients with AIS. CONCLUSION Exercise therapy has a positive effect on lung volumes in patients with AIS. The quality of many studies was only 'fair,' therefore more suitably powered higher level clinical trials are required.
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Affiliation(s)
- Anthony Rafferty
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Neil Fleming
- Department of Anatomy, School of Medicine, Trinity College, Level 1, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - Patrick Kiely
- Department of Orthopaedics, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - David Mockler
- Trinity Research, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Sara Dockrell
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
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Çimen O, Öner A, Köksal A, Dirvar F, Mert M. Evaluation of the Parameters Affecting Respiratory Functions at Adolescent Idiopathic Scoliosis Patients. Clin Spine Surg 2022; 35:E236-E241. [PMID: 34039890 DOI: 10.1097/bsd.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective observational study. OBJECTIVE The objective of the study was to evaluate the spinal and extraspinal factors responsible for pulmonary dysfunction in adolescent idiopathic scoliosis patients. SUMMARY OF BACKGROUND DATA Development of thoracic deformity due to scoliosis results with the restrictive ventilatory pattern and the reduced pulmonary function. To prevent pulmonary function deterioration, it is imperative to understand which factors are causing the restrictive lung disease in adolescent idiopathic scoliosis patients. MATERIALS AND METHODS An online database search was conducted in a hospital computerized archive between 2008 and 2018 years. Cobb angle of >30 degrees, Lenke type 1 and 2 patients treated in a single spine unit were included. Coronal and sagittal Cobb angle, bending correction rate for evaluation of flexibility, Risser score, apical vertebra rotation (AVR), and pulmonary function test of patients were obtained. RESULTS There was a moderate negative correlation between forced expiratory volume in the first second, forced vital capacity, and AVR. There was no correlation between forced expiratory volume in the first second and forced vital capacity with age, sex, Cobb angle, Risser score, kyphosis, and bending correction rate. CONCLUSIONS When considering the results of the current study and the other studies in the literature there is not any strong correlation between the features of scoliotic curvature and respiratory functions. In the current study, 52 (72.22%) of 72 patients with moderate to severe scoliosis had mild to severe respiratory dysfunction. Considering the age-related physiological respiratory loss, to evaluate the necessity of surgical treatment in patients with moderate and severe scoliosis, especially in patients with high AVR, the respiratory functions of the patient should also be evaluated. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Osman Çimen
- Department of Orthopedics and Traumatology, Ministry of Health Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
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Spirometry Examination of Adolescents with Thoracic Idiopathic Scoliosis: Is Correction for Height Loss Useful? J Clin Med 2021; 10:jcm10214877. [PMID: 34768398 PMCID: PMC8584555 DOI: 10.3390/jcm10214877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Loss of body height is observed in patients with idiopathic scoliosis (IS) due to spine curvatures. The study compared pulmonary parameters obtained from spirometry examination considering the measured versus the corrected body height. One hundred and twenty adolescents with Lenke type 1 or 3 IS who underwent preoperative spirometry examination and radiographic evaluation were enrolled. The mean thoracic Cobb angle was 68° ± 12.6, range 48-102°. The difference between the measured and the corrected body height increased with the greater Cobb angle. Using the corrected body height instead of the measured body height significantly changed the predicted values of pulmonary parameters and influenced the interpretation of the pulmonary testing results.
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Inao T, Amano M, Hashimoto S, Izumi C, Tamaki Y, Tamura T, Taguchi Y, Hajiro T. Rapid Improvement of Severe Pulmonary Hypertension Due to Scoliosis-related Restrictive Ventilatory Disorder. Intern Med 2021; 60:3289-3293. [PMID: 33967134 PMCID: PMC8580779 DOI: 10.2169/internalmedicine.6525-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Few reports have highlighted the serial changes in pulmonary hypertension during respiratory management. An 18-year-old girl with severe scoliosis was referred to our hospital for worsening dyspnea on exertion. Based on chest X-ray and transthoracic echocardiography findings showing a tricuspid regurgitation pressure gradient (TRPG) of 64 mmHg, the patient was diagnosed with severe alveolar hypoventilation due to thoracic deformity and severe pulmonary hypertension. Her oxygenation improved rapidly under noninvasive positive pressure ventilation, although partial pressure of carbon dioxide remained >80 Torr. Transthoracic echocardiography on day 7 showed clinically significant and rapid improvement of pulmonary hypertension with a TRPG of 30 mmHg.
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Affiliation(s)
- Takashi Inao
- Department of Respiratory Medicine, Shinko Hospital, Japan
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
- Department of Cardiology, Tenri Hospital, Japan
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
- Department of Cardiology, Tenri Hospital, Japan
| | - Yodo Tamaki
- Department of Cardiology, Tenri Hospital, Japan
| | | | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Takashi Hajiro
- Department of Respiratory Medicine, Tenri Hospital, Japan
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Immediate Effects of Sforzesco ® Bracing on Respiratory Function in Adolescents with Idiopathic Scoliosis. Healthcare (Basel) 2021; 9:healthcare9101372. [PMID: 34683052 PMCID: PMC8535408 DOI: 10.3390/healthcare9101372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022] Open
Abstract
The thoraco-lumbar bracing is an effective management of adolescent idiopathic scoliosis (AIS). Studies have shown that brace wearing reduces lung volume. Whether or not the Sforzesco brace, frequently used in Italy, affects lung volume has not been investigated. We studied the immediate effect of Sforzesco bracing on lung volumes in 11 AIS patients (10 F, 1 M; aged 13.6 ± 1.6 yrs) mean Cobb angle 26 ± 4.49 degrees. Lung function variables and the perceived respiratory effort were recorded twice, before and 5 min after bracing. The one-way analysis of variance repeated measures, and multiple comparison tests, showed that means of unbraced variables were not significantly different from the corresponding means of predicted values, whereas means under brace were significantly lower (p < 0.05) compared to both predicted and baseline values of respiratory variables. In addition, a significant correlation (p < 0.0001) was found between unbraced and braced values, and linear regression equations were calculated. A significant but clinically unimportant increase in perceived effort was observed under the brace. In conclusion, data indicate that lung function is not impaired in moderate AIS and that wearing the Sforzesco brace causes an immediate, predictable reduction of lung volumes. Data also suggest that the respiratory discomfort during brace wearing could not be due to respiratory function defects.
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14
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Schlager B, Krump F, Boettinger J, Jonas R, Liebsch C, Ruf M, Beer M, Wilke HJ. Morphological patterns of the rib cage and lung in the healthy and adolescent idiopathic scoliosis. J Anat 2021; 240:120-130. [PMID: 34346505 PMCID: PMC8655162 DOI: 10.1111/joa.13528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023] Open
Abstract
The morphology of the rib cage affects both the biomechanics of the upper body's musculoskeletal structure and the respiratory mechanics. This becomes particularly important when evaluating skeletal deformities, as in adolescent idiopathic scoliosis (AIS). The aim of this study was to identify morphological characteristics of the rib cage in relation to the lung in patients with non‐deformed and scoliotic spines. Computed tomography data of 40 patients without any visible spinal abnormalities (healthy group) and 21 patients with AIS were obtained retrospectively. All bony structures as well as the right and left lung were reconstructed using image segmentation. Morphological parameters were calculated based on the distances between characteristic morphological landmarks. These parameters included the rib position, length, and area, the rib cage depth and width, and the rib inclination angle on either side, as well as the spinal height and length. Furthermore, we determined the left and right lung volumes, and the area of contact between the rib cage and lung. Differences between healthy and scoliotic spines were statistically analysed using the t‐test for unpaired data. The rib cage of the AIS group was significantly deformed in the dorso‐ventral and medio‐lateral directions. The anatomical proximity of the lung to the ribs was nearly symmetrical in the healthy group. By contrast, within the AIS group, the lung covered a significantly greater area on the left side of the rib cage at large thoracic deformities. Within the levels T1–T6, no significant difference in the rib length, depth to width relationship, or area was observed between the healthy and AIS groups. Inferior to the lung (T7–T12), these parameters exhibited greater variability. The ratio between the width of the rib cage at T6 and the thoracic spinal height (T1–T12) was significantly increased within the thoracic AIS group (1.1 ± 0.08) compared with the healthy group (1.0 ± 0.05). No statistical differences were found between the lung volumes among all the groups. While the rib cage was frequently strongly deformed in the AIS group, the lung and its surrounding ribs appeared to be normally developed. The observed rib hump in AIS appeared to be formed particularly by a more ventral position of the ribs on the concave side. Furthermore, the rib cage width to spinal height ratio suggested that the spinal height of the thoracic AIS‐spine is reduced. This indicates that the spine would gain its growth‐related height after correcting the spinal deformity. These are the important aspects to consider in the aetiology research and orthopaedic treatment of AIS.
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Affiliation(s)
- Benedikt Schlager
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Florian Krump
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Julius Boettinger
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Michael Ruf
- Skoliosechirurgie, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, SRH Klinikum Karlsbad-Langensteinbach gGmbH, Karlsbad, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
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15
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Vergari C, Skalli W, Abelin-Genevois K, Bernard JC, Hu Z, Cheng JCY, Chu WCW, Assi A, Karam M, Ghanem I, Bassani T, Galbusera F, Sconfienza LM, Brayda-Bruno M, Courtois I, Ebermeyer E, Vialle R, Langlais T, Dubousset J. Effect of curve location on the severity index for adolescent idiopathic scoliosis: a longitudinal cohort study. Eur Radiol 2021; 31:8488-8497. [PMID: 33884474 DOI: 10.1007/s00330-021-07944-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/08/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder in children. A severity index was recently proposed to identify the stable from the progressive scoliosis at the first standardized biplanar radiographic exam. The aim of this work was to extend the validation of the severity index and to determine if curve location influences its predictive capabilities. METHODS AIS patients with Cobb angle between 10° and 25°, Risser 0-2, and no previous treatment were included. They underwent standing biplanar radiography and 3D reconstruction of the spine and pelvis, which allowed to calculate their severity index. Patients were grouped by curve location (thoracic, thoracolumbar, lumbar). Patients were followed up until skeletal maturity (Risser ≥ 3) or brace prescription. Their outcome was compared to the prediction made by the severity index. RESULTS In total, 205 AIS patients were included; 82% of them (155/189, 95% confidence interval [74-90%]) were correctly classified by the index, while 16 patients were unclassified. Positive predictive ratio was 78% and negative predictive ratio was 86%. Specificity (78%) was not significantly affected by curve location, while patients with thoracic and lumbar curves showed higher sensitivity (≥ 89%) than those with thoracolumbar curves (74%). CONCLUSIONS In this multicentric cohort of 205 patients, the severity index was used to predict the risk of progression from mild to moderate scoliosis, with similar results of typical major curve types. This index represents a novel tool to aid the clinician and the patient in the modulation of the follow-up and, for progressive patients, their decision for brace treatment. KEY POINTS • The severity index of adolescent idiopathic scoliosis has the potential to detect patients with progressive scoliosis as early as the first exam. • Out of 205 patients, 82% were correctly classified as either stable or progressive by the severity index. • The location of the main curve had small effect on the predictive capability of the index.
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Affiliation(s)
- Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France.
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France
| | - Kariman Abelin-Genevois
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge française, Centre Médico-Chirurgical et de Réadaptation des Massues, Lyon, France
| | - Jean Claude Bernard
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge française, Centre Médico-Chirurgical et de Réadaptation des Massues, Lyon, France
| | - Zongshan Hu
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Jack Chun Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Mohammad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | | | - Eric Ebermeyer
- Unite Rachis, CHU - Hopital Bellevue, Saint-Etienne, France
| | - Raphael Vialle
- Sorbonne Université, Department of Pediatric Orthopaedics, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tristan Langlais
- Sorbonne Université, Department of Pediatric Orthopaedics, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean Dubousset
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France
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16
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There's More to Consider Than Thoracic Spine Height-The Case for Primary Spine Fusion in Older Early-onset Scoliosis Patients. Spine (Phila Pa 1976) 2021; 46:139-142. [PMID: 33181778 DOI: 10.1097/brs.0000000000003802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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17
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Chen J, Sui WY, Yang JF, Deng YL, Xu J, Huang ZF, Yang JL. The radiographic, pulmonary, and clinical outcomes of patients with severe rigid spinal deformities treated via halo-pelvic traction. BMC Musculoskelet Disord 2021; 22:106. [PMID: 33485304 PMCID: PMC7825157 DOI: 10.1186/s12891-021-03953-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/04/2021] [Indexed: 11/12/2022] Open
Abstract
Background The severe rigid deformity patients with pulmonary dysfunction could not tolerate complicated corrective surgery. Preoperative traction are used to reduce the curve magnitude and improve the pulmonary function before surgery, including halo-gravity traction (HGT) and halo-pelvic traction (HPT). The present study aimed to retrospectively compare the radiographic, pulmonary and clinical outcomes of preoperative HGT and HPT in severe rigid spinal deformity with respiratory dysfunction. Methods 81 cases of severe rigid kyphoscoliosis treated with preoperative traction prior to corrective surgery for spinal deformity between 2016 and 2019 were retrospectively reviewed. Two patient groups were compared, HPT group (N = 30) and HGT group (N = 51). Patient demographics, coronal and sagittal Cobb angles and correction rates, pulmonary function, traction time, osteotomy grade, and postoperative neurological complications were recorded for all cases. Results The coronal Cobb angle was corrected from 140.67 ± 2.63 to a mean of 120.17 ± 2.93° in the HGT group, and from 132.32 ± 4.96 to 87.59 ± 3.01° in the HPT group (mean corrections 15.33 ± 1.53 vs. 34.86 ± 3.11 %) (P = 0.001). The mean major sagittal curve decreased from 134.28 ± 3.77 to 113.03 ± 4.57° in the HGT group and from 129.60 ± 8.45 to 65.61 ± 7.86° in the HPT group (P < 0.001); the mean percentage corrections were 16.50 ± 2.13 and 44.09 ± 9.78 % (P < 0.001). A significant difference in the pulmonary function test results was apparent between the two groups; the mean improvements in the FVC% of the HGT and HPT groups were 6.76 ± 1.85 and 15.6 ± 3.47 % (P = 0.024). The HPT group tended to exhibit more FEV% improvement than the HGT group, but the difference was not significant (5.15 ± 2.27 vs. 11.76 ± 2.22 %, P = 0.91). Conclusions Patients with severe rigid kyphoscoliosis who underwent preoperative HPT exhibited better radiographic correction of the deformity, and pulmonary function, and required fewer osteotomies compared to the HGT group. Thus, HPT may be useful for severe rigid spinal deformity patients with pulmonary dysfunction.
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Affiliation(s)
- Jian Chen
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Wen-Yuan Sui
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Jing-Fan Yang
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Yao-Long Deng
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Jing Xu
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Zi-Fang Huang
- Department of Orthopaedic Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jun-Lin Yang
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
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18
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Shi J, Al-Shamli N, Chiang J, Amin R. Management of Rare Causes of Pediatric Chronic Respiratory Failure. Sleep Med Clin 2020; 15:511-526. [PMID: 33131661 DOI: 10.1016/j.jsmc.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The need for long-term noninvasive positive pressure ventilation (NiPPV) in children with chronic respiratory failure is rapidly growing. This article reviews pediatric-specific considerations of NiPPV therapy. Indications for NiPPV therapy can be categorized by the cause of the respiratory failure: (1) upper airway obstruction, (2) musculoskeletal and/or neuromuscular disease, (3) lower respiratory tract diseases, and (4) control of breathing abnormalities. The role of NiPPV therapy in select rare conditions (spinal muscular atrophy, congenital central hypoventilation syndrome, cerebral palsy, scoliosis, and Chiari malformations) is also reviewed.
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Affiliation(s)
- Jenny Shi
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Nawal Al-Shamli
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Jackie Chiang
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada.
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19
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Kazemi K, Rahmani N, Rahimi F, Ravanbakhsh M. The association between spinal column deformity and breathing function: A systematic review. J Bodyw Mov Ther 2020; 24:172-180. [PMID: 32825985 DOI: 10.1016/j.jbmt.2020.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/07/2019] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Khadijeh Kazemi
- Musculoskeletal Research Center, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd., PO Box 33133 -61357, Ahvaz, Iran
| | - Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rahimi
- Musculoskeletal Research Center, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd., PO Box 33133 -61357, Ahvaz, Iran
| | - Majid Ravanbakhsh
- Musculoskeletal Research Center, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd., PO Box 33133 -61357, Ahvaz, Iran.
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20
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Demura S, Watanabe K, Suzuki T, Saito T, Yamamoto T, Kotani T, Nohara A, Tsuji T, Ogura Y, Tsuchiya H, Uno K, Matsumoto M, Kawakami N. Comparison of Pulmonary Function After Selective Anterior Versus Posterior Fusion for the Correction of Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis. Global Spine J 2020; 10:433-437. [PMID: 32435563 PMCID: PMC7222688 DOI: 10.1177/2192568219859573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVES To compare the selective anterior spinal fusion (ASF) versus posterior spinal fusion (PSF) on postoperative pulmonary function testing (PFT) whether thoracotomy with separation of the diaphragm by anterior approach influences the PFT in thoracolumbar and lumbar adolescent idiopathic scoliosis (AIS). METHODS A multicenter series of AIS patients who underwent selective spinal fusion were retrospectively reviewed. Seventy-nine female patients were included (mean 15.8 years). There were 35 patients in the ASF group and 44 patients in the PSF group. Patient demographics, radiographic measurements, and PFT data from preoperative to 2-year follow-up were analyzed. RESULTS Preoperatively, there were no significant differences in PFTs between the groups. The ASF group patients were more likely to undergo shorter fusions (4.5 instrumented vertebral levels) than those in the PSF group (5.2 levels). At 2-year follow-up, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) in ASF group were statistically lower than those in PSF group. When comparing preoperative and 2-year changes on each procedure, only %FVC showed significant difference in ASF while FVC, FEV1, and %FEV1 did not. Meanwhile, the ASF group showed a significant decrease in FVC at 6 and 12 months compared to preoperative values. In PSF group, there was a decrease at 6 months, returned to preoperative value at 1-year follow-up. CONCLUSIONS Pulmonary function after ASF and PSF was similar at 2 years; however, anterior group did not return to the baseline at 6 months and 1 year suggesting anterior approach may affect early postoperative pulmonary function.
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Affiliation(s)
- Satoru Demura
- Kanazawa University, Kanazawa, Japan,Satoru Demura, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | | | - Teppei Suzuki
- National Hospital Organization, Kobe Medical Center, Kobe, Japan
| | | | | | | | | | | | | | | | - Koki Uno
- National Hospital Organization, Kobe Medical Center, Kobe, Japan
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21
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Burjek NE, Rao KE, Wieser JP, Evans MA, Toaz EE, Balmert LC, Sarwark JF, Jagannathan N. Preoperative Pulmonary Function Test Results Are Not Associated With Postoperative Intubation in Children Undergoing Posterior Spinal Fusion for Scoliosis: A Retrospective Observational Study. Anesth Analg 2020; 129:184-191. [PMID: 31210654 DOI: 10.1213/ane.0000000000004143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Preoperative pulmonary function tests are routinely obtained in children with scoliosis undergoing posterior spinal fusion despite unclear benefits as a perioperative risk assessment tool and frequent inability of patients to provide acceptable results. The goal of this study was to determine whether preoperative pulmonary function test results are associated with the need for postoperative intubation or intensive care unit admission after posterior spinal fusion. METHODS The electronic medical records of patients who underwent posterior spinal fusion at a pediatric tertiary hospital between June 2012 and August 2017 were reviewed. Pulmonary function tests were consistently ordered for all patients, unless the patient was deemed unable to perform the test due to cognitive disability. Cases were categorized as primary or secondary scoliosis.Demographic data, preoperative bilevel positive airway pressure use, Cobb angle, intraoperative allogeneic blood transfusion, and ability to produce acceptable pulmonary function test results were collected for each patient. In patients with satisfactory pulmonary function test results, forced vital capacity and maximum inspiratory pressure were collected. Primary outcomes for analysis were postoperative intubation and intensive care unit admission. Univariable logistic regression models were used to assess the association between each variable of interest and the primary outcomes. RESULTS The study sample included 433 patients, 288 with primary scoliosis and 145 with secondary scoliosis. Among patients with primary scoliosis, 90% were able to produce acceptable pulmonary function test results, zero remained intubated postoperatively, and 6 were admitted to the intensive care unit. Among patients with secondary scoliosis, 44% could not attempt pulmonary function tests. Among those who did attempt the test, 30% were unable to produce meaningful results. Forced vital capacity and maximum inspiratory pressure were not found to be associated with postoperative intubation or intensive care unit admission. Weight, Cobb angle, intraoperative blood transfusion, American Society of Anesthesiologists physical status classification, and preoperative bilevel positive airway pressure use were associated with patient outcomes. Among 357 total patients who attempted pulmonary function tests, 37 had high-risk results. Only 1 of these 37 patients remained intubated postoperatively. CONCLUSIONS Patients undergoing posterior spinal fusion, especially those with secondary scoliosis, are frequently unable to adequately perform pulmonary function tests. Among patients with interpretable pulmonary function tests, there was no association between results and postoperative intubation or intensive care unit admission. Routine pulmonary function testing for all patients with scoliosis may not be indicated for purposes of risk assessment before posterior spinal fusion. Clinicians should consider a targeted approach and limit pulmonary function tests to patients for whom results may guide preoperative optimization as this may improve outcomes and reduce inefficiencies and costs.
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Affiliation(s)
- Nicholas E Burjek
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristen E Rao
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John P Wieser
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michael A Evans
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin E Toaz
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren C Balmert
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John F Sarwark
- Division of Orthopaedic Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Narasimhan Jagannathan
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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22
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Xavier VB, Avanzi O, de Carvalho BDMC, Alves VLDS. Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: a randomised trial. J Physiother 2020; 66:33-38. [PMID: 31859153 DOI: 10.1016/j.jphys.2019.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/25/2019] [Indexed: 11/17/2022] Open
Abstract
QUESTION In adolescents with idiopathic scoliosis, does combined aerobic and resistance training improve respiratory function, perceived exertion and functional exercise capacity more than aerobic training only? DESIGN Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS Forty adolescents with idiopathic scoliosis and formal indication for surgical correction (spinal curvature ≥ 45 deg). INTERVENTION Both groups undertook three 60-minute training sessions per week for 12 weeks. The experimental group performed combined aerobic and resistance training and the control group performed only aerobic training. OUTCOME MEASURES At baseline and upon completion of treatment, participants completed: a 6-minute walk test with Borg scale (0 to 10) rating of exertion, spirometry, maximal respiratory pressures and peak expiratory flow measurement. RESULTS After 12 weeks of training, the experimental group improved more than the control group on the 6-minute walk test (MD 22 m, 95% CI 4 to 40), with lower perceived exertion at the end of the test (MD -1.2, 95% CI -1.9 to -0.4). The experimental group also improved more than the control group on several respiratory measures, including: FEV1 (MD 270 ml, 95% CI 30 to 510), maximal inspiratory pressure (MD 4 cmH2O, 95% CI 1 to 8) and peak expiratory flow (MD 33 l/minute, 95% CI 7 to 58). CONCLUSION In adolescents with idiopathic scoliosis, combined aerobic and resistance training improves functional exercise capacity and several respiratory outcomes more than a similar training regimen with aerobic training only. It is unclear whether the magnitude of the benefits is large enough to be worthwhile. TRIAL REGISTRATION NCT02413788.
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Affiliation(s)
| | - Osmar Avanzi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Vera Lúcia Dos Santos Alves
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil; Universidade de Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil.
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23
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Villamor GA, Andras LM, Redding G, Chan P, Yang J, Skaggs DL. A Comparison of Maximal Voluntary Ventilation and Forced Vital Capacity in Adolescent Idiopathic Scoliosis Patients. Spine Deform 2019; 7:729-733. [PMID: 31495472 DOI: 10.1016/j.jspd.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/15/2019] [Accepted: 02/09/2019] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Prospective, single center. OBJECTIVE To compare maximal voluntary ventilation (MVV) and forced vital capacity (FVC) testing in the outpatient scoliosis clinic to determine their relative feasibility and sensitivity in assessing pulmonary function in the AIS population. SUMMARY OF BACKGROUND DATA Evidence of compromised pulmonary function in patients with severe AIS is well established. The American Thoracic Society (ATS) has established criteria for the reliability and accuracy of pulmonary function tests (PFTs), including MVV and FVC. METHODS A total of 91 AIS patients with thoracic curves of 20° or greater were enrolled in the orthopedic clinic. Patients performed PFTs using the CareFusion MicroLoop Spirometer. MVV and FVC values were collected. Results were considered reliable or "passing" when ATS spirometer guidelines were met. RESULTS Eighty-seven of the 91 patients (96%) met ATS criteria for the MVV test and 43 of the 91 patients (47%) met criteria for the FVC test. Both MVV (r = -0.41, p < .01) and FVC (r = -0.37, p = .01) were significantly correlated with thoracic Cobb angle. The percentile predicted (%predicted) MVV (r = -0.24, p = .03) and %predicted FVC (r = -0.32, p = .04) were also significantly correlated with thoracic Cobb angle. Of those who passed both tests (42/91 patients), 26% had abnormal MVV results with normal FVC results, and 5% had abnormal FVC results with normal MVV results. CONCLUSION MVV and FVC correlated closely with Cobb angle. Twice as many AIS patients could perform an MVV test compared with an FVC test. MVV seems to be a more practical and sensitive PFT than FVC for assessing the pulmonary function of AIS patients in the orthopedic clinic setting. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Gabriela A Villamor
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Lindsay M Andras
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Greg Redding
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Priscella Chan
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Joshua Yang
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - David L Skaggs
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
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Zhao H, Hu Z, Zhao D, Wang F, Zhong R, Liang Y. The valuation of concave-side thoracoplasty on the treatment of extremely severe scoliosis with severe pulmonary dysfunction on the base of halo-pelvic traction. Medicine (Baltimore) 2019; 98:e17073. [PMID: 31490408 PMCID: PMC6739012 DOI: 10.1097/md.0000000000017073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extremely severe scoliosis patients, especially main thoracic Cobb' s angle >150°, often have severe thoracic deformity and pulmonary dysfunction, even the scoliosis is reduced by halo-pelvic traction, the improvement of pulmonary function is not satisfactory, the risk of spinal osteotomy in the next stage is still very high and left with obvious thoracic deformity. How to further improve the pulmonary function and appearance of these patients is a difficult problem to be solved.Twenty extremely severe scoliosis patients with severe pulmonary dysfunction who underwent concave-side thoracoplasty in our hospital from September 2014 to September 2017 were included, data of thoracic volume and pulmonary function were collected before and after operation. The pulmonary function value reported was predicted forced vital capacity (FVC%), T-test was used to analyze the changes of the data by the statistical software SPSS21.0.The 20 patient's averaged Cobb's angle of main thoracic was 163° ± 8° at admission and all of them with severe pulmonary dysfunction before concave-side thracoplasty. After operation, the thoracic volume of patients increased by 500.9 ± 222.9 mL, FVC% increased by 8.9% ± 7.5%. Both the difference has statistical significance (P < .01).Concave-side thoracoplasty based on the halo-pelvic traction cannot only enlarge the volume of the concave thoracic cavity, lighten the compression of lung and further improve the pulmonary function of extremely severe scoliosis, but also can strengthen the correction of scoliosis and spinal rotation. Therefore, it is a safe and effective surgical approach.
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Affiliation(s)
| | - Zhengjun Hu
- Department of Orthopedics, The Third People's Hospital of Chengdu, Chengdu, China
| | - Deng Zhao
- Department of Orthopedics, The Third People's Hospital of Chengdu, Chengdu, China
| | - Fei Wang
- Department of Orthopedics, The Third People's Hospital of Chengdu, Chengdu, China
| | - Rui Zhong
- Department of Orthopedics, The Third People's Hospital of Chengdu, Chengdu, China
| | - Yijian Liang
- Department of Orthopedics, The Third People's Hospital of Chengdu, Chengdu, China
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Yaszay B, Jankowski PP, Bastrom TP, Lonner B, Betz R, Shah S, Asghar J, Miyanji F, Samdani A, Newton PO. Progressive decline in pulmonary function 5 years post-operatively in patients who underwent anterior instrumentation for surgical correction of adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1322-1330. [PMID: 30798454 DOI: 10.1007/s00586-019-05923-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 01/17/2019] [Accepted: 02/12/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate changes in pulmonary function tests (PFT) at 5 years post-operatively in patients with adolescent idiopathic scoliosis (AIS) and to determine whether these changes are progressive or static after 2 years. METHODS AIS surgical patients with pre-operative and 5 year post-operative forced expiratory volume (FEV) and forced vital capacity (FVC) were included. The percentage of patients with pulmonary impairment at 5 years was calculated. Repeated measures ANOVA was used to evaluate changes between pre-operative PFT and 5 years post-operative PFT and to determine whether the changes differed between curve types and approach. A sub-analysis of patients with 2 year data was performed to determine whether PFT changes were static or progressive. RESULTS Two hundred and sixty-two patients had undergone pre-operative and 5 year post-operative PFTs. At 5 years, 42% were normal, 41% had mild impairment, and 17% had moderate-severe impairment. Overall, there was a decline in % predicted FVC (p < 0.05); FEV remained stable. There was no difference based on major curve type (p > 0.05). Anterior instrumentation cases declined significantly between pre-operative PFT and 5 years post-operative PFT (FEV: - 10% open, - 6% thoracoscopic; FVC: - 13% open, - 8% thoracoscopic) (p ≤ 0.02). The posterior cases remained stable (2% FEV, p = 0.7; - 0.6% FVC, p = 0.06). A subgroup of 90 patients with 2 year post-operative PFTs demonstrated that changes were progressive between 2 and 5 years post-operatively. The average change in FVC from 2 to 5 years was significantly different between the anterior open (- 9%) and posterior-only (0.7%) groups (p = 0.015). CONCLUSION In patients who underwent anterior instrumentation, PFTs declined from the pre-operative to the 5 years post-operative time point. There was a progressive decline of 4-10% beyond 2 years post-operatively. Patients who underwent posterior instrumentation remained stable. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Burt Yaszay
- Rady Children's Hospital, 3020 Children's Way, MC5062, San Diego, CA, 92123, USA.
| | | | - Tracey P Bastrom
- Rady Children's Hospital, 3020 Children's Way, MC5062, San Diego, CA, 92123, USA
| | | | - Randal Betz
- The Institute for Spine and Scoliosis, Lawrenceville, NJ, USA
| | - Suken Shah
- Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Firoz Miyanji
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Amer Samdani
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - Peter O Newton
- Rady Children's Hospital, 3020 Children's Way, MC5062, San Diego, CA, 92123, USA
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Abstract
STUDY DESIGN Observational study of ribcage motion in scoliosis. OBJECTIVE To see whether noninvasive ventilation corrected paradoxical inward motion of the ribs during inspiration. SUMMARY OF BACKGROUND DATA Paradoxical inward motion of the ribs is observed after rib fractures, low cervical cord injury, and in chronic obstructive pulmonary disease. It is not well recognized in scoliosis and the mechanism in this group has not been studied. METHODS Linearized magnetometers were used to measure the diameter of the ribcage. Changes in diameter during tidal breathing were recorded during spontaneous ventilation and noninvasive ventilation in 10 subjects with idiopathic or congenital thoracic scoliosis. RESULTS During spontaneous breathing, the median change in ribcage diameter during inspiration was -1.5 (range -2.3 to -0.8) cm. The median change in ribcage diameter during noninvasive ventilation was +0.5 (range -1.1 to +1.2) cm. Noninvasive ventilation improved paradoxical motion in all subjects, completely correcting it in six. CONCLUSION Paradoxical inward motion of the ribcage is seen in some subjects with severe scoliosis. This abnormal motion is improved or abolished by noninvasive ventilation. Since noninvasive ventilation takes over the work of breathing from the respiratory muscles, we suggest that inspiratory muscle contraction causes distortion of part of the ribcage in scoliosis, probably because of the abnormal orientation of diaphragmatic muscle fibers. LEVEL OF EVIDENCE 2.
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Abraham V, Grewal S, Bhatia G, Kaur N, Raghav W, Jain P, Gupta N, Singh M, George C. Pierre robin sequence with cervicothoracic kyphoscoliosis: An anesthetic challenge. J Anaesthesiol Clin Pharmacol 2018; 34:128-129. [PMID: 29643641 PMCID: PMC5885432 DOI: 10.4103/joacp.joacp_256_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- V Abraham
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - S Grewal
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - G Bhatia
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - N Kaur
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - W Raghav
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - P Jain
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - N Gupta
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - M Singh
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - C George
- Department of Anaesthesiology and Neuro Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:3. [PMID: 29435499 PMCID: PMC5795289 DOI: 10.1186/s13013-017-0145-8] [Citation(s) in RCA: 408] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). METHODS Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. RESULTS The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. CONCLUSION The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.
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Affiliation(s)
- Stefano Negrini
- Clinical and Experimental Sciences Department, University of Brescia Viale Europa 11, Brescia, Italy
- IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Angelo Gabriele Aulisa
- U.O.C. of Orthopedics and Traumatology, Children’s Hospital Bambino Gesù, Institute of Scientific Research, 00165 Rome, Italy
| | - Dariusz Czaprowski
- Center of Body Posture, Olsztyn, Poland
- Department of Physiotherapy, Józef Rusiecki University College, Olsztyn, Poland
| | - Sanja Schreiber
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Department of Surgery, Edmonton, Canada
| | | | - Helmut Diers
- Department of Orthopedics and Trauma Surgery, University Medical Center, Mainz, Germany
| | - Theodoros B. Grivas
- Department of Orthopaedics and Traumatology, “Tzaneio” General Hospital of Piraeus, Piraeus, Greece
| | - Patrick Knott
- Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| | - Andrea Lebel
- Scoliosis Physiotherapy & Posture Centre, 231 McLeod Street, Ottawa, Ontario K2P0Z8 Canada
| | - Cindy Marti
- Schroth-Barcelona Institute, LLC, Spinal Dynamics of Wisconsin, SC., Barcelona, Spain
| | - Toru Maruyama
- Saitama Prefectural Rehabilitation Center, Saitama, Japan
| | - Joe O’Brien
- National Scoliosis Foundation, Stoughton, MA USA
| | - Nigel Price
- Section of Spine Surgery, Children’s Mercy Hospitals and Clinics, UMKC Orthopedics, Kansas City, MO USA
| | - Eric Parent
- Department of Physical Therapy, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Manuel Rigo
- Salvá SLP (E. Salvá Institute), Vía Augusta 185, 08021 Barcelona, Spain
| | - Michele Romano
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Luke Stikeleather
- National Scoliosis Center, 3023 Hamaker Court, Suite LL-50, Fairfax, VA 22124 USA
| | - James Wynne
- Boston Orthotics & Prosthetics, Boston, MA USA
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
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Abstract
BACKGROUND Scoliosis has been shown to have detrimental effects on pulmonary function, traditionally measured by pulmonary function tests, which is theorized to be correlated to the distortion of the spine and thorax. The changes in thoracic volume with surgical correction have not been well quantified. This study seeks to define the effect of surgical correction on thoracic volume in patients with adolescent idiopathic scoliosis. METHODS Images were obtained from adolescents with idiopathic scoliosis enrolled in a multicenter database (Prospective Pediatric Scoliosis Study). A convenience sample of patients with Lenke type 1 curves with a complete data set meeting specific parameters was used. Blender v2.63a software was used to construct a 3-dimensional (3D) computational model of the spine from 2-dimensional calibrated radiographs. To accomplish this, the 3D thorax model was deformed to match the calibrated radiographs. The thorax volume was then calculated in cubic centimeters using Mimics v15 software. RESULTS The results using this computational modeling technique demonstrated that surgical correction resulted in decreased curve measurement as determined by Cobb method, and increased postoperative thoracic volume as expected. Thoracic volume significantly increased by a mean of 567 mm (P<0.001). The percent change in thoracic volume after surgical correction averaged 40% (range, 3% to 87%). The smaller the baseline volume, the greater the change in volume postoperatively (r=-0.86).Evaluation of postoperative data demonstrated that spinal curve measurement as determined by Cobb method was significantly reduced from a mean of 69 degrees (range, 50 to 96 degrees) preoperatively to 27 degrees (range, 13 to 33 degrees) postoperatively (P<0.001). CONCLUSIONS This pilot study demonstrates methodologic plausibility for measuring 3D changes in thoracic volumes using 2-dimensional imaging. This is an assessment of the novel modeling technique, to be used in larger future studies to assess clinical significance. LEVEL OF EVIDENCE Level 3-retrospective comparison of prospectively collected data.
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Abstract
STUDY DESIGN Descriptive cross-sectional study. OBJECTIVE To measure respiratory muscle function in children with early onset scoliosis (EOS), determine the frequency of respiratory muscle weakness, and correlate these measures with vital capacity, body mass index, and Cobb angle. SUMMARY OF BACKGROUND DATA Progressive restrictive respiratory disease is common among children with moderate to severe EOS. Reduced respiratory muscle strength is associated with the loss of lung function in adolescents and adults with scoliosis. We hypothesized that reduced inspiratory and expiratory respiratory muscle strength also occur in children with EOS and correlate with reduced vital capacity, poor nutritional status, and severity of the spine deformity. METHODS We measured maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), forced vital capacity (FVC), body mass index IBMI), and Cobb angle in 49 children with EOS but with no diagnosis of underlying muscle weakness. We measured these indices in 12 children serially over 18 months to see if abnormal respiratory muscle function was sustained. RESULTS FVC averaged 51% (SD 21) of predicted norms with 26 subjects having an FVC <50% predicted. The mean MIP was 57% (SD 25) and the mean MEP was 53% (SD 23) of predicted norms. Thirteen (27%) of the group had MIP values >2SD below the age and sex-based norms. BMI ranged between 1% and 99% of age-based norms. Cobb angle averaged 59° (SD27). MIP% and MEP% significantly correlated with FVC% (r =0.37, P = 0.01 and r = 0.52, P < 0.001 respectively)) but not with BMI or Cobb angle. Reduced MIP% and MEP% were sustained over 7 to 41 months. CONCLUSION Respiratory muscle weakness is common and persistent in children with EOS and correlates with reductions in vital capacity. Mechanisms for abnormal respiratory function are unclear but must be determined to develop surgical treatment strategies that preserve respiratory muscle function in children with EOS throughout childhood. LEVEL OF EVIDENCE 2.
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Jeans KA, Lovejoy JF, Karol LA, McClung AM. How Is Pulmonary Function and Exercise Tolerance Affected in Patients With AIS Who Have Undergone Spinal Fusion? Spine Deform 2017; 5:416-423. [PMID: 29050719 DOI: 10.1016/j.jspd.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/27/2017] [Accepted: 04/02/2017] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Prospectively enrolled AIS patients who underwent spinal fusion, with 2 year follow-up. OBJECTIVES To evaluate the cardiovascular fitness and activity level in patients with AIS pre- and post-spinal fusion and to determine if initial curve magnitude or pulmonary function is predictive of exercise capacity. SUMMARY OF BACKGROUND DATA Researchers have tried to link pulmonary function testing (PFT) to exercise capacity; the results are mixed. Some report no improvement in PFTs or aerobic activity after surgical correction, and PFT measures were not predictive of exercise capacity. Conflicting results have shown Vo2max results to fall within normal range in AIS patients while PFTs show minimal impairment. METHODS AIS patients underwent PFT and oxygen consumption (VO2) testing during a submaximal graded exercise test (GXT) pre- and post-spinal fusion. Vo2max was predicted in those patients who completed the test to 85% of maximal heart rate. Pre- to postoperative changes were assessed and then compared to age-matched control subjects. Correlations between Vo2max and curve severity, pulmonary function, and activity level were assessed. RESULTS Thirty-seven patients participated. Vo2max was predicted in 23 patients pre- and postoperation. There was a significant reduction in Vo2max postfusion (39.5 ± 6.5 mL/kg/min vs 42.1 ± 8.1 mL/kg/min, p = .033); however, compared with controls (40.5 ± 6.5 mL/kg/min), all data were within the normal range (p > .05). AIS patients reporting high activity had significantly greater Vo2max than those reporting low activity both pre and postoperatively, but this difference only met statistical significance preop (p < .05). Curve magnitude and PFT measures were not found to correlate with Vo2max (p > .05). CONCLUSIONS Vo2max in patients with AIS is within normal range both pre- and postfusion. Pulmonary limitations are accommodated for with a slightly increased breathing rate and a slightly reduced overall workload. Activity level rather than curve severity affects Vo2max outcomes following fusion in AIS.
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Affiliation(s)
- Kelly A Jeans
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA.
| | - John F Lovejoy
- Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA
| | - Lori A Karol
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Anna M McClung
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
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Johari J, Sharifudin MA, Ab Rahman A, Omar AS, Abdullah AT, Nor S, Lam WC, Yusof MI. Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients. Singapore Med J 2017; 57:33-8. [PMID: 26831315 DOI: 10.11622/smedj.2016009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This retrospective review aimed to examine the relationship between preoperative pulmonary function and the Cobb angle, location of apical vertebrae and age in adolescent idiopathic scoliosis (AIS). To our knowledge, there have been no detailed analyses of preoperative pulmonary function in relation to these three factors in AIS. METHODS A total of 38 patients with thoracic or thoracolumbar scoliosis were included. Curvature of spinal deformity was measured using the Cobb method. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were used to evaluate preoperative pulmonary function. Statistical methods were used to analyse the relationship between preoperative pulmonary function and the factors that may contribute to poor pulmonary function. RESULTS The 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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Affiliation(s)
- Joehaimey Johari
- Department of Orthopaedics, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia.,Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
| | - Mohd Ariff Sharifudin
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia.,Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Azriani Ab Rahman
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ahmad Sabri Omar
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
| | | | - Sobri Nor
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
| | - Weii Cheak Lam
- Department of Orthopaedics, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | - Mohd Imran Yusof
- Department of Orthopedics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Gait and energy consumption in adolescent idiopathic scoliosis: A literature review. Ann Phys Rehabil Med 2016; 60:107-116. [PMID: 27986427 DOI: 10.1016/j.rehab.2016.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. The disease can modify human gait. OBJECTIVE We aimed to review articles describing the measurement of gait parameters and energy consumption in AIS during walking without any intervention. STUDY DESIGN Literature review. METHODS The search strategy was based on the Population Intervention Comparison Outcome method and included all relevant articles published from 1996 to 2015. Articles were searched in MEDLINE via PubMed, Science Direct, Google Scholar, and ISI Web of Knowledge databases. RESULTS We selected 33 studies investigating the effect of scoliosis deformity on gait parameters and energy expenditure during walking. Most of the studies concluded no significant differences in walking speed, cadence and step width in scoliosis patients and normal participants. However, patients showed decreased hip and pelvic motion, excessive energy cost of walking, stepping pattern asymmetry and ground reaction force asymmetry. CONCLUSION We lack consistent evidence of the effect of scoliosis on temporal spatial and kinematic parameters in AIS patients as compared with normal people. However, further research is needed to assess the effect of scoliosis on gait and energy consumption.
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Relationship between Lung Volume and Pulmonary Function in Patients With Adolescent Idiopathic Scoliosis: Computed Tomographic-based 3-Dimensional Volumetric Reconstruction of Lung Parenchyma. Clin Spine Surg 2016; 29:E396-400. [PMID: 27642778 DOI: 10.1097/bsd.0000000000000161] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective. OBJECTIVES We determined values for the volume of right lung (Vr), left lung (Vl), total lung volume (Vt), and left/right lung volume ratio (Vl/Vr), allowing comparison between those data measured and those of age-matched controls. To find whether lung volume correlates with preoperative pulmonary function. SUMMARY OF BACKGROUND DATA To our knowledge, no study on relationship between computed tomographic (CT) scans determined lung volume and pulmonary function test (PFT) in scoliosis have been published. METHODS All examinations with PFT (31 cases) were identified. Three-dimensional volumetric reconstruction of lung parenchyma was performed on existing preoperative CT scans for 26 idiopathic scoliosis patients. Vl, Vr, Vt, Vl/Vr, and absolute value of right volume minus left volume (|Vr-Vl|) were calculated and correlated with PFTs. To determine if significant difference of preoperative lung volume exists between idiopathic scoliosis patients and controls. Linear regression models, using 3-dimensional lung volume parameters as predictors for vital capacity (VC), forced vital capacity (FVC), and total lung capacity (TLC), were created. RESULTS Vt was positively correlated with VC, FVC, forced expiratory volume in 1 second (FEV1), TLC, predicted value for FVC (FVC%), predicted value for FEV1 (FEV1%), predicted value for TLC (TLC%), and predicted value for maximal ventilator volume (MVV%) (P<0.05); |Vr-Vl| was not correlated with ventilation parameters (P>0.05); Diffusion parameters were not correlated with CT-reconstructed lung volume parameters (P>0.05); male and female adolescent idiopathic scoliosis patients had less Vt, Vr, and Vl compared with those of age-matched controls (P<0.05). CONCLUSIONS Vt was positively correlated with VC, FVC, FEV1, TLC, FVC%, FEV1%, TLC%, and MVV%. Vt, Vr, and Vl of adolescent idiopathic scoliosis patients were less than those of age-matched controls.
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Yaszay B, Bastrom TP, Bartley CE, Parent S, Newton PO. The effects of the three-dimensional deformity of adolescent idiopathic scoliosis on pulmonary function. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1658-1664. [DOI: 10.1007/s00586-016-4694-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 05/23/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, Stokes IA, Weinstein SL, Burwell RG. Adolescent idiopathic scoliosis. Nat Rev Dis Primers 2015; 1:15030. [PMID: 27188385 DOI: 10.1038/nrdp.2015.30] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.
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Affiliation(s)
- Jack C Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Centre of The Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Winnie C Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Aina J Danielsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthew B Dobbs
- Departments of Orthopaedic Surgery Neurology and Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Theodoros B Grivas
- Trauma and Orthopaedic Department, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Christina A Gurnett
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Keith D Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Alain Moreau
- Viscogliosi Laboratory in Molecular Genetics of Musculoskeletal Diseases, Sainte-Justine University Hospital Research Center, Montreal, Quebéc, Canada.,Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, Quebéc, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebéc, Canada
| | - Peter O Newton
- Department of Orthopedic Surgery, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Ian A Stokes
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Stuart L Weinstein
- Department of Orthopedic Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust - Queen's Medical Centre Campus, Nottingham, UK
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Body Mass Index as an Indicator of Pulmonary Dysfunction in Patients With Adolescent Idiopathic Scoliosis. ACTA ACUST UNITED AC 2015; 28:226-31. [DOI: 10.1097/bsd.0b013e31825d97df] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fu J, Liu C, Zhang YG, Zheng GQ, Zhang GY, Song K, Tang XY, Wang Y. Three-dimensional computed tomography for assessing lung morphology in adolescent idiopathic scoliosis following posterior spinal fusion surgery. Orthop Surg 2015; 7:43-9. [PMID: 25708035 DOI: 10.1111/os.12151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the changes in lung morphology in subjects with adolescent idiopathic scoliosis (AIS) following posterior spinal fusion surgery. METHODS From April 2009 to August 2013, 30 AIS patients (nine males and 21 females) were enrolled in this study. All scans were obtained with the patient in the supine position and the breath held in deep inspiration and performed both before and after surgery. Syngo software was used to manage the computed tomography scan imaging and to calculate the lung volume, lung height and pulmonary cross-sectional area in the apical vertebral plane. RESULTS Left lung, right lung and total lung volumes and convex to concave lung volume ratio did not change significantly after corrective surgery. There was a statistically significant improvement in left lung and right lung heights after posterior spinal fusion surgery. However, the pulmonary cross-sectional area in the apical vertebrae plane was smaller postoperatively than preoperatively. CONCLUSIONS This study showed that lung height in AIS patients increased significantly immediately postoperatively whereas lung volume did not change significantly. Thoracic symmetry was improved postoperatively in these patients.
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Affiliation(s)
- Jun Fu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
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Scoliosis and chest cage deformity measures predicting impairments in pulmonary function: a cross-sectional study of 492 patients with scoliosis to improve the early identification of patients at risk. Spine (Phila Pa 1976) 2014; 39:2024-33. [PMID: 25202929 DOI: 10.1097/brs.0000000000000601] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study examines the correlations between pulmonary function tests (PFTs) and radiographical measures of spinal deformities in patients with scoliosis. OBJECTIVE To define the parameters that enable more accurate predictions of restricted pulmonary function (PF) in patients with scoliosis. SUMMARY OF BACKGROUND DATA The early identification of patients with scoliosis who are at risk of developing severe curve progression and restricted PF is critical to improving patient care. METHODS A total of 492 patients with a thoracic/thoracolumbar curve (TC) and preoperative PFTs as well as radiographical analysis of the TC and thoracic kyphosis (TK) were assessed. The forced vital capacity (FVC) was expressed as a percentage of the predicted value (FVC%). According to guidelines for the severity of pulmonary impairments, classifications were used: no impairment (FVC > 80%), mild (65 < FVC ≤ 80%), moderate (50 < FVC ≤ 65), and severe impairment (FVC ≤ 50%). Main radiographical parameters were included and statistical analyses were used to identify radiographical predictors and to develop prediction models. RESULTS The average age was 17 years, 94% of the patients had adolescent idiopathic scoliosis, 20% had lordoscoliosis (TK <10°). The average FVC% was 75% ± 17%, their average TC was 57° ± 21°, and TK was 26° ± 25°. A total of 38% had no impairment, 37% exhibited mild impairment, 15% had moderate impairments, and 10% were severely impaired. Spinal deformities identified by radiographical analysis (TC, TC-flexibility, apical vertebral rotation, TK, and rib hump) significantly influenced FVC% (P < 0.01). TK logistic regression analysis revealed that 2 factors are predictive for an FVC 50% or less: increased scoliosis with a low TK less than 0° (odds ratio = 7.3) or a high TK more than 60° (odds ratio = 20). A model for predicting FVC values more than 50% was established and shown to achieve a correct classification rate of 94%. CONCLUSION Patients with increasing coronal and sagittal plane deformities with a high thoracic scoliosis apex are at the highest risk for reduced FVC%. The models developed provided improved estimations of actual PF based on the magnitude of the radiographical deformity.
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Functional aerobic exercise capacity limitation in adolescent idiopathic scoliosis. Spine J 2014; 14:2366-72. [PMID: 24486477 DOI: 10.1016/j.spinee.2014.01.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 10/17/2013] [Accepted: 01/17/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Exercise limitation has been described in patients with adolescent idiopathic scoliosis (AIS); however, whether the walking performance is impaired in these patients should be elucidated. PURPOSE Thus, we aimed to evaluate the physiologic responses to the incremental shuttle walk test (ISWT) in patients with AIS. STUDY DESIGN/SETTING Cross-sectional study. PATIENT SAMPLE Twenty-nine patients with AIS and 20 healthy adolescents aged between 11 and 18 years old. OUTCOME MEASURES Oxygen uptake (VO₂), incremental shuttle walk distance (ISWD), ΔVO₂/Δwalking velocity, ΔHR/ΔVO₂, ΔVE/ΔVCO₂, and linearized Δtidal volume (VT)/ΔlnVE, forced expiratory volume in the first second of expiration (FEV1), and forced vital capacity (FVC). METHODS We performed two ISWTs, and the data used were acquired in the second test. We also evaluated the lung function and respiratory muscle strength through spirometry test and manovacuometry, respectively. All authors confirm that there are no conflicts of interest. To compare the means or medians of variables between patients and healthy subjects, we used the unpaired t test or Mann-Whitney U test, respectively. The correlations were assessed by Pearson or Spearman coefficients according to the distribution of the studied variables. The probability of alpha error was set at 5% for all analyses. RESULTS Adolescent idiopathic scoliosis patients showed significant lower values of ISWD, VO₂, and ventilation at the end of the ISWT, as well as lower FEV₁ and FVC; they also presented significantly shallower slope of ΔVT/ΔlnVE, whereas VO₂ related significantly with ISWD (r=0.80), FVC (r=0.78), FEV₁ (r=0.73), and ΔVT/ΔlnVE (r=0.58). CONCLUSIONS Adolescent idiopathic scoliosis correlated to walking limitation and was associated to reduced pulmonary function and worse breathing pattern during exercise. Our results suggest that walking-based aerobic exercises should be encouraged in these patients.
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Xue X, Shen J, Zhang J, Zhao H, Li S, Wang Y, Liang J, Weng X, Qiu G. An analysis of thoracic cage deformities and pulmonary function tests in congenital scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:1415-21. [DOI: 10.1007/s00586-014-3327-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 11/30/2022]
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Lee DK, Chun EM, Suh SW, Yang JH, Shim SS. Evaluation of postoperative change in lung volume in adolescent idiopathic scoliosis: Measured by computed tomography. Indian J Orthop 2014; 48:360-5. [PMID: 25143638 PMCID: PMC4137512 DOI: 10.4103/0019-5413.136223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Change in total lung volume after surgical correction in adolescent idiopathic scoliosis (AIS), measured by computed tomography (CT), has not been studied previously. The primary objective of this study was to measure the change in lung volume between pre and postoperative AIS using low-dose CT and secondary objective was to investigate its relationship to postoperative pulmonary complications. MATERIALS AND METHODS 55 AIS patients underwent surgery for correction and fusion using a posterior only approach and pedicle screws. Pre and postoperative lung volumes were measured using a 3-dimensional (3D) whole spine CT (low dose protocol: Tube current, 60 mA; tube voltage 120 kV). Postoperative low dose CT was undertaken at 4 weeks after operation to evaluate the acute changes of postoperative lung volumes and pulmonary complications. The software that was used recognizes the "air density shade" of the lung and the volume of every section of the lung. The software then automatically calculates total lung volume by summation of all section volumes. The relationships between postoperative pulmonary complications and changes in lung volume on low dose CT as well as preoperative forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were calculated using logistic regression analysis. RESULTS There was a decrease of 12% ± 23.2% in total lung volume postoperatively on 3D low dose CT (P < 0.001). Thirteen patients had increased lung volume while 42 had decreased lung volume postoperatively. Pulmonary complications were treated without severe sequale. Lung volume increased by 19.65% ± 19.84% in 13 patients and decreased by 21.85% ± 13.32% in 42 patients (P = 0.647). Lung volume was increased in patients whose preoperative lung volume, FEV1 and FVC were lower than in patients whose values were higher (r = -0.273, -0.291 and - 0.348; P = 0.044, 0.045 and 0.015, respectively). Postoperative lung volume was also increased when intraoperative fluid administration was larger and operative time was longer (r = 0.354, 0.417 and P = 0.008, 0.002, respectively). There was a statistically significant negative correlation in the change of lung volume in female patients when compared with male patients (r = -0.294, P = 0.03). CONCLUSION Patients with AIS who have preoperative reduced lung volumes or lung functions can achieve further increased lung volume after surgical correction. Pulmonary complications during perioperative period were mostly treated with proper management without severe sequale. Therefore, although surgery for AIS is considered to be a high risk procedure, we can recommend to correct spine deformity in patients with severe AIS in order to improve lung function and long term prognosis.
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Affiliation(s)
- Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Scoliosis Research Institute, Korea University, Guro Hospital, Seoul, Republic of Korea
| | - Eun Mi Chun
- Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Seoul, Republic of Korea,Address for correspondence: Prof. Eun Mi Chun, Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Republic of Korea. E-mail:
| | - Seung Woo Suh
- Department of Orthopedics, Scoliosis Research Institute, Korea University, Guro Hospital, Seoul, Republic of Korea
| | - Jae Hyuk Yang
- Department of Orthopedics, Scoliosis Research Institute, Korea University, Guro Hospital, Seoul, Republic of Korea
| | - Sung Shine Shim
- Department of Radiology, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
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Should postoperative pulmonary function be a criterion that affects upper instrumented vertebra selection in adolescent idiopathic scoliosis surgery? Spine (Phila Pa 1976) 2013; 38:1920-6. [PMID: 23921325 DOI: 10.1097/brs.0b013e3182a637a8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multicenter, prospective evaluation of pulmonary function testing (PFT) and radiographical measures in patients surgically treated for adolescent idiopathic scoliosis (AIS). OBJECTIVE The objective of this study was to evaluate pulmonary function to determine whether a more proximal upper instrumented vertebra (UIV) negatively impacts pulmonary function in patients surgically treated for AIS. SUMMARY OF BACKGROUND DATA There seems to be increasing concern that a more proximal extent of posterior thoracic spinal instrumentation and fusion reduces postoperative pulmonary function. However, there are few reports that analyze the relation between the selection of UIV and pulmonary function in AIS. METHODS PFT and radiographical examination of 154 patients with major thoracic AIS (Lenke type 1-4) undergoing posterior thoracic spinal instrumentation and fusion without thoracoplasty were completed prospectively. Patients were divided into groups based on UIV (T1-T3 vs. T4-T5) and Lenke curve type (2 and 4 vs. 1 and 3) and analyzed respectively. Demographic, radiographical measurements, and PFT data from preoperative and 2-year time points were analyzed. RESULTS Patients with a structural upper thoracic curve (Lenke 2 and 4) had significantly lower preoperative PFT values than those without a structural upper thoracic curve (Lenke 1 and 3). Lenke 2 and 4 patients were also more likely to be fused proximally (82%, T1-T3) than those in the Lenke 1 and 3 groups (42%, T1-T3, P< 0.05). Preoperatively, those with UIV from T1 to T3 tended to have lower PFT values than those with UIV from T4-T5; however, only percent total lung capacity was statistically different (P< 0.05). Both UIV groups showed significant increases in all absolute values (forced vital capacity, forced expiratory volume in 1s, total lung capacity) at 2-year follow-up (P< 0.05) as expected with growth, and the percent predicted values (% forced vital capacity, % forced expiratory volume in 1s, % total lung capacity) remained stable. CONCLUSION Although patients with UIV: T1-T3 showed slightly lower PFT values than UIV: T4-T5, the presence of a double thoracic curve was the primary cause of PFT reduction in these patients. Including the upper thoracic spine in the fusion had no significant effect on pulmonary function 2 years after surgical correction of AIS. LEVEL OF EVIDENCE 3.
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Monazzam S, Newton PO, Bastrom TP, Yaszay B. Multicenter Comparison of the Factors Important in Restoring Thoracic Kyphosis During Posterior Instrumentation for Adolescent Idiopathic Scoliosis. Spine Deform 2013; 1:359-364. [PMID: 27927393 DOI: 10.1016/j.jspd.2013.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 05/17/2013] [Accepted: 06/27/2013] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Multicenter review, prospectively collected data. OBJECTIVES To determine factors predictive of postoperative correction of hypokyphosis when segmental posterior pedicle screw implants were used in treating thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Correcting hypokyphosis, which is common in patients with thoracic AIS, may be important in preventing junctional kyphosis, maintaining lumbar lordosis, and improving pulmonary function. METHODS A multicenter, prospective database was reviewed for Lenke type 1-4 AIS patients with preoperative kyphosis of 5° to 20°, treated with posterior pedicle screws and 5.5-mm rods. Surgeons with a minimum of 20 patients identified were included. Patients were divided into 2 groups postoperatively based on first erect X-rays: those remaining hypokyphotic (HK) (T5-T12 less than 20° or an increase less than 5° in T5-T12 kyphosis) and those restored to normal kyphosis (NK) (T5-T12 greater than 20° with 5° or more increase). Regression analysis was done on 5 preoperative factors thought to influence the postoperative kyphosis: preoperative kyphosis, surgeon, rod material (standard, high-strength, and ultra-high-strength steel; titanium; and cobalt chromium), implant density, and use or no use of a posterior release (Ponte osteotomies). RESULTS Of 280 patients included, 222 remained hypokyphotic and 53 achieved normal kyphosis. There were no differences in preoperative kyphosis (13.4° ± 5°, HK group vs. 14.5° ± 4°, NK group) and age (14.7, HK group vs. 14.6, NK group) between patients brought to greater than 20° (NK) and those who remained less than 20° (HK). Of the factors evaluated, the surgeon who performed the operation was the only significant predictor of restoration of normal kyphosis. Comparison of surgeons showed that the rate of normalizing kyphosis ranged from 6% to 42% (p = .001). There was no difference in the degree of preoperative kyphosis among surgeons. CONCLUSIONS Restoration of thoracic kyphosis remains a challenge in posteriorly treated thoracic AIS patients. The surgeon was the only significant predictor of restoring normal kyphosis, which emphasizes the importance of intraoperative techniques.
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Affiliation(s)
- Shafagh Monazzam
- Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, 3030 Children's Way, Suite 410, San Diego, CA 92123, USA
| | - Peter O Newton
- Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, 3030 Children's Way, Suite 410, San Diego, CA 92123, USA.
| | - Tracey P Bastrom
- Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, 3030 Children's Way, Suite 410, San Diego, CA 92123, USA
| | - Burt Yaszay
- Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, 3030 Children's Way, Suite 410, San Diego, CA 92123, USA
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- Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, 3030 Children's Way, Suite 410, San Diego, CA 92123, USA
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Abstract
It is uncommon for the lungs to be primarily involved in neurological conditions but severe respiratory problems can arise indirectly. These are usually the result of disorders of central ventilatory control, respiratory muscle weakness, or bulbar involvement. The effects of those disorders can be predicted by an understanding of the nervous control mechanisms and mechanical factors that determine effective ventilation. Awareness of these potential complications, and the increased availability of more advanced diagnostic and monitoring techniques in everyday clinical practice, has resulted in the introduction of specific treatments to try to reduce consequent morbidity and mortality.
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Horacek O, Chlumsky J, Mazanec R, Kolar P, Andel R, Kobesova A. Pulmonary function in patients with hereditary motor and sensory neuropathy: A comparison of patients with and without spinal deformity. Neuromuscul Disord 2012; 22:1083-9. [DOI: 10.1016/j.nmd.2012.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/16/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
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Min K, Sdzuy C, Farshad M. Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:345-54. [PMID: 23064806 DOI: 10.1007/s00586-012-2533-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/09/2012] [Accepted: 10/02/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Since early 1990s pedicle screws in thoracic spine have been used in posterior correction of adolescent idiopathic scoliosis (AIS). Long-term results are scarce. We report clinical, radiological and pulmonary function results of 48 consecutive patients with 10-year minimal follow-up. METHODS Forty-eight consecutive patients (42 females, 6 males) with 41 Lenke 1 (lumbar modifier A = 19, B = 8, C = 14), 7 Lenke 2 (lumbar modifier A = 2, B = 4, C = 1) were operated for AIS from posterior with pedicle screw alone instrumentation. Risser stage at the time of operation was 0-3 in 24, more than 3 in 24 patients. Mean age was 15.3 years. The data were prospectively collected preoperatively, at 6 weeks, 2 years and 10 years postoperatively. Cobb angle, sagittal and coronal balance, distal adjacent disc angle and lowest fused vertebral tilt were documented at all time-points. Choice of fusion levels is described. Not every vertebra was instrumented with pedicle screws. The implant density was average one pedicle screw per vertebra or 50 %. Derotation and translation of apical vertebrae on the concave side were performed for correction. The overall outcome and the outcome of different curve types were analyzed statistically. RESULTS Lowest instrumented vertebra (LIV) was distal end vertebra in two-thirds of the patients and was one below distal end vertebra in one-third of the patients. The main thoracic curve correction was 63 %, from 58° ± 12° preoperative to 21° ± 9° at 6 weeks. The Cobb angle was 23° ± 10° at 2 years and 26° ± 10° at 10 years. The apical vertebral rotation improved 35 %, the non-instrumented lumbar curves improved 47 %, the distal adjacent disc angle decreased from 6° ± 3° preoperatively to -2° ± 4° postoperatively and the last instrumented vertebral tilt decreased from 23° ± 8° preoperatively to 5° ± 5° postoperatively. All these parameters remained stable up to 10-year follow-up. The scoliosis correction was not associated with any change in the preoperative thoracic kyphosis and lumbar lordosis. The % FVC remained unchanged with 74 ± 21 % preoperatively to 74 ± 11 % at 2 years and 75 ± 10 % at 10 years. The SRS-24 score was 93 ± 18 points at 2 years and 95 ± 22 points at 10 years. There were no neurological complications, no pedicle screw-related complications. CONCLUSION Posterior correction of thoracic AIS with pedicle screw instrumentation is safe and produces a long-term stable correction and high patient satisfaction. An implant density of 50 % is sufficient to achieve these results. LIV can be the distal end vertebra or one below the distal end vertebra depending on the position of the distal end vertebra to the centre sacral line. The preoperative pulmonary function does not change on long term.
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Affiliation(s)
- Kan Min
- Deptarment of Orthopaedics, Balgrist Clinic, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
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Tsiligiannis T, Grivas T. Pulmonary function in children with idiopathic scoliosis. SCOLIOSIS 2012; 7:7. [PMID: 22445133 PMCID: PMC3410782 DOI: 10.1186/1748-7161-7-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/23/2012] [Indexed: 11/10/2022]
Abstract
Idiopathic scoliosis, a common disorder of lateral displacement and rotation of vertebral bodies during periods of rapid somatic growth, has many effects on respiratory function. Scoliosis results in a restrictive lung disease with a multifactorial decrease in lung volumes, displaces the intrathoracic organs, impedes on the movement of ribs and affects the mechanics of the respiratory muscles. Scoliosis decreases the chest wall as well as the lung compliance and results in increased work of breathing at rest, during exercise and sleep. Pulmonary hypertension and respiratory failure may develop in severe disease. In this review the epidemiological and anatomical aspects of idiopathic scoliosis are noted, the pathophysiology and effects of idiopathic scoliosis on respiratory function are described, the pulmonary function testing including lung volumes, respiratory flow rates and airway resistance, chest wall movements, regional ventilation and perfusion, blood gases, response to exercise and sleep studies are presented. Preoperative pulmonary function testing required, as well as the effects of various surgical approaches on respiratory function are also discussed.
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Affiliation(s)
- Theofanis Tsiligiannis
- Pediatric Pulmonology, Mitera Pediatric Hospita, Kifisias & Erythrou Stavrou Street 6, Amarousion, 15123 Athens, Greece
- Office address: Theofanis Tsiligiannis MD, Aegialias 30 Amarousion, 15125 Athens, Greece
| | - Theodoros Grivas
- Department of Trauma and Orthopaedics, "Tzanio" General Hospital of Piraeus, Tzani & Afendouli str, 18536 Piraeus, Greece
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Koller H, Zenner J, Gajic V, Meier O, Ferraris L, Hitzl W. 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. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:514-29. [PMID: 22042044 PMCID: PMC3296862 DOI: 10.1007/s00586-011-2046-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 07/30/2011] [Accepted: 10/07/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The treatment of rigid and severe scoliosis and kyphoscoliosis is a surgical challenge. Presurgical halo-gravity traction (HGT) achieves an increase in curve flexibility, a reduction in neurologic risks through gradual traction on a chronically tethered cord and an improvement in preoperative pulmonary function. However, little is known with respect to the ideal indications for HGT, its appropriate duration, or its efficacy in the treatment of rigid deformities. MATERIALS AND METHODS To investigate the use of HGT in severe deformities, we performed a retrospective review of 45 patients who had severe and rigid scoliosis or kyphoscoliosis. The analysis focused on the impact of HGT on curve flexibility, pulmonary function tests (PFTs), complications and surgical outcomes in a single spine centre. RESULTS PFTs were used to assess the predicted forced vital capacity (FVC%). The mean age of the sample was 24±14 years. 39 patients had rigid kyphoscoliosis, and 6 had scoliosis. The mean apical rotation was 3.6°±1.4°, according to the Nash and Moe grading system. The curve apices were mainly in the thoracic spine. HGT was used preoperatively in all the patients. The mean preoperative scoliosis was 106.1°±34.5°, and the mean kyphosis was 90.7°±29.7°. The instrumentation used included hybrids and pedicle screw-based constructs. In 18 patients (40%), a posterior concave thoracoplasty was performed. Preoperative PFT data were obtained for all the patients, and 24 patients had ≥3 assessments during the HGT. The difference between the first and the final PFTs during the HGT averaged 7.0±8.2% (p<.001). Concerning the evolution of pulmonary function, 30 patients had complete data sets, with the final PFT performed, on average, 24 months after the index surgery. The mean preoperative FVC% in these patients was 47.2±18%, and the FVC% at follow-up was 44.5±17% (a difference that did not reach statistical significance). The preoperative FVC% was highly predictive of the follow-up FVC% and the response during HGT. The mean flexibility of the scoliosis curve during HGT was only 14.8±11.4%, which was not significantly different from the flexibility measures achieved on bending radiographs or Cotrel traction radiographs. In rigid curves, the Cobb angle difference between the first and final radiographs during HGT was only 8°±9° for scoliosis and 7°±12° for kyphosis. Concerning surgical outcomes, 13 patients (28.9%) experienced minor and 15 (33.3%) experienced major complications. No permanent neurologic deficits or deaths occurred. Additional surgery was indicated in 12 patients (26.7%), including 7 rib-hump resections. At the final evaluation, 69% of the patients had improved coronal balance, and at a mean follow-up of 33±23.3 months, 39 patients (86.7%) were either satisfied or very satisfied with the overall outcome. CONCLUSION The improvement of pulmonary function and the restoration of sagittal and coronal balance are the main goals in the treatment of severe and rigid scoliosis and kyphoscoliosis. A review of the literature showed that HGT is a useful tool for selected patients. Preoperative HGT is indicated in severe curves with moderate to severe pulmonary compromise. HGT should not be expected to significantly improve severe curves without a prior anterior and/or posterior release. The data presented in this study can be used in future studies to compare the surgical and pulmonary outcomes of severe and rigid deformities.
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Affiliation(s)
- Heiko Koller
- German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Im Kreuzfeld 4, 34537, Bad Wildungen, Germany.
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Added value of percutaneous vertebroplasty: effects on respiratory function. AJR Am J Roentgenol 2012; 198:W51-4. [PMID: 22194515 DOI: 10.2214/ajr.11.6730] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to investigate the effects of percutaneous vertebroplasty on respiratory function in patients with compression fractures caused by osteoporosis. SUBJECTS AND METHODS Ninety-eight patients (87 women, 11 men; mean age, 74 years; age range, 60-90 years) with compression fractures of 75 thoracic (Th7-Th12) and 89 lumbar (L1-L5) vertebrae were enrolled in this study. Percentage vital capacity (VC%), percentage forced vital capacity (FVC%), and percentage forced expiratory volume in 1 second (%FEV1) were measured using a spirometer before, 1 day after, and 1 month after percutaneous vertebroplasty. The Wilcoxon signed rank test was used to evaluate whether any significant differences in VC%, FVC%, or %FEV1 values existed between before, 1 day after, and 1 month after percutaneous vertebroplasty. RESULTS The VC% and FVC% values had improved significantly by 1 month after percutaneous vertebroplasty compared with before percutaneous vertebroplasty (p<0.01). No significant difference was noted between values before and 1 day after percutaneous vertebroplasty. Likewise, no significant difference was identified in %FEV1 before percutaneous vertebroplasty and either 1 day or 1 month after percutaneous vertebroplasty. The mean degree of improvement in VC% values after percutaneous vertebroplasty for patients with one vertebra treated, which we refer to as the "single-vertebroplasty" group, and for patients with two or more vertebrae treated, or "multiple-vertebroplasty" group, was 1.1%±7% (SD) and 6.3%±8%, respectively, representing a significant difference between groups (p=0.01). The mean VC% values before and 1 month after percutaneous vertebroplasty differed significantly (p=0.02) in the thoracic group and overlapping group. CONCLUSION Percutaneous vertebroplasty improves restrictive ventilatory impairment, but this improvement requires approximately 1 month to occur. Greater improvement in restrictive ventilatory dysfunction was observed in patients who underwent multiple vertebroplasty procedures than those who underwent a single procedure and in patients who underwent treatment of thoracic vertebrae than those who underwent treatment of other vertebrae.
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