Journal List > J Korean Soc Spine Surg > v.11(3) > 1035621

Lee, Park, Park, and Suh: Comparision of the pulmonary function between open anterior release and thoracoscopic anterior release

Abstract

Study Design

Retrospective study

Objectives

To evaluate the results of a serial pulmonary function test in severe scoliosis that required an anterior release and posterior fusion

Summary of Literacture Review

There are a few reports on the pulmonary function after an anterior release and posterior fusion in severe scoliosis.

Materials and Methods

Twenty two cases of severe scoliosis requiring an anterior release and posterior fusion were followed up more than 2 years. The patients were divided into two groups (group 1: 10 cases of open thoracotomy and posterior fusion, group 2: 12 cases of thoracoscopic release and posterior fusion). The forced vital capacity (FVC), forced expiratory volume 1 (FEV1), total lung capacity (TLC), the predicted FVC, predicted FEV1and predicted TLC in the preoperative, 3 month, 6 month, 1year, 2 year postoperative period in the two groups were compared. Statistical analysis was performed using a paired T- test.

Results

The average preoperative FVC in groups 1 and 2 were checked as 2.20 L and 2.30 L, respectively. The postoperative 3 month FVC were checked as 1.60 L and 1.81 L, respectively, which were the lowest levels throughout the serial followup. The postoperative 6 month FVC were 1.70 L and 2.15 L, respectively. The postoperative 2 year FVC were 2.17 L and 2.18 L, respectively, which were 98.6% and 94.8% of the preoperative FVC. The average preoperative FEV1 of group 1 was 1.95 L. The postoperative 3 month FEV1were at the lowest level and the postoperative 2 year FEV1was 1.80 L (92.3% of preoperative value). The average preoperative FEV1 of group 2 was 2.05 L. The postoperative 6 month FEV1 was 1.90 L (92.7% of preoperative value). The TLC of group 2 showed a faster recovery than that of group 1. The predicted FVC, FEV1and TLC of both groups at 2 years after surgery were 2∼4% lower than the baseline. The recovery pattern in group 1was steady for 2 years. The postoperative 6- month value was similar to the postoperative 2- year value in group 2.

Conclusions

In severe scoliosis with a decreased pulmonary function, those undergoing thoracoscopic anterior release had a faster pulmonary function recovery than those undergoing an open thoracotomy.

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Table 1.
Absolute values of pulmonary function test in Group 1
Pulmonary fuction Preoperative 3 Months 6 Months 1 Year 2 Years
FVC 2.20± 0.45 1.60± 0.40 1.70± 0.36 1.90± 0.36 2.17± 0.41
(p=0.005) (p=0.005) (p=0.019) (p=0.706)
FEV1 1.95± 0.38 1.30± 0.36 1.50± 0.32 1.70± 0.31 1.80± 0.35
(p=0.005) (p=0.005) (p=0.012) (p=0.132)
TLC 2.70± 0.52 2.15± 0.41 2.21± 0.41 2.47± 0.40 2.63± 0.41
(p=0.005) (p=0.005) (p=0.009) (p=0.314)
Table 2.
Absolute values of pulmonary function test in Group 2
Pulmonary fuction Preoperative 3 Months 6 Months 1 Year 2 Years
FVC 2.30± 0.74 1.81± 0.65 2.15± 0.69 2.14± 0.68 2.18± 0.68
(p=0.002) (p=0.059) (p=0.054) (p=0.081)
FEV1 2.05± 0.70 1.52± 0.53 1.90± 0.59 1.91± 0.60 1.89± 0.59
(p=0.002) (p=0.111) (p=0.131) (p=0.134)
TLC 2.90± 0.78 2.38± 0.68 2.64± 0.74 2.65± 0.74 2.65± 0.72
(p=0.002) (p=0.037) (p=0.037) (p=0.046)
Table 3.
Percent predicted values of pulmonary function test in Group 1
Pulmonary fuction Preoperative 3 Months 6 Months 1 Year 2 Years
FVC 66.3± 6.6 53.5± 6.0 57.8± 6.3 60.2± 6.1 63.3± 6.6
(p=0.005) (p=0.005) (p=0.005) (p=0.189)
FEV1 62.9± 6.8 45.6± 6.1 50.6± 5.8 56.0± 5.9 59.4± 7.1
(p=0.005) (p=0.005) (p=0.007) (p=0.089)
TLC 71.9± 6.5 59.7± 5.5 61.2± 5.7 66.1± 6.1 68.5± 6.8
(p=0.005) (p=0.005) (p=0.005) (p=0.067)
Table 4.
Percent predicted values of pulmonary function test in Group 2
Pulmonary fuction Preoperative 3 Months 6 Months 1 Year 2 Years
FVC 66.5± 6.5 57.5± 6.3 62.7± 6.3 63.3± 6.1 63.7± 6.5
(p=0.002) (p=0.060) (p=0.084) (p=0.117)
FEV1 63.1± 6.4 49.6± 5.9 58.5± 6.2 61.2± 6.2 61.0± 5.9
(p=0.002) (p=0.048) (p=0.289) (p=0.347)
TLC 72.2± 6.7 63.2± 7.0 69.6± 7.1 69.6± 6.9 69.8± 6.7
(p=0.002) (p=0.136) (p=0.117) (p=0.117)
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