A Change of Pulmonary Function in the Patients with Severe Non-Idiopathic Scoliosis Following Reconstructive Spine Surgery

ak-Sun Kim; Eun-Su Moon; Jin-Oh Park; Hwan-Mo Lee; Seong-Hwan Moon; Jung-Won Ha; Dong-Eun Shin; Dong-Jun Shim; Hyung-Keun Song

doi:10.7469/JKSS.2006.13.2.106

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Kim, Moon, Park, Lee, Moon, Ha, Shin, Shim, and Song: A Change of Pulmonary Function in the Patients with Severe Non-Idiopathic Scoliosis Following Reconstructive Spine Surgery

Original Research

Journal of Korean Spine Surg 2006;13(2):106-113.

Published online: 18 January 2006

DOI: https://doi.org/10.7469/JKSS.2006.13.2.106

A Change of Pulmonary Function in the Patients with Severe Non-Idiopathic Scoliosis Following Reconstructive Spine Surgery

ak-Sun Kim, M.D., Eun-Su Moon, M.D., Jin-Oh Park, M.D., Hwan-Mo Lee, M.D., Seong-Hwan Moon, M.D., Jung-Won Ha, M.D.^#, Dong-Eun Shin, M.D.^§, Dong-Jun Shim, M.D.^†, Hyung-Keun Song, M.D.

Department of Orthopedic Surgery, Yonsei University College of Medicine

^{^#}Department of Orthopaedic Surgery, National Health Insurance Corporation Ilsan Hospital

^{^§}Department of Orthopaedic Surgery, Cha University College of Medicine

^{^†}Department of Orthopaedic Surgery, Ahn Sei Hospital

Address reprint requests to Eun SU Moon, M.D. Department of Orthopaedic Surgery, Young-Dong Severance Hospital, Yonsei University College of Medicine, Dogok-Dong, Kangnam-Ku, Seoul, Korea, 135-720 Tel: 82-2-2019-3418, Fax: 82-2-573-5393, E-mail: mes1007@yumc.yonsei.ac.kr

∗ 본 논문의 요지는 2005년 대한 척추학회 춘계 학술대회에서 발표되었음.

∗ 이 논문은 2005년도 연세대학교 두뇌 한국 21 의과학 사업에 의하여 지원 되었음.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study design

This is a retrospective study Objectives: We wanted to investigate the changes in pulmonary function after spine surgery for the patients suffering with severe non-idiopathic scoliosis.

Summary of Literature Review

The potential for pulmonary function change after scoliosis surgery may be much greater for the patients with neuromuscular, congenital or neuro-fibromatosis because of the severe thoracic deformity. Yet few studies have been performed on this subject.

Materials and Methods

12 non-idiopathic scoliosis patients (average age: 11.1 years) were followed up for more than one year. Among these patients, 7 had muscular dystrophy, 3 had spinal muscular atrophy, 1 had Guillain-BarreSyndrome and 1 had neuro-fibromatosis. Surgery was done through the anterior and posterior approaches in 7 cases, and the posterior approach was used in 5 cases. In the former group, open thoracotomy was performed in 6 cases. NIPPV (non-invasive positive pressure venti-lation) was used for 4 patients before surgery.

Results

The average Cobb's angle improved from preoperative 93.9 to postoperative 42.4, showing 55% correction. The average FVC was 1270ml before surgery and 1365 ml postoperatively, and the average FEV1 was 1163 ml preoperatively and 1300 ml postoperatively, showing a slightly increased FEV1. When these data were analyzed in detail, the FVC was decreased from preoperative 72.3% to 63.8% postoperatively in the 6 patients who underwent open thoracotomy. On the other hand, it was increased from preoperative 43% to 47.5% postoperatively in the 6 patients who did not undergo thoracotomy.

Conclusion

Although the pulmonary function deteriorated after reconstructive spine surgery in some patients, worsening was seen mainly in those patients who underwent thoracotomy. The pulmonary function was actually improved in the patients who underwent surgery without thoracotomy to correct their severe scoliosisKey Words: Scoliosis, Pulmonary function

Keywords: Scoliosis, Pulmonary function

REFERENCES

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Fig. 1.

The change of the FVC and FEV1 in the volume (A) and the percentage of predicted normal values(B). (A) The average volume of FVC was 1270 ml before surgery and 1365 ml by postoperative 1 year, and the average FEV1 was 1163 ml and 1300 ml, showing slightly increase in FEV1. (B) The average percentage of FVC decreased from 57.3% before surgery to 56.6% by postoperative 1yr and the average FEV1 was also decreased from 57.3% to 55.2%.

Fig. 2.

When these data were analyzed in detail, FVC (A) was decreased from preoperative 72.3% to 63.8% postoperatively in 6 patients who underwent open thoracotomy. On the other hand, it was increased from preoperative 43% to 47.5% post-operative 1year in 6 patients. FEV1 (B) was decreased from preoperative 72.5% to 63.8% postoperatively in 6 patients who underwent open thoracotomy. On the other hand, it was increased from preoperative 42.2% to 46.5% postoperative 1year in 6 patients.

Fig. 3.

Case 11. (A, B) Sitting posteroanterior (PA) and lateral radiography of 12 year 5 month patient with spinal muscular atrophy. (C, D) Postoperative sitting PA and lateral radiography. The clinical picture shows (E) evident pelvic obliquity and (F) the correction of pelvic obliquity after operation.

Fig. 4.

Preoperative picture (A) of a 13-yr-old Guillain Barre syndrome patient. Before operation, she can stand for a moment. Post-operative PA (B) and lateral (C) radiography with pedicle technique the scoliosis was reduced to less than 20 degrees. (D) She can walk without support after opeatrion

Table 1.

A Part of Saint George's Hospital Respiratory Questionnaire

등급	내용
1	앉거나 드러누워 있어도 숨이 차다
2	세수하거나 옷을 입을 때도 숨이 차다
3	집 주위를 돌아 다니면 숨이 차다
4	집에서 멀리 나가면 숨이 차다
5	계단을 올라가면 숨이 차다
6	언덕을 올라가면 숨이 차다
7	운동이나 게임을 하면 숨이 차다

Table 2.

Surgical Data of Patients

	HD-S∗	F/U	OP	staging	fusion level	Rib resected	Anterior OR time (min)	Anterior EBL (mL)	Posterior OR time (min)	Posterior EBL (mL)
1	18	44	p	1	P: T4 - SIJ	none			410	2800
2	18	37	P	1	P: T3-SIJ	none			605	2000
3	32	37	P	1	P: T1-SIJ	none			375	1000
4	18	24	P	1	P: T1-L2	none			580	1900
5	24	28	P	1	P: T1-L2	none			625	1500
6	17	16	A+P	2	A: L1-S1	none	365	850	625	1250
					P: T2- SIJ
7	21	36	A+P	2	A: T4-T9	A-1	240	100	555	650
					P: T1-L3
8	53	46	A+P	2	A: T6-T9^‡	none	240	700	375	500
					P: T2-T12
9	16	34	A+P	2	A: T5-L1	A-1	385	550	680	1800
					P: T1-L1
10	15	33	A+P	2	A: T11-L2	A-2	385	1600	630	3000
					P: T7-SIJ
11	19	23	A+P	2	A: T6-L4^‡	none	375	600	630	3000
					P: T3-L4
12	18	18	A+P	2	A: T4-L1	A-1	225	800	395	1200
					P: T6-L3
Average	22.4	31.3			ant : 5.3		316	743	540	1717
					post: 14.5
SD^†	10.65	9.62					76.63	451.32	116.26	866.11

^∗ : Hospital day after surgery,

^† : standard deviation,

^‡ : thoracoscopic surgery, A-1 : One rib was resected in anterior surgery, A-2: Two rib was resected in anterior surgery

Table 3.

Pulmonary Function and Complications

	Age (yr)	Dx	Pre-FVC	Pre-FVC (%)	Pre-FEV1	Pre-FEV1 (%)	Post-FVC	Post-FVC (%)	Post-FEV1	Post-FEV1 (%)	Preop vent. mode	Ventilaton (day)	St. George score	Cx
1	12	SMA	900	38	870	41	930	37	850	39	NIPPV	3	2 2	P∗
2	9	PMD	810	41	710	39	810	36	720	36		1	3 3none
3	8	PMD	810	51	710	49	1230	72	1080	68	NIPPV	1	2 3	none
4	9	NF	1070	51	960	50	1290	55	1140	53		1	5 7	none
5	13	GBS	600	20	560	20	907	27	880	30	NIPPV	4	2 4	none
6	10	SMA	1290	57	1160	54	1316	59	1183	53		1	3 4	none
7	11	PMD	1010	97	890	98	741	71	667	73		0	3 3	none
8	13	PMD	1220	63	1140	63	1390	58	1250	55		2	4 4	A^†
9	14	PMD	1370	58	1120	52	2180	80	1760	71		2	4 4	none
10	13	PMD	2320	65	2260	69	2200	58	2120	61	NIPPV	2	4 4	PL^†
11	12	SMA	2370	80	2240	83	1800	61	1728	64		5	4 4	none
12	9	PMD	1470	71	1340	70	1475	65	1254	59		1	3 3	none
Average	11.1		1270	57.7	1163	57.3	1355.8	56.6	1219.3	55.24	cases	1.93		cases
SD	2.02			20.18		20.89		15.89		13.92		1.44	P=0.026

^∗ : pneumonia,

^† : atelectasis,

^‡ : pleural effusion

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