青少年特发性脊柱侧凸患者术前肺功能与肺容积相关性研究：利用CT三维重建肺容积

目的 搜集三维CT重建下青少年特发性脊柱侧凸患者术前总肺容积（total lung volume,Vt）、右肺容积（volume of right lung,Vr ）、左肺容积（volume of left lung,Vl ）和左侧肺容积/右侧肺容积比值（Vl/Vr）与年龄相关对照值比较是否存在差异,并且回顾性研究术前肺容积和肺功能参数相关性.方法 共24例患者,平均Cobb角52°.所有患者术前行肺功能检查（通气和弥散）,胸部CT扫描,并进行肺实质三维重建.Vt、Vr、Vl、Vl/Vr和右侧与左侧肺容积差值绝对值（︱Vr-Vl︱）分别与肺功能测量结果进行相关性分析.以肺活量（vital capacity,VC）、用力肺活量（forced vital capacity,FVC）和肺总量（total lung capacity,TLC）为因变量,与肺容积数据建立多元线性回归分析模型,获得回归方程.结果 Vt与VC、FVC呈正相关（P＜0.05）,Vt与TLC近似正相关（P=0.055）,与50%肺活量时最大呼气流量（forced expiratory flow of 50% forced vital capacity,FEF50%）、FEF75%呈负相关,与其他参数均无相关性（P＞0.05）.︱Vr-Vl︱与最大通气量占预计值百分比（percentages of maximal ventilatory volume to predicted values,MVV%）呈负相关,与弥散参数无相关性（P＞0.05）;男性和女性患者Vt与Vr较对照值均减小,女性患者Vl/Vr和对照值差异有统计学意义.结论 青少年特发脊柱侧凸术前Vt与VC、FVC、TLC呈明显正相关;侧凸患者Vt、Vr较正常对照值减小.从单纯的保存肺功能角度,建议后路手术尽量减少两侧肺容积不对称性,可以阻止MVV%继续下降.     

青少年特发性脊柱侧凸患者术前肺功能影响因素分析及临床意义

目的 分析影响青少年特发性脊柱侧凸患者术前肺功能的相关影像学参数及其临床意义.方法 回顾性研究2009年7月～2012年8月本院收治的青少年特发性脊柱侧凸患者24例,术前肺功能检查、胸部CT扫描资料完整.分析肺功能结果与站立位全长X线片Cobb角、顶椎偏移、椎体旋转分度（Nash/Moe法）、顶椎肋椎角差值、矢状位T5-12后凸角和胸段累及椎体数目之间相关性.结果 患者年龄平均14.8岁,Cobb角平均52.8°;主弯Cobb角与术前肺活量占预计值百分比、第1秒最大呼气容积占预计值百分比、用力肺活量占预计值百分比、最大通气量占预计值百分比、肺总量占预计值百分比、一氧化碳弥散量占预计值百分比和一氧化碳弥散量呈负相关;顶椎偏移与肺总量占预计值百分比、一氧化碳弥散量占预计值百分比及一氧化碳弥散量呈明显负相关;站立位顶椎凸凹侧肋椎角差值分别与肺总量占预计值百分比、肺总量、一氧化碳弥散量占预计值百分比和一氧化碳弥散量呈负相关;Bending位顶椎凸凹侧肋椎角差值与肺总量、一氧化碳弥散量呈负相关;胸段累及椎体数≥7个组患者50％肺活量时最大呼气流量、75％肺活量时最大呼气流量、最大用力呼气中段流速占预计值百分比、最大通气量占预计值百分比及一氧化碳弥散量占预计值百分比数值,比胸段累及椎体数＜7个组患者有减少（P＜0.05）.结论 术前站立位主弯Cobb角愈大,主弯顶椎偏移增大,站立位以及Bending位顶椎凸凹侧肋椎角差值增加,肺功能下降.近胸弯≥30°组较之＜30°组,胸段累及椎体数≥7个组较之＜7个组,肺功能数值下降.     

青少年脊柱侧弯的肺功能研究

作者研究了４８７例无症状青少年特发性脊柱侧弯患者肺通气功能，并以正常同龄青少年２５０例作对照。结果表明：患者肺活量，肺活量占预计值百分比，深吸气量，用力肺活量，１秒钟用力呼气容积，最大通气量，最大通气量占预计值的百分比较同龄正常组明显降低；而潮气容积，１秒钟用力呼气容积占用力肺活量比值，最大呼气中段流量，最大呼气中段流量占预计值的百分比与对照组无显著性差异。并进一步研究表明：肺活量占预计值的百分比的降低与脊柱侧弯的Ｃｏｂｂ角、侧弯顶椎的椎体楔变度及旋转度发病年龄有关，而与脊柱侧弯方向无关。     

支具治疗对女性青少年特发性脊柱侧凸患者肺功能的影响

目的:观察支具治疗对女性青少年特发性脊柱侧凸(AIS)患者肺功能的影响。方法:2001年2月~2009年12月283例女性AIS患者在我院接受矫形手术治疗,术前检测患者用力肺活量(FVC)、第1秒用力呼气容积(FEV1),记录预计值、实测值及实测值占预计值百分比。根据术前是否曾接受支具治疗分为2组,支具治疗组80例(A组),未接受支具治疗组203例(B组)。分析2组患者术前肺功能参数的差异,同时对A组患者肺功能FVC及FEV1的实测值占预计值百分比(FVC%、FEV1%)与术时年龄、身高、主弯冠状面Cobb角、主侧凸累及节段数、主胸弯矢状面Cobb角、每日支具治疗时间、支具治疗总时长进行多元线性回归分析。结果:A、B组患者FVC预计值分别为3.23±0.40L和3.20±0.40L,FEV1预计值分别为2.76±0.40L和2.73±0.30L,A组与B组比较均无统计学差异(P>0.05);A、B组FVC实测值分别为2.58±0.60L和2.72±0.60L,FEV1实测值分别为2.34±0.50L和2.49±0.50L,A、B组FVC%分别为(80.3±16.5)%和(85.4±16.5)%、FEV1%分别为(85.6±18.4)%和(91.3±16.9)%,A组FEV1实测值、FVC%及FEV1%较B组均明显降低(P<0.05),其中主弯为胸弯患者(173例)明显(P<0.05),而主弯为胸腰弯/腰弯患者(110例)不明显(P>0.05)。A组患者中,胸段侧凸矢状面Cobb角与FVC%、FEV1%呈正相关(P<0.05),支具治疗总时长与FEV1%呈负相关(P<0.05);而术时年龄、身高、主弯冠状面Cobb角、主侧凸累及节段数、每日支具治疗时间(8~23h,平均18.7h)与FVC%及FEV1%均无显著相关性(P>0.05)。结论:支具治疗可使女性青少年特发性胸段脊柱侧凸患者肺功能FVC%及FEV1%下降,支具治疗总时长和胸段侧凸矢状面Cobb角可能是影响患者肺功能FVC%及FEV1%的相关因素。     

短节段肋骨切除胸廓成形对脊柱侧凸患者肺功能的影响

目的探讨特发性脊柱侧凸后路矫形凸侧短节段肋骨切除胸廓成形术对肺功能的影响。方法 2006年1月至2007年5月,19例特发性胸椎侧凸患者行后路三维矫形术,并经同一切口行凸侧短节段肋骨切除胸廓成形术。男9例,女10例,年龄11～20岁,平均14.5岁。Lenke分型：1型13例,2型6例;术前Cobb角60°～104°,平均73.9°;术中切除肋骨4～6根,平均5.4根,切除长度1.5～2cm。所有患者术前均进行肺功能检查,选择用力肺活量（forced vital capacity,FVC）、第1秒最大呼气量（forced expiratory volume in 1 second,FEV_1）及二者占预计值百分比（FVC%,FEV_1%）作为观察指标,并分别于术后3个月、6个月、1年、2年复查肺功能,了解肺功能变化情况。所得数据用统计学方法进行分析。结果本组病例术后Cobb角10°～59°,平均26.5°,侧凸矫正率为64.1%;术后3个月时,FVC、FEV_1、FVC%及FEV_1%较术前均有下降,但其差异无统计学意义,术后6个月时接近术前水平,术后1年及2年较术前均有升高。校正年龄和身高对肺功能的影响后,FVC%及FEV_1%的动态变化显示术后3个月至2年患者肺功能在持续改善。结论脊柱侧凸后路三维矫形结合凸侧短节段肋骨切除胸廓成形对患者的肺功能干扰小,术后肺功能恢复快,可作为脊柱侧凸合并中重度胸牢的治疗选择。     

The immediate effect of a Boston brace on lung volumes and pulmonary compliance in mild adolescent idiopathic scoliosis

Idiopathic scoliosis (IS) is known to result in lung volume and pulmonary compliance reduction. Boston brace treatment of IS is an additional factor causing restrictive respiratory syndrome due to external chest wall compression. Nevertheless, the immediate effect of Boston bracing on the pulmonary compliance of scoliotic patients has not been studied systematically. Spirometric and plethysmographic lung volumes, static lung compliance (C_ST(L)) and specific lung compliance (C_ST(L)/functional residual capacity) of 15 scoliotic adolescents (14 females and 1 male, of mean age 14.1 ± 1.67 years, with mean Cobb angle 24.1°± 7.88°) were recorded twice, in a random sequence: once without the Boston brace (nBB) and once immediately after wearing the brace (BB). Our findings showed that bracing reduced vital capacity, residual volume, functional residual capacity (FRC), total lung capacity, and forced expiratory volume in 1 s in a proportional and significant way (P < 0.001). C_ST(L) was also significantly reduced (P < 0.001), but C_ST(L)/FRC remained unaltered. All BB and nBB indices were highly correlated. We concluded that Boston bracing in IS patients results in an immediate, predictable, and uniform reduction of lung volumes and pulmonary compliance. The reduction of C_ST(L) under bracing conditions was related to the decrease of lung volume; the C_ST(L)/FRC remained unaltered. Received: 4 November 1997 Revised: 2 September 1998 Accepted: 19 October 1998     

Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure

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

前路胸腔镜下松解联合后路矫形对特发性脊柱侧凸患者肺功能早期影响的研究

目的研究前路胸腔镜下脊柱松解联合后路矫形术对特发性脊柱侧凸(idiopathic scoliosis,IS)患者肺功能早期影响。方法对2004年4月-2008年6月行前路胸腔镜下松解联合后路矫形手术治疗的21例IS患者肺功能进行评估。男9例,女12例;年龄12～24岁,平均15.6岁。左侧凸2例,右侧凸19例。Lenke分型:Ⅰ型12例,Ⅱ型9例。发现脊柱侧凸1年6个月～9年,平均2.5年。胸椎冠状面Cobb角为65～125°,平均为79.6°。于术前及术后6个月行肺功能检测,包括肺容量、通气功能、胸廓顺应性三部分。结果前路胸腔镜下松解术中胸腔开放时间为90～150 min,平均127 min。术后切口均Ⅰ期愈合,无胸腔内感染发生。后路矫形术完成后1周患者冠状面Cobb角为36～75°,平均43.7°。术后患者均获随访,随访时间6～36个月,平均13.5个月。术后6个月时,患者肺活量及最大通气量均较术前显著提高(P<0.05),但实测值占预计值的百分比较术前无明显变化(P>0.05);功能残气量较术前下降(P<0.05);残气量实测值及与预计值的百分比均较术前下降(P<0.05)。第1秒用力呼气肺活量及其与用力呼气肺活量比值与术前比较无明显改善(P>0.05),最大自主通气量较术前显著上升(P<0.05)。患者总气道阻力、吸入气道阻力及呼出气道阻力均较术前显著下降(P<0.05)。结论前路胸腔镜下脊柱松解联合后路矫形术对IS患者胸腔有一定干扰,但矫形后随着胸腔形态变化和软组织松解,术后早期患者肺容量、通气功能、胸廓顺应性均得到不同程度改善,肺储备能力提高,但远期肺功能情况仍需进一步观察。     

Pulmonary function after thoracoplasty in adolescent idiopathic scoliosis

The current study evaluated sequential pulmonary function tests prospectively at a minimum of 2 years after thoracoplasty in adolescent patients with idiopathic scoliosis. Twenty patients were divided into two groups: Group I (n=12) was comprised of patients who had posterior instrumented fusion with external thoracoplasty, and Group II (n=8) was comprised of patients who in addition to a posterior instrumented fusion, had an anterior release and fusion via video-assisted thoracoscopic surgery (n=4) or open thoracotomy (n=4) because of rigid severity. Forced vital capacity and forced expiratory volume in 1 second of percent predicted values in Group I declined 9% at 3 months postoperatively and returned to the preoperative baseline at 1 year. However, forced vital capacity and forced expiratory volume in 1 second of percent predicted values in Group II declined 11% to 18% postoperatively and did not return to the preoperative baseline at 2 years. Posterior instrumented fusion with thoracoplasty in adolescent patients with idiopathic scoliosis significantly decreased pulmonary function at 3 months, but returned to the preoperative baseline at 1 year. The addition of an anterior releasing procedure resulted in poorer pulmonary function, which did not return to the preoperative baseline by the 2-year followup.     

Pulmonary function before and after anterior spinal surgery in adult idiopathic scoliosis.

BACKGROUND: Little is known about the long term effects of anterior spinal surgery on pulmonary function in adult patients with idiopathic scoliosis. A study was therefore undertaken of pulmonary function before and after anterior spinal surgery in this group of patients. METHODS: Fourteen patients (12 women) of mean age 26.5 years (range 17-50, 10 > or = 20 years) were studied. All 14 patients underwent thoracotomy and anterior arthrodesis, and five also underwent posterior arthrodesis. Scoliosis curves and lung volumes were measured preoperatively and at a mean follow up of 32 months (range 14-49) after surgery. RESULTS: At long term follow up after surgery the mean (SD) Cobb angle of the thoracic curve improved from 59 degrees (25 degrees) to 39 degrees (18 degrees), a correction of 31%. Despite this there was a fall in mean forced vital capacity (FVC) of 0.21 litres (95% confidence interval 0.04 to 0.38). In the patients who underwent anterior surgery without posterior surgery (n = 9) there was a fall in mean FVC of 0.31 litres (95% confidence interval 0.12 to 0.50); mean forced expiratory volume in one second and total lung capacity were also reduced and there was an increase in mean residual volume. CONCLUSIONS: Forced vital capacity is reduced at long term follow up in adult patients with idiopathic scoliosis who undergo anterior spinal surgery. The fall in FVC is small and is unlikely to be of clinical significance in patients with reasonable lung function in whom surgery is planned for prevention of curve progression or improvement of cosmetic appearance and pain. However, surgical intervention should not be undertaken in an attempt to improve pulmonary function.     

脊柱平衡疗法对青少年特发性脊柱侧凸患者肺功能及表面平均肌电比值的影响

目的 :评价中医脊柱平衡综合疗法(导引、推拿、小针刀)对青少年特发性脊柱侧凸患者(AIS)肺功能和侧凸两侧表面平均肌电(AEMG)比值的影响。方法:2008年3月至2014年2月收集的AIS门诊病例140例,男40例,女83例;年龄9~12岁。随机分为中医组(中医综合疗法65例)和对照组(支具法58例)。治疗组采用导引2次/d,40 min/次;脊柱平衡推拿正骨2次/周,25 min/次,12个月;脊柱平衡针刀松解1次/周,共10次。对照组应用Milwaukee支具治疗,至少22 h/d,连续佩戴12个月。观察两组患者治疗后第12个月的肺功能,治疗后6、12、18、24个月时的侧凸两侧表面平均肌电(AEMG)比值,其中肺功能的观察指标包括肺活量(VC)、第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)、每分钟最大通气量(MVV)。结果:治疗组VC、FEV1/FVC、MVV各指标较治疗前上升(P0.05),对照组各指标下降(P0.05);AEMG比值的动态观测,治疗组表现为持续降低并趋向于1,表明侧凸两侧肌张力的不平衡改善;对照组比值增大,表明侧凸两侧肌张力不平衡加剧,侧凸进展。结论:遵循中医"筋骨并治""动静结合"原则的中医脊柱平衡法能显著改善侧凸脊柱肌力不平衡,阻止侧凸进展,并能提高肺功能;动态观测侧凸脊柱两侧的AEMG比值是评价疗效和评估侧凸进展的有效方法 ,可替代定期、频繁X线摄片,避免对青少年身体造成潜在危害。     

Vertical expandable prosthetic titanium rib device insertion: does it improve pulmonary function?

Purpose

Vertical expandable prosthetic titanium rib (VEPTR) insertion and expansion has been advocated to increase thoracic volume and pulmonary function in patients with thoracic insufficiency syndrome. We reviewed our experience with VEPTR implantation to determine if lung function and growth is augmented, to determine the children's functional status, and if the scoliosis is controlled.

Methods

From 2006 to 2010, 29 insertions and 57 expansions were performed in 26 patients at our institution. Demographic data were reviewed in conjunction with complications, scoliosis angles, pulmonary function tests (PFTs), and computed tomography-guided 3D reconstructions to determine lung volumes; and quality of life scores were determined using a modified Scoliosis Research Society (SRS) questionnaire preoperatively and postoperatively. The groups were also stratified by age (because of lung growth potential), disease (congenital or infantile scoliosis, Jeune syndrome, neuromuscular, other structural thoracic disorders), and sex. Analyses using SPSS (SPSS, Chicago, Ill) were performed with P < .05 considered significant.

Results

Each patient underwent 3.03 ± 1.8 surgeries, spending 0.97 ± 1.8 days in the intensive care unit and 4.41 ± 6 days in the hospital for each procedure. Mean age was 90.7 ± 41 months. Of the 36 complications, most were because of infection (12), half requiring operative repair (hardware removal). The average PFT percent predicted values for forced expiratory volume in 1 second, forced vital capacity, and RV were 54.6 ± 22, 58.1 ± 24, and 145.3 ± 112, respectively, preoperatively and 51.8 ± 20, 55.9 ± 20, and 105.6 ± 31, respectively, postoperatively. The lung volumes measured by computed tomography when corrected for age do not increase significantly postoperatively. The mean Cobb measurement for the preoperative major curves was 64.7° and postoperatively was 46.1° for those curves measured preoperatively, for a 29% curve improvement. All postoperative curves had a mean of 56.4° and 58.1° at final follow-up, a 3% curve increase. The SRS scores for patients remained unchanged and no statistical difference was seen from preoperative to postoperative values. No statistically significant difference was seen in complications, PFT (forced expiratory volume in 1 second, forced vital capacity, RV), lung volumes, scoliosis angles, and SRS scores between sex, age, and disease categories.

Conclusion

There was mild improvement in scoliosis angles but no improvement in lung function and volume. Scoliosis Research Society scores indicate that the children have near normal function both before and after VEPTR placement. Pulmonary function, lung volume, and patient subjective assessments did not increase dramatically after VEPTR placement, although scoliosis angles improved.     

Anterior surgery for adolescent idiopathic scoliosis

Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50–60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pull-out, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of >70° have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS (>90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3.     

Cerebral glucose metabolic abnormality in patients with congenital scoliosis

A possible association between congenital scoliosis and low mental status has been recognized, but there are no reports describing the mental status or cerebral metabolism in patients with congenital scoliosis in detail. We investigated the mental status using a mini-mental status exam as well as the cerebral glucose metabolism using F-18 fluorodeoxyglucose brain positron emission tomography in 12 patients with congenital scoliosis and compared them with those of 14 age-matched patients with adolescent idiopathic scoliosis. The mean mini-mental status exam score in the congenital scoliosis group was significantly lower than that in the adolescent idiopathic scoliosis group. Group analysis found that various brain areas of patients with congenital scoliosis showed glucose hypometabolisms in the left prefrontal cortex (Brodmann area 10), right orbitofrontal cortex (Brodmann area 11), left dorsolateral prefrontal cortex (Brodmann area 9), left anterior cingulate gyrus (Brodmann area 24) and pulvinar of the left thalamus. From this study, we could find the metabolic abnormalities of brain in patients with congenital scoliosis and suggest the possible role of voxel-based analysis of brain fluorodeoxyglucose positron emission tomography.     

Transverse plane pelvic rotation in adolescent idiopathic scoliosis: primary or compensatory?

Several studies have suggested that the pelvis is involved in the etiology or pathogenesis of adolescent idiopathic scoliosis (AIS). The purpose of this retrospective, cross-sectional radiographic study is to identify any correlation between the transverse plane rotational position of the pelvis in stance and operative-size idiopathic or congenital scoliosis deformities, using Scheuermann’s kyphosis and isthmic spondylolisthesis patients for comparison. The hypothesis tested was that the direction of transverse pelvic rotation is the same as that for a thoracic scoliosis. As a group, AIS patients had a significant transverse plane pelvic rotation in the same direction as the thoracic curve. When subdivided into the six Lenke curve patterns, this was true for the groups with a major thoracic curve: thoracic (1), double thoracic (2) and double curve patterns (3). It was not true for patterns with a major thoracolumbar/lumbar curve: single thoracolumbar/lumbar (5) and double thoracic-thoracolumbar/lumbar (6). Nor was it true for triple (4) curves. The Lenke 1 and 2 major thoracic curves without compensatory thoracolumbar/lumbar curves did not have the predicted pelvic rotation. All congenital scoliosis patients studied had main thoracic curves and significant transverse plane pelvic rotation in the same direction as the thoracic curve. There was no transverse plane pelvic rotation in the Scheuermann’s kyphosis or isthmic spondylolisthesis patients. We interpret these findings as consistent with a compensatory rotation of the pelvis in the same direction as the main thoracic curve in most patients with a compensatory thoracolumbar/lumbar curve as well as in patients with main thoracic congenital scoliosis.     

Lung volumes in scoliosis before and after correction by the Harrington instrumentation method.

Studies of static lung volumes were performed before and after surgery in 92 scoliotic patients, aged 10 to 25 years. The majority of the patients had idiopathic dorsal curves. Vital capacity, total lung capacity, functional residual capacity and residual volume were measured at least 18 months after surgery. A significant increase was observed in all static volumes, averaging 10 per cent; the pre- and postoperative values were expressed in per cent of predicted normal values according to age and height. Correction of body height was taken into consideration in the prediction of normal values. Patients with the more advanced scoliosis had the greatest improvement in lung volumes. The patients were treated postoperatively with a Milwaukee brace for an average of 15 months. The use of this brace, which allows for chest expansions, might account for the improved lung function compared to previous series where plaster body jackets were used. Thus the correction of idiopathic scoliosis by the standard posterior fusion with Harrinton instrumentation together with our postoperative routine provides a lasting reduction of the spinal deformity, prevents progression of respiratory impairment and, in fact, increases the lung volumes, vital capacity, total lung capacity and functional residual capacity by an average of 10 per cent.     

Pulmonary function in children and adolescents with untreated idiopathic scoliosis: a systematic review with meta-regression analysis

BACKGROUND CONTEXTOne of the controversies in untreated idiopathic scoliosis is the influence of curve size on respiratory function. Whereas scoliosis patients with curves over 90 to 100 degrees are agreed to be at risk for cardiorespiratory failure in later life, the impairment of curves below 90 degrees is generally considered mild. Although various studies showed that pulmonary function is affected in patients with scoliosis, quantification of the relation between curve size and pulmonary function is lacking.PURPOSEThis systematic review with meta-regression analysis aims to characterize the relation between pulmonary function tests and scoliosis severity in children and adolescents with idiopathic scoliosis.STUDY DESIGNSystematic review with meta-regression analysis.METHODSPubmed, Embase, Cochrane, and CINAHL were systematically searched until November 3, 2020, for original articles that reported (1) severity of scoliosis quantified in Cobb angle, and (2) pulmonary function tests in children and adolescents with untreated idiopathic scoliosis. Exclusion criteria were other types of scoliosis, non-original data, post-treatment data, and case reports. All study designs were included, and relevant study details and patient characteristics were extracted. The primary outcome was the effect of Cobb angle on pulmonary function as expressed by the slope coefficient of a linear meta-regression analysis.RESULTSA total of 126 studies, including 8,723 patients, were retrieved. Meta-regression analysis revealed a statistically significant inverse relation between thoracic Cobb angle and absolute and predicted forced vital capacity in 1 second, forced vital capacity, vital capacity, and total lung capacity. For these outcomes, the slope coefficients showed a decrease of 1% of the predicted pulmonary function per 2.6 to 4.5 degrees of scoliosis. A multivariable meta-regression analysis of potential confounders (age, year of publication, and kyphosis) hardly affected the majority of the outcomes.CONCLUSIONThis meta-regression analysis of summary data (means) from 126 studies showed an inverse relationship between the thoracic Cobb angle and pulmonary function. In contrast to previous conclusions, the decline in pulmonary function appears to be gradual over the full range of Cobb angles between <20 and >120 degrees. These findings strengthen the relevance of minimizing curve progression in children with idiopathic scoliosis.     

Collagen Changes in Congenital and Idiopathic Scoliosis

Collagen abnormalities in adolescent idiopathic scoliosis have been recorded. in this condition the platelet aggregating power of collagen is decreased and the amount of collagen in suspensions prepared from fascia is increased. We found the same abnormalities in two out of four patients with congenital scoliosis, operated on according to Harrington. in idiopathic as well as in congenital scoliosis the decrease in the platelet aggregating power was more conspicuous in the younger patients.     

The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis

BACKGROUND: Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth and is seen in patients who have severe congenital scoliosis with fused ribs. Traditional spinal surgery does not directly address this syndrome. METHODS: Twenty-seven patients with congenital scoliosis associated with fused ribs of the concave hemithorax had an opening wedge thoracostomy with primary longitudinal lengthening with use of a chest-wall distractor known as a vertical, expandable prosthetic titanium rib. Repeat lengthenings of the prosthesis were performed at intervals of four to six months. Radiographs were analyzed with respect to correction of the spinal deformity, as indicated by a change in the Cobb angle, and lateral deviation of the spine, as indicated by the interpedicular line ratio. Spinal growth was assessed by measuring the change in the length of the spine. Correction of the thoracic deformity and thoracic growth were assessed on the basis of the increase in the height of the concave hemithorax compared with the height of the convex hemithorax (the space available for the lung), the increase in the thoracic spinal height, and the increase in the thoracic depth and width. The thoracic deformity in the transverse plane was measured with computed tomography, and the scans were analyzed for spinal rotation, thoracic rotation, and the posterior hemithoracic symmetry ratio. Clinically, the patients were assessed on the basis of the relative heights of the shoulders and of head and thorax compensation. Pulmonary status was evaluated on the basis of the respiratory rate, capillary blood gas levels, and pulmonary function studies. RESULTS: The mean age at the time of the surgery was 3.2 years (range, 0.6 to 12.5 years), and the mean duration of follow-up was 5.7 years. All patients had progressive congenital scoliosis, with a mean increase of 15 degrees /yr before the operation. The scoliosis decreased from a mean of 74 degrees preoperatively to a mean of 49 degrees at the time of the last follow-up. Both the mean interpedicular line ratio and the space available for the lung ratio improved significantly. The height of the thoracic spine increased by a mean of 0.71 cm/yr. At the time of the last follow-up, the mean percentage of the predicted normal vital capacity was 58% for patients younger than two years of age at the time of the surgery, 44% for those older than two years of age (p < 0.001), and 36% for those older than two years of age who had had prior spine surgery. In a group of patients who had sequential testing, all increases in the volume of vital capacity were significant (p < 0.0001), but the changes in the percentages of the predicted normal vital capacity were not. There was a total of fifty-two complications in twenty-two patients, with the most common being asymptomatic proximal migration of the device through the ribs in seven patients. CONCLUSIONS: Opening wedge thoracostomy with use of a chest-wall distractor directly treats segmental hypoplasia of the hemithorax resulting from fused ribs associated with congenital scoliosis. The operation addresses thoracic insufficiency syndrome by lengthening and expanding the constricted hemithorax and allowing growth of the thoracic spine and the rib cage. The procedure corrects most components of chest-wall deformity and indirectly corrects congenital scoliosis, without the need for spine fusion. The technique requires special training and should be performed by a multispecialty team.     

The change in ratio of convex and concave lung volume in adolescent idiopathic scoliosis: a 3D CT scan based cross sectional study of effect of severity of curve on convex and concave lung volumes in 99 cases

To study the effect of the degree of scoliosis, degree of hypokyphosis/lordosis and rotation of apical vertebra on individual lung volume (measured with CT scan) in asymptomatic adolescent idiopathic scoliosis (AIS) patients. Individual (right and left) lung volume, angle of kyphosis and rotation of apical vertebra, were measured in 77 asymptomatic AIS patients having right thoracic curve, using modern computed tomography (CT) scan. To compare, lung volumes were measured in 22 normal persons (control group). The ratio of “right to left lung volume (convex to concave side)” was obtained and compared among these groups. With increased Cobb’s angle, ratio of convex to concave lung volume increased. For Cobb’s angle more than 40°, it was increased significantly (P = 0.0042). A significant degree of correlation was found between axial rotation angle of apical vertebra and right to left lung volume ratio (P = 0.0067, r = 0.271). A significant inverse correlation was found between the angle of kyphosis and right to left lung volume ratio, i.e., as the angle of kyphosis decreased the convex to concave lung volume ratio increased (P = 0.0109, r = −0.255). In asymptomatic, AIS patients, with increase in degree of curvature, and rotation of apical vertebra, the ratio of convex to concave side lung volume increases; indicating concave side lung volume is comparatively more affected (decreased) than convex side lung volume. On the other hand with decrease in the angle of kyphosis the convex to concave lung volume ratio increases indicating kyphotic angle has an inverse relation to convex to concave lung volume ratio. An erratum to this article can be found at