Assessing the Long-term Pulmonary Outcomes of Scoliosis Surgery

Surgical Rounds®June 2014

Adolescent idiopathic scoliosis patients who experience pain, cosmetic deformity, or impending respiratory compromise can benefit from spinal surgery.

Young patients with progressive adolescent idiopathic scoliosis (AIS) may also experience impaired lung function. In fact, many AIS patients exhibit mean forced expiratory volumes (FEV1) and forced vital capacities (FVC) at least 3 standard deviations below normal levels prior to undergoing spinal surgery.

While the purpose of the surgery is to prevent lung decline and poor quality of life (QOL), it remains unclear whether the procedure actually produces those outcomes. Therefore, a team of researchers from the Royal Hospital for Sick Children in the United Kingdom set out to determine whether AIS patients’ lung function and QOL return to normal levels after combined anterior and posterior spinal fusion (A/PSF).

Published online in Archives of Diseases in Childhood, the prospective cohort study followed 12 patients who underwent A/PSF around age 14. Using spirometry and the Scoliosis Research Society-22 (SRS-22) questionnaire to assess outcomes, the researchers found the patients’ heights increased from a mean 169 cm preoperatively to 175 cm at follow-up, which indicated that their statures and postures improved. The patients’ lung function also improved after A/PSF, as FEV1 and FVC returned to preoperative or expected values at long-term follow-up.

The patients were extremely satisfied with the outcomes of their surgeries and indicated their QOL significantly improved at 2 years, with additional improvement accruing over the next 4 years. However, the study was limited by the fact that a single surgeon performed all of the operations, and the study subjects had more severe scoliosis than subjects enrolled in previous trials.

Nevertheless, the authors indicated patients with AIS who experience pain, cosmetic deformity, or impending respiratory compromise will benefit from surgery.

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