Clinical Orthopaedics and Related Research®

, Volume 469, Issue 5, pp 1330–1334

Structure-Respiration Function Relationships Before and After Surgical Treatment of Early-onset Scoliosis

Symposium: Early Onset Scoliosis

DOI: 10.1007/s11999-010-1621-0

Cite this article as:
Redding, G.J. & Mayer, O.H. Clin Orthop Relat Res (2011) 469: 1330. doi:10.1007/s11999-010-1621-0

Abstract

Background

Spine and chest wall deformities in children with early onset scoliosis (EOS) frequently impair respiratory function and postnatal growth of the lung. While a relationship between deformity and such impairment has been reported in children with adolescent idiopathic scoliosis it is not well understood in children with early-onset scoliosis (EOS).

Questions/purposes

We therefore describe (1) the preoperative relation between Cobb angle and forced vital capacity (FVC) in infants with EOS; (2) how changes in Cobb angle before and after surgery relate to changes in lung ventilation and perfusion in the right and left lungs.

Methods

We measured FVC in 10 children with EOS < 3 years old using the raised volume rapid thoracic compression (RVRTC) technique and correlated them with Cobb angles. We then measured right lung contributions to total lung ventilation and perfusion using lung scans before and 4 to 57 months after placement of vertical expandable prosthetic titanium ribs (VEPTRs) in 15 children with EOS and correlated changes in right lung function with postoperative changes in Cobb angles.

Results

In children 4 to 57 months of age, preoperative FVC (mean value, 83%; range, 63%–109% of predicted values) did not correlate with Cobb angles (mean value, 56º; range, 14°–120º). In children 1.8 to 11.5 years old, right lung ventilation and perfusion were abnormal in eight and seven children, respectively, but neither ventilation nor perfusion predictably normalized despite reductions in Cobb angle postoperatively.

Conclusions

The data extend the age range of children with EOS whose Cobb angles correlate poorly with FVC preoperatively. The data are also consistent with reports that reduced Cobb angles after VEPTR insertion do not correlate with postoperative changes in respiratory function.

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  1. 1.Pediatric Pulmonary Division, Room A-5937Seattle Children’s Hospital, 4800 Sand Point Way NESeattleUSA
  2. 2.Division of Pulmonary MedicineChildren’s Hospital of PhiladelphiaPhiladelphiaUSA