Clinical Orthopaedics and Related Research®

, Volume 469, Issue 5, pp 1302–1307

Correlation of Spine Deformity, Lung Function, and Seat Pressure in Spina Bifida

  • Jayesh Patel
  • Janet L. Walker
  • Vishwas R. Talwalkar
  • Henry J. Iwinski
  • Todd A. Milbrandt
Symposium: Myelomeningocele

Abstract

Background

Spinal deformity, a common problem in children with myelodysplasia, is associated with alterations in pulmonary function and sitting balance. Sitting imbalance causes areas of high pressure in patients already at high risk for developing pressure ulcers due to insensate skin.

Questions/purposes

We asked: Does spinal deformity affect pulmonary function tests in children with myelodysplasia? Does the magnitude of spinal curvatures and pelvic obliquity affect seating pressures? Does spinal deformity and seated pressures correlate with a history of pressure ulcers?

Patients and Methods

We retrospectively reviewed 32 patients with myelodysplasia and scoliosis (mean age, 14 years). The mean thoracic scoliosis was 64° with a mean pelvic obliquity of 15°. The mean forced vital capacity was 59% of predicted. The mean of the average and peak seated pressures were 24 and 137 mm Hg, respectively. We examined spinal radiographs, pulmonary function tests, and seated pressure maps and evaluated correlations of spinal deformity measures, pulmonary function, and seated pressures.

Results

The thoracic scoliosis inversely correlated with lung volume and weakly related with only the forced midexpiratory volume parameter (R2 = 31%). The curve magnitude was associated with % seated area with pressures of 38 to 70 mm Hg while lesser degrees of pelvic obliquity were associated with % seating area with pressures of less than 38 mm Hg (R2 = 25% and 24%, respectively). A history of pressure ulcers did not correlate with any spinal deformity or seated pressure measures.

Conclusions

All patients displayed a reduced forced vital capacity, but this reduction was not related to increasing scoliosis. The smaller scoliosis curves and lesser degrees of pelvic obliquity were associated with larger areas of low seated pressures.

References

  1. 1.
    Drummond D, Breed AL, Narechania R. Relationship of spine deformity and pelvic obliquity on sitting pressure distributions and decubitus ulceration. J Pediatr Orthop. 1985;5:396–402.PubMedCrossRefGoogle Scholar
  2. 2.
    Drummond D, Moreau M, Cruess R. The results and complications of surgery for the paralytic hip and spine in myelomeningocele. J Bone Joint Surg Br. 1980;62:49–53.PubMedGoogle Scholar
  3. 3.
    Drummond D, Narechania R, Rosenthal AN, Breed AL, Lange TA, Drummond DK. A study of pressure distributions measured during balanced and unbalanced sitting. J Bone Joint Surg Am. 1982;64:1034–1039.PubMedGoogle Scholar
  4. 4.
    Gal TJ. Pulmonary function testing. In: Miller RD, ed. Anesthesia. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000:886–887.Google Scholar
  5. 5.
    Guille JT, Sarwark JF, Sherk HH, Kumar SJ. Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Orthop Surg. 2006;14:294–302.PubMedGoogle Scholar
  6. 6.
    Henderson J, Price SH, Brandstater ME, Mendac BR. Efficacy of three measures to relieve pressure in seated persons with spinal cord injury. Arch Phys Med Rehabil. 1994;75:535–539.PubMedGoogle Scholar
  7. 7.
    Müller EB, Nordwall A. Prevalence of scoliosis in children with myelomeningocele in western Sweden. Spine (Phila Pa 1976). 1992;17:1097–1102.Google Scholar
  8. 8.
    Müller EB, Nordwall A, Oden A. Progression of scoliosis in children with myelomeningocele. Spine (Phila Pa 1976). 1994;19:147–150.Google Scholar
  9. 9.
    Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. J Bone Joint Surg Am. 2005;87:1937–1946.PubMedCrossRefGoogle Scholar
  10. 10.
    Osebold WR, Mayfield JK, Winter RB, Moe JH. Surgical treatment of paralytic scoliosis associated with myelomeningocele. J Bone Joint Surg Am. 1982;64:841–856.PubMedGoogle Scholar
  11. 11.
    Piggot H. The natural history of scoliosis in children with myelodysplasia. J Bone Joint Surg Br. 1980;62:54–58.Google Scholar
  12. 12.
    Rodgers WB, Frim DM, Emans JB. Surgery of the spine in myelodysplasia: an overview. Clin Orthop Relat Res. 1997;338:19–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Samuelsson L, Eklöf O. Scoliosis in myelomeningocele. Acta Orthop Scand. 1988;59:122–127.PubMedGoogle Scholar
  14. 14.
    Shurtleff DB, Goiney R, Gorden LD, Livermore N. Myelodysplasia: the natural history of kyphosis and scoliosis. A preliminary report. Dev Med Child Neurol Suppl. 1976;37:126–133.PubMedGoogle Scholar
  15. 15.
    Smith R, Emans J. Sitting balance and spinal deformity. Spine (Phila Pa 1976). 1992;17:1103–1109.Google Scholar
  16. 16.
    Standardization of spirometry: 1994 update. American Thoracic Society. Am J Respir Crit Care Med. 1995;152:1107–1136.Google Scholar
  17. 17.
    Trivedi, J, Thomson, JD, Slakey JB, Banta JV, Jones PW. Clinical and radiographic predictors of scoliosis in patients with myelomeningocele. J Bone Joint Surg Am. 2002;84:1389–1394.PubMedGoogle Scholar
  18. 18.
    Weinstein SL. Adolescent idiopathic scoliosis: natural history. In: Weinstein SL, ed. The Pediatric Spine: Principles and Practice. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2001:355–369.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Jayesh Patel
    • 1
  • Janet L. Walker
    • 1
    • 2
  • Vishwas R. Talwalkar
    • 1
    • 2
  • Henry J. Iwinski
    • 1
    • 2
  • Todd A. Milbrandt
    • 1
    • 2
  1. 1.Department of Orthopaedic SurgeryUniversity of KentuckyLexingtonUSA
  2. 2.Shriners Hospital for Children–LexingtonLexingtonUSA

Personalised recommendations