Correlation of Spine Deformity, Lung Function, and Seat Pressure in Spina Bifida
- First Online:
- 265 Downloads
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.
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.
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.
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.
- 4.Gal TJ. Pulmonary function testing. In: Miller RD, ed. Anesthesia. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000:886–887.Google Scholar
- 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.Müller EB, Nordwall A, Oden A. Progression of scoliosis in children with myelomeningocele. Spine (Phila Pa 1976). 1994;19:147–150.Google Scholar
- 11.Piggot H. The natural history of scoliosis in children with myelodysplasia. J Bone Joint Surg Br. 1980;62:54–58.Google Scholar
- 15.Smith R, Emans J. Sitting balance and spinal deformity. Spine (Phila Pa 1976). 1992;17:1103–1109.Google Scholar
- 16.Standardization of spirometry: 1994 update. American Thoracic Society. Am J Respir Crit Care Med. 1995;152:1107–1136.Google Scholar
- 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