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The effects of the three-dimensional deformity of adolescent idiopathic scoliosis on pulmonary function

Abstract

Purpose

Utilizing 2D measurements, previous studies have found that in AIS, increased thoracic Cobb and decreased thoracic kyphosis contribute to pulmonary dysfunction. Recent technology has improved our ability to measure and understand the true 3D deformity in AIS. The purpose of this study was to evaluate which 3D radiographic measures predict pulmonary dysfunction.

Methods

One hundred and sixty-three surgically treated AIS patients with preoperative PFTs (FEV, FVC, TLC) and EOS® imaging were identified at a single center. Each spine was reconstructed in 3D to obtain the true coronal, sagittal, and apical rotational deformities. These were then correlated with the patient’s preoperative PFT measurements. Regression analysis was performed to determine the relative effect of each radiographic measure.

Results

There were 124 thoracic and 39 lumbar major curves. The range of preoperative thoracic and lumbar 3D coronal angle was 11–115° and 11–98°, respectively. The range of preoperative thoracic 3D kyphosis (T5–T12) and thoracic apical vertebral rotation was −56 to 44° and 0–29°, respectively. Increasing thoracic 3D Cobb and thoracic vertebral rotation and decreasing thoracic 3D kyphosis most significantly correlated with decreasing pulmonary function, especially FEV. In patients with the largest degree of thoracic deformity (3D Coronal Cobb > 80°, 3D thoracic lordosis >20°, and absolute apical rotation >25°), the majority of patients had moderate to severe pulmonary impairment (≤65 % predicted). 3D thoracic kyphosis was the most consistent predictor of FEV (r 2 = 0.087), FVC (r 2 = 0.069), and TLC (r 2 = 0.098) impairment.

Conclusions

Larger thoracic coronal, sagittal, and axial deformities increase the risk of pulmonary impairment in patients with AIS. Of these, decreasing 3D thoracic kyphosis is the most consistent predictor. This information can guide surgeons in the decision making process for determining which surgical techniques to utilize and which component of the deformity to focus on.

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References

  1. Gillingham BL, Fan RA, Akbarnia BA (2006) Early onset idiopathic scoliosis. J Am Acad Orthop Surg 14:101–112

    Article  PubMed  Google Scholar 

  2. Goldberg CJ, Gillic I, Connaughton O, Moore DP, Fogarty EE, Canny GJ, Dowling FE (2003) Respiratory function and cosmesis at maturity in infantile-onset scoliosis. Spine (Phila Pa 1976) 28:2397–2406

    CAS  Article  Google Scholar 

  3. Redding G, Song K, Inscore S, Effmann E, Campbell R (2008) Lung function asymmetry in children with congenital and infantile scoliosis. Spine J 8:639–644

    Article  PubMed  Google Scholar 

  4. Chen SH, Huang TJ, Lee YY, Hsu RW (2002) Pulmonary function after thoracoplasty in adolescent idiopathic scoliosis. Clin Orthop Relat Res 399:152–161

    Article  Google Scholar 

  5. Gagnon S, Jodoin A, Martin R (1989) Pulmonary function test study and after spinal fusion in young idiopathic scoliosis. Spine (Phila Pa 1976) 14:486–490

    CAS  Article  Google Scholar 

  6. Graham EJ, Lenke LG, Lowe TG, Betz RR, Bridwell KH, Kong Y, Blanke K (2000) Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 25:2319–2325

    CAS  Article  Google Scholar 

  7. Kim YJ, Lenke LG, Bridwell KH, Kim KL, Steger-May K (2005) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am 87:1534–1541

    PubMed  Google Scholar 

  8. Kinnear WJ, Kinnear GC, Watson L, Webb JK, Johnston ID (1992) Pulmonary function after spinal surgery for idiopathic scoliosis. Spine (Phila Pa 1976) 17:708–713

    CAS  Article  Google Scholar 

  9. Kumano K, Tsuyama N (1982) Pulmonary function before and after surgical correction of scoliosis. J Bone Joint Surg Am 64(2):242–248

  10. Lenke LG, Bridwell KH, Blanke K, Baldus C (1995) Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis. Spine (Phila Pa 1976) 20:1343–1350

    CAS  Article  Google Scholar 

  11. Lenke LG, Newton PO, Marks MC, Blanke KM, Sides B, Kim YJ, Bridwell KH (2004) Prospective pulmonary function comparison of open versus endoscopic anterior fusion combined with posterior fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29:2055–2060

    Article  Google Scholar 

  12. Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG (2005) Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients. J Bone Joint Surg Am 87:1937–1946

    PubMed  Google Scholar 

  13. Vedantam R, Lenke LG, Bridwell KH, Haas J, Linville DA (2000) A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine (Phila Pa 1976) 25:82–90

    CAS  Article  Google Scholar 

  14. Wong CA, Cole AA, Watson L, Webb JK, Johnston ID, Kinnear WJ (1996) Pulmonary function before and after anterior spinal surgery in adult idiopathic scoliosis. Thorax 51:534–536

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. Wood KB, Schendel MJ, Dekutoski MB, Boachie-Adjei O, Heithoff KH (1996) Thoracic volume changes in scoliosis surgery. Spine (Phila Pa 1976) 21:718–723

    CAS  Article  Google Scholar 

  16. Yaszay B, Jazayeri R, Lonner B (2009) The effect of surgical approaches on pulmonary function in adolescent idiopathic scoliosis. J Spinal Disord Tech 22:278–283

    Article  PubMed  Google Scholar 

  17. Gitelman Y, Lenke LG, Bridwell KH, Auerbach JD, Sides BA (2011) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine (Phila Pa 1976) 36:1665–1672

    Article  Google Scholar 

  18. Johnston CE, Richards BS, Sucato DJ, Bridwell KH, Lenke LG, Erickson M (2011) Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 36:1096–1102

    Article  Google Scholar 

  19. Verma K, Lonner BS, Kean KE, LE Dean, Valdevit A (2011) Maximal pulmonary recovery after spinal fusion for adolescent idiopathic scoliosis: how do anterior approaches compare? Spine (Phila Pa 1976) 36:1086–1095

    Article  Google Scholar 

  20. Weinstein SL, Zavala DC, Ponseti IV (1981) Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg Am 63:702–712

    CAS  Article  PubMed  Google Scholar 

  21. Jackson RP, Simmons EH, Stripinis D (1989) Coronal and sagittal plane spinal deformities correlating with back pain and pulmonary function in adult idiopathic scoliosis. Spine (Phila Pa 1976) 14:1391–1397

    CAS  Article  Google Scholar 

  22. Kearon C, Viviani GR, Kirkley A, Killian KJ (1993) Factors determining pulmonary function in adolescent idiopathic thoracic scoliosis. Am Rev Respir Dis 148:288–294

    CAS  Article  PubMed  Google Scholar 

  23. Upadhyay SS, Mullaji AB, Luk KD, Leong JC (1995) Relation of spinal and thoracic cage deformities and their flexibilities with altered pulmonary functions in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 20:2415–2420

    CAS  Article  Google Scholar 

  24. Aaro S, Ohlund C (1984) Scoliosis and pulmonary function. Spine (Phila Pa 1976) 9:220–222

    CAS  Article  Google Scholar 

  25. Labelle H, Aubin CE, Jackson R, Lenke L, Newton P, Parent S (2011) Seeing the spine in 3D: how will it change what we do? J Pediatr Orthop 31:S37–S45

    Article  PubMed  Google Scholar 

  26. Stokes IA (1994) Three-dimensional terminology of spinal deformity. A report presented to the Scoliosis Research Society by the Scoliosis Research Society Working Group on 3-D terminology of spinal deformity. Spine (Phila Pa 1976) 19:236–248

    CAS  Article  Google Scholar 

  27. Glaser DA, Doan J, Newton PO (2012) Comparison of 3-dimensional spinal reconstruction accuracy: biplanar radiographs with EOS versus computed tomography. Spine (Phila Pa 1976) 37:1391–1397

    Article  Google Scholar 

  28. Somoskeoy S, Tunyogi-Csapo M, Bogyo C, Illes T (2012) Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Spine J 12:1052–1059

    Article  PubMed  Google Scholar 

  29. Newton PO, Fujimori T, Doan J, Reighard FG, Bastrom TP, Misaghi A (2015) Defining the “three-dimensional sagittal plane” in thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 97:1694–1701

    Article  PubMed  Google Scholar 

  30. Carreau JH, Bastrom T, Petcharaporn M, Schulte C, Marks M, Illés T, Somoskeöy S, Newton PO (2014) Computer-generated, three-dimensional spine model from biplanar radiographs: a validity study in idiopathic scoliosis curves greater than 50°. Spine Deform 2:81–88

    Article  PubMed  Google Scholar 

  31. Newton PO, Khandwala Y, Bartley CE, Reighard FG, Bastrom TP, Yaszay B (2016) New EOS imaging protocol allows a substantial reduction in radiation exposure for scoliosis patients. Spine Deform 4:138–144

    Article  PubMed  Google Scholar 

  32. Ilharreborde B, Steffen JS, Nectoux E, Vital JM, Mazda K, Skalli W, Obeid I (2011) Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine 36:E1306–E1313

    Article  PubMed  Google Scholar 

  33. Somoskeöy S, Tunyogi-Csapó M, Bogyó C, Illés T (2012) Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Spine J 12:1052–1059

    Article  PubMed  Google Scholar 

  34. Al-Aubaidi Z, Lebel D, Oudjhane K, Zeller R (2013) Three-dimensional imaging of the spine using the EOS system: is it reliable? A comparative study using computed tomography imaging. J Pediatr Orthop B 22:409–412

    Article  PubMed  Google Scholar 

  35. Murray J, Nadel J, Boushey H, Mason R (eds) (2000) Textbook of Respiratory Medicine. Saunders, Philadelphia

    Google Scholar 

  36. Johari J, Sharifudin MA, Ab Rahman A, Omar AS, Abdullah AT, Nor S, Lam WC, Yusof MI (2016) Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients. Singapore Med J 57:33–38

    Article  PubMed  PubMed Central  Google Scholar 

  37. Harris JA, Mayer OH, Shah SA, Campbell RM Jr, Balasubramanian S (2014) A comprehensive review of thoracic deformity parameters in scoliosis. Eur Spine J 23:2594–2602

    Article  PubMed  Google Scholar 

  38. Tsiligiannis T, Grivas T (2012) Pulmonary function in children with idiopathic scoliosis. Scoliosis 7:7

    Article  PubMed  PubMed Central  Google Scholar 

  39. Chun EM, Suh SW, Modi HN, Kang EY, Hong SJ, Song HR (2008) 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. Eur Spine J 17:224–229

    Article  PubMed  Google Scholar 

  40. Yu W, Song K, Zhang Y, Zheng GQ, Dong T (2014) Relationship between lung volume and pulmonary function in patients with adolescent idiopathic scoliosis: computed tomographic-based three-dimensional volumetric reconstruction of lung parenchyma. J Spinal Disord Tech (Epub ahead of print)

  41. Sarwahi V, Sugarman EP, Wollowick AL, Amaral TD, Harmon ED, Thornhill B (2014) Scoliosis surgery in patients with adolescent idiopathic scoliosis does not alter lung volume: a 3-dimensional computed tomography-based study. Spine (Phila Pa 1976) 39:E399–E405

    Article  Google Scholar 

  42. Kuklo TR, Potter BK, Polly DW Jr, O’Brien MF, Schroeder TM, Lenke LG (2005) Reliability analysis for manual adolescent idiopathic scoliosis measurements. Spine (Phila Pa 1976) 30:444–454

    Article  Google Scholar 

  43. Lam GC, Hill DL, Le LH, Raso JV, Lou EH (2008) Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 3:16

    Article  PubMed  PubMed Central  Google Scholar 

  44. Stokes IA, Bigalow LC, Moreland (1986) Measurement of axial rotation of vertebrae in scoliosis. Spine (Phila Pa 1976) 11:213–218

    CAS  Article  Google Scholar 

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Acknowledgments

Research support is gratefully acknowledged from the Rady Children’s Foundation Assaraf Family Research Fund and the Setting Scoliosis Straight Foundation.

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Correspondence to Burt Yaszay.

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Study conducted Rady Children’s Hospital, San Diego.

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Yaszay, B., Bastrom, T.P., Bartley, C.E. et al. The effects of the three-dimensional deformity of adolescent idiopathic scoliosis on pulmonary function. Eur Spine J 26, 1658–1664 (2017). https://doi.org/10.1007/s00586-016-4694-y

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  • DOI: https://doi.org/10.1007/s00586-016-4694-y

Keywords

  • Pulmonary function
  • Idiopathic scoliosis
  • Kyphosis