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The influence of isolated thoracoplasty on the evolution of pulmonary function after treatment of severe thoracic scoliosis

Abstract

Introduction and purpose

Isolated thoracoplasty (iTP) on the convex side is performed long time after scoliosis surgery has been performed. ITP is thought to cause a further decline in pulmonary function (PF); however, the amount of decline is ill defined. The objectives of this study were to examine the influence of iTP on the postoperative evolution of PF and rib hump reduction in patients that previously undergone scoliosis surgery.

Methods

Over an 11-year period, 75 patients underwent iTP. The authors performed a retrospective case series review. Patients with data from PF tests performed preoperatively and at the last follow-up were included. Minimum follow-up was 12 months. The PF value reported was predicted FVC (FVC%). According to the American Thoracic Society, pulmonary impairment was classified as no impairment (FVC: >80–100%), mild (FVC: >65 ≤80%), moderate (FVC: >50 ≤65), and severe (FVC ≤50%). The outcome was studied using validated measures (SRS-24 score, COMI, and the COPD Assessment Test (CAT)). The CAT is stratified into mild impairment (<10 pts), moderate impairment (10–20 pts), severe impairment (>20–30 pts), and disabled (>30 pts).

Results

Twenty-six patients fulfilled the inclusion criteria. The patients’ average age was 28 years at surgery with iTP, and 22 were females; the average BMI was 23, and the average follow-up was 76 months. Twenty of the patients had AIS, and six had congenital scoliosis. The time between scoliosis correction and iTP averaged 39 months. The mean number of resected rib segments was 7, and the mean blood loss was 834 ml. FVC% was 66% preoperatively and 57% at follow-up, with a significant change of 9% (p < .02). Fourteen patients had a FVC% change between preoperation and follow-up that was ≥5%; this change was not dependent on the preoperative FVC%. PF showed a slight but non-significant improvement with longer follow-up. At the time of iTP, the thoracic curve averaged 67°, and thoracic kyphosis averaged 46°. Rib hump height was 34 mm before iTP and 15 mm at follow-up (p < .03). At follow-up, the SRS-24 score was 81, the COMI score was 4 points, and the CAT score was 8 points. Eight patients had a CAT >10. Two patients had a major complication. A comparison of patients with pulmonary impairment preoperation vs. follow-up found 4 vs. 1 patients had no PF impairment, 8 vs. 4 patients had mild impairment, 10 vs. 13 patients had moderate impairment, and 4 vs. 8 patients had severe impairment.

Conclusions

Isolated TP was shown an effective technique for rib hump resection. Six years after iTP, the FVC% declined by an average of 9%. Several patients had long-lasting effects in terms of %FVC decline. iTP should be reserved for patients with significant rib hump deformity.

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References

  1. Helenius I, Remes V, Yrjönen T, Ylikoski M, Schlenzka D, Helenius M, Poussa M (2003) Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis. Long-term functional and radiographic outcomes. J Bone J Surg 85-A:2303–2309

    Article  Google Scholar 

  2. Asher M, Min Lai S, Burton D, Manna B (2003) Discrimination validity of the scoliosis research society-22 patient questionnaire: relationship to idiopathic scoliosis curve pattern and curve size. Spine 28–1:70–73

    Article  Google Scholar 

  3. Samdani AF, Hwang SW, Miyanji F, Lonner B, Marks MC, Sponseller PD, Newton PO, Cahill PJ, Shufflebarger HL, Betz RR (2011) Direct vertebral body derotation, thoracoplasty, or both: which is better with respect to inclinometer and scoliosis research society-22 scores? Spine 37:E849–E853

    Article  Google Scholar 

  4. Suk SI, Kim JH, Kim SS, Lee JJ, Han YT (2008) Thoracoplasty in thoracic adolescent idiopathic scoliosis. Spine 33:1061–1067

    Article  PubMed  Google Scholar 

  5. Geissele MAE, Ogilvie JW, Cohen M, Bradford DS (1994) Thoracoplasty for the treatment of rib prominence in thoracic scoliosis. Spine 19:1636–1642

    CAS  Article  PubMed  Google Scholar 

  6. Greggi T, Bakaloudis G, Fusaro I, Di Silvestre M, Lolli F, Martikos K, Vommaro F, Barbanti-Brodano G, Cioni A, Giacomini S (2010) Pulmonary function after thoracoplasty in the surgical treatment of adolescent idiopathic scoliosis. J Spinal Disord 23:E63–E69

    Article  Google Scholar 

  7. Hwang SW, Samdani AF, Lonner B, Miyanji F, Stanton P, Marks MC, Bastrom T, Newton PO, Betz RR, Cahill PJ (2012) Impact of direct vertebral body derotation on rib prominence: are preoperative factors predictive of changes in rib prominence? Spine 37:E86–E89

    Article  PubMed  Google Scholar 

  8. Rushton PR, Grevitt MP (2014) Do vertebral derotation techniques offer better outcomes compared to traditional methods in the surgical treatment of adolescent idiopathic scoliosis? Eur Spine J 23:1166–1176

    Article  PubMed  Google Scholar 

  9. Lykissas MG, Sharma V, Jain VV, Crawford AH (2015) Assessment of rib hump deformity correction in adolescent idiopathic scoliosis with or without costoplasty using the double rib contour sign. J Spinal Disord Tech 28:134–139

    Article  PubMed  Google Scholar 

  10. Dreimann M, Hoffmann M, Kossow K, Hitzl W, Meier O, Koller H (2014) Scoliosis and chest cage deformity measures predicting impairments in pulmonary function: a cross-sectional study of 492 patients with scoliosis to improve the early identification of patients at risk. Spine 39:2024–2033

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Xue X, Shen J, Zhang J, Zhao H, Li S, Wang Y, Liang J, Weng X, Qiu G (2015) An analysis of thoracic cage deformities and pulmonary function tests in congenital scoliosis. Eur Spine J 24:1415–1421

    Article  PubMed  Google Scholar 

  13. Liang J, Qiu G, Shen J, Zhang J, Wang Y, Li S, Zhao H (2010) Predictive factors of postoperative pulmonary complications in scoliotic patients with moderate or severe pulmonary dysfunction. J Spinal Disord Tech 23:388–392

    Article  PubMed  Google Scholar 

  14. Tiziana G, Bakaloudis G, Fusaro I (2010) Pulmonary function after thoracoplasty in the surgical treatment of adolescent idiopathic scoliosis. J Spinal Disord 23:E63–E69

    Article  Google Scholar 

  15. Kishan S, Bastrom T, Betz RR, Lenke LG, Lowe TG, Clements D, D’Andrea L, Sucato DJ, Newton PO (2007) Thoracoscopic scoliosis surgery affects pulmonary function less than thoracotomy at 2 years postsurgery. Spine 32:453–458

    Article  PubMed  Google Scholar 

  16. Newton PO, Perry A, Bastrom TP, Lenke LG, Betz RR, Clements D, D’Andrea L (2007) Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis. Spine 32:1875–1882

    Article  PubMed  Google Scholar 

  17. Glassmann SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine 32:2764–2770

    Article  Google Scholar 

  18. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J 6:5–40

    Article  PubMed  Google Scholar 

  19. Murray RJ (2007) Respiratory manifestations of extrapulmonary disorders. Elsevier Saunders, Philadelphia

    Google Scholar 

  20. Mannion AF, Junge A, Fairbank JC, Dvorak J, Grob D (2005) Development of a German version of the Oswestry disability index. Part I: cross cultural adaption, reliability, and validity. Eur Spine J 15:55–65

    Article  PubMed  PubMed Central  Google Scholar 

  21. Blinded for Review

  22. Koller H, Zenner J, Gajic V, Meier O, Ferraris L, Hitzl W (2012) The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. Eur Spine J 21:514–529

    Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  24. Barrett DS, MacLean JG, Bettany J, Ransford AO, Edgar MA (1993) Costoplasty in adolescent idiopathic scoliosis. Objective results in 55 patients. J Bone Jt Surg Br 75:881–885

    CAS  Google Scholar 

  25. Min K, Sdzuy C, Farshad M (2013) Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up. Eur Spine J 22:345–354

    Article  PubMed  Google Scholar 

  26. Min K, Haefeli M, Mueller D, Klammer G, Hahn F (2012) Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical radidological and pulmonary function results. Eur Spine J Suppl 6:S765–S772

    Article  Google Scholar 

  27. Yang JH, Bhandarkar AW, Kasat NS, Suh SW, Hong JY, Modi HN, Hwang JH (1993) Costoplasty in adolescent idiopathic scoliosis. Objective results in 55 patients. J Bone Jt Surg Br 75:881–885

    Google Scholar 

  28. Liang J, Qiu G, Shen J, Zhang J, Wang Y, Li S, Zhao H (2010) Predictive factors of postoperative pulmonary complications in scoliotic patients with moderate or severe pulmonary dysfunction. J Spinal Disord 23:388–392

    Article  Google Scholar 

  29. Koller H, Meier O, Albrecht H, Schmidt R, Zenner J, Hitzl W (2014) Selective thoracic fusion in AIS curves: the definition of target outcomes improves the prediction of spontaneous lumbar curve correction (SLCC). Eur Spine J 23:1263–1281

    Article  PubMed  Google Scholar 

  30. Gitelman Y, Lenke LG, Bridwell KH, Auerbach JD, Sides BA (2011) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. Spine 36:1665–1672

    Article  PubMed  Google Scholar 

  31. 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 

  32. Kim YJ, Lenke LG, Bridwell KH, Cheh G, Whorton J, Sides B (2007) Prospective pulmonary function comparison following posterior segmental spinal instrumentation and fusion of adolescent idiopathic scoliosis. Spine 32:2685–2693

    Article  PubMed  Google Scholar 

  33. Yang JH, Bhandarkar AW, Kasat NS, Suh SW, Hong JY, Modi HN, Hwang JH (2013) Isolated percutaneous thoracoplasty procedure for skeletally mature adolescent idiopathic scoliosis patients, with rib deformity as their only concern: short-term outcomes. Spine 38:37–43

    Article  PubMed  Google Scholar 

  34. Harding IJ, Chopin D, Charosky S, Vialle R, Carrizo D, Delecourt C (2005) Long-term results of Schollner costoplasty in patients with idiopathic scoliosis. Spine 30:1627–1631

    Article  PubMed  Google Scholar 

  35. Chunguang Z, Yueming S, Limin L, Qingquan K, Hao L, Quan G, Tao L, Jiancheng Z (2011) Convex short length rib resection in thoracic adolescent idiopathic scoliosis. J Pediatr Orthop 31:757–763

    Article  PubMed  Google Scholar 

  36. Lao L, Weng X, Qiu G, Shen J (2013) The role of preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis. J Orthop Surg Res 8:32

    Article  PubMed  PubMed Central  Google Scholar 

  37. Owen R, Turner A, Bamforth JS, Taylor JF, Jones RS (1986) Costectomy as the first stage of surgery for scoliosis. J Bone J Surg 68-B:91–95

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Correspondence to Heiko Koller.

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Koller, H., Schulte, T.L., Meier, O. et al. The influence of isolated thoracoplasty on the evolution of pulmonary function after treatment of severe thoracic scoliosis. Eur Spine J 26, 1765–1774 (2017). https://doi.org/10.1007/s00586-017-4982-1

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  • DOI: https://doi.org/10.1007/s00586-017-4982-1

Keywords

  • Thoracoplasty
  • Rib hump resection
  • Scoliosis surgery
  • Pulmonary function
  • Clinical outcome