Abstract
Purpose
Historically, early-onset scoliosis was treated with early fusion to prevent further deformity at the expense of thoracic growth. This has proven to have a detrimental effect on pulmonary function. The purpose of this study is to evaluate patients’ pulmonary and functional status at long-term follow-up after undergoing thoracic fusion at a young age.
Methods
All patients at a single institution who had undergone thoracic spinal fusion prior to age nine with minimum 13-year follow-up were eligible. Patients underwent pulmonary function testing, radiographic analysis, and functional testing. Results were compared to the patients’ previous pulmonary function data at average of 11 years post-surgery.
Results
Fifteen out of twenty-eight eligible patients returned for testing. The average age at the time of surgery was 3.3 years (range 0.9–8.4 years) with follow-up of 23.6 years (range 13.2–33.2 years). There was a statistically significant interval decline in predicted forced vital capacity (42.8% versus 54.7% of normal predicted values, p = 0.0001) and predicted forced expiratory volume in one second (42.2% versus 55.2% of normal predicted values, p = 0.0001) when compared to previous follow-up. There was a strong positive correlation between thoracic height and forced vital capacity (r = 0.925, p = 0.002).
Conclusions
Pulmonary function in patients who had undergone thoracic spinal fusion for scoliosis prior to the age of six continues to decline into adulthood at a rate that is faster than that of their peers. The majority of these patients have clinically important restrictive lung disease, which can be fatal. Alternative treatment strategies should be considered.
Level of evidence
III.
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All of the below authors made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. They also drafted the work and revised it critically for important intellectual content. Additionally, they gave final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DB: conceptualization, methodology, formal analysis and investigation, writing—original draft preparation, writing—review and editing. LK: conceptualization, methodology, formal analysis and investigation, writing—original draft preparation, writing—review and editing. KP: conceptualization, methodology, formal analysis and investigation, writing—original draft preparation, writing—review and editing. CJ: conceptualization, methodology, formal analysis and investigation, writing—original draft preparation, writing—review and editing.
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Daniel Bouton has no conflict of interest. Lori Karol has no conflict of interest. Kiley Poppino has no conflict of interest. Charles Johnston receives Royalties from Medtronic and Elsevier, neither of which are relevant to this manuscript.
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The study was approved by the Texas Scottish Rite Hospital Institutional Review Board and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Bouton, D., Karol, L., Poppino, K. et al. Continued deterioration in pulmonary function at average 23-year follow-up from early thoracic fusion in non-neuromuscular scoliosis. Spine Deform 9, 587–594 (2021). https://doi.org/10.1007/s43390-020-00224-z
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DOI: https://doi.org/10.1007/s43390-020-00224-z