Document Detail

Pulmonary function after thoracoplasty in the surgical treatment of adolescent idiopathic scoliosis.
MedLine Citation:
PMID:  20625329     Owner:  NLM     Status:  In-Process    
STUDY DESIGN: Retrospective case series review.
OBJECTIVE: To compare two similar groups of adolescents surgically treated for their spinal deformity either by posterior segmental fusion alone (PSF) or by posterior spinal fusion and thoracoplasty (PSF+T); attention was focused on the long-term effects of thoracoplasty on pulmonary function in the surgical treatment of adolescent idiopathic scoliosis.
SUMMARY OF BACKGROUND DATA: Posterior spinal arthrodesis with thoracoplasty and an open anterior approach, with respect to a posterior only fusion have been found to have a deleterious effect on pulmonary function for as long as five years postoperatively after surgical treatment of adolescent idiopathic scoliosis.
METHODS: A group of 40 consecutive adolescent patients, surgically treated between 1998 and 2001 by posterior spinal fusion and thoracoplasty, was compared with a similar cohort of 40 adolescents treated in the same period by posterior segmental fusion alone. Pedicle screw instrumentation alone and a minimum five-year follow-up were requested as inclusion criteria. Both a radiographic analysis and a chart review was performed, evaluating the pulmonary function tests (PFTs), the SRS-30 score questionnaire and the Lenke classification system. A radiographic Rib Hump (RH) assessment was also performed.
RESULTS: The entire series was reviewed at an average clinical follow-up of 8.3 years. There were no statistically significant differences between the two groups in terms of gender, age (PSF+T: 16.3 y vs. PSF: 15.2 y), Lenke curve type classification and preoperative Cobb's main thoracic (MT) curve magnitude (PSF+T: 66° vs. PSF: 63°), whereas both final MT percent correction (PSF+T: 53.03% vs. PSF: 51.35%; P<0.03), RH absolute correction (PSF+T: -2.1 cm vs. PSF: -1.05; P<0.01) and RH overall percent correction (PSF+T: 55.4% vs. PSF: 35.4%; P<0.0001) were greater in the thoracoplasty group. No statistical differences were observed between the two groups in PFTs both pre-operatively and at last follow-up. Nevertheless, comparing preoperative to final PFT'S within each group, only in the PSF group both forced vital capacity and forced expiratory volume in one second showed a statistically significant improvement at final evaluation. At last follow-up visit, the SRS-30 scores did not show any statistical difference between the two groups (total score PSF+T: 4.1 vs. PSF: 4.3).
CONCLUSIONS: Our findings suggest that thoracoplasty did not adversely affect long-term PFTs in AIS patients treated by posterior spinal fusion alone using pedicle screws instrumentation, as already highlighted by previous reports. A trend towards better coronal plane correction and rib hump improvement was seen, although not clearly reported in a self-assessment disease-specific questionnaire.
Tiziana Greggi; Georgios Bakaloudis; Isabella Fusaro; Mario Di Silvestre; Francesco Lolli; Konstantinos Martikos; Francesco Vommaro; Giovanni Barbanti-Brodano; Alfredo Cioni; Stefano Giacomini
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  23     ISSN:  1539-2465     ISO Abbreviation:  J Spinal Disord Tech     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-07     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e63-9     Citation Subset:  IM    
Spine Deformity Department, Istituti Ortopedici Rizzoli, Bologna, Italy.
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