Progressive decline in pulmonary function 5 years post-operatively in patients who underwent anterior instrumentation for surgical correction of adolescent idiopathic scoliosis
To evaluate changes in pulmonary function tests (PFT) at 5 years post-operatively in patients with adolescent idiopathic scoliosis (AIS) and to determine whether these changes are progressive or static after 2 years.
AIS surgical patients with pre-operative and 5 year post-operative forced expiratory volume (FEV) and forced vital capacity (FVC) were included. The percentage of patients with pulmonary impairment at 5 years was calculated. Repeated measures ANOVA was used to evaluate changes between pre-operative PFT and 5 years post-operative PFT and to determine whether the changes differed between curve types and approach. A sub-analysis of patients with 2 year data was performed to determine whether PFT changes were static or progressive.
Two hundred and sixty-two patients had undergone pre-operative and 5 year post-operative PFTs. At 5 years, 42% were normal, 41% had mild impairment, and 17% had moderate-severe impairment. Overall, there was a decline in % predicted FVC (p < 0.05); FEV remained stable. There was no difference based on major curve type (p > 0.05). Anterior instrumentation cases declined significantly between pre-operative PFT and 5 years post-operative PFT (FEV: − 10% open, − 6% thoracoscopic; FVC: − 13% open, − 8% thoracoscopic) (p ≤ 0.02). The posterior cases remained stable (2% FEV, p = 0.7; − 0.6% FVC, p = 0.06). A subgroup of 90 patients with 2 year post-operative PFTs demonstrated that changes were progressive between 2 and 5 years post-operatively. The average change in FVC from 2 to 5 years was significantly different between the anterior open (− 9%) and posterior-only (0.7%) groups (p = 0.015).
In patients who underwent anterior instrumentation, PFTs declined from the pre-operative to the 5 years post-operative time point. There was a progressive decline of 4–10% beyond 2 years post-operatively. Patients who underwent posterior instrumentation remained stable.
KeywordsPulmonary function Adolescent idiopathic scoliosis Anterior spinal fusion Posterior spinal fusion
This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet. Harms Study Group Investigators: Aaron Buckland, MD; New York University Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia Amit Jain, MD; Johns Hopkins Hospital Baron Lonner, MD; Mount Sinai Hospital Benjamin Roye, MD; Columbia University Burt Yaszay, MD; Rady Children’s Hospital Chris Reilly, MD; BC Children’s Hospital Daniel Hedequist, MD; Boston Children’s Hospital Daniel Sucato, MD; Texas Scottish Rite Hospital David Clements, MD; Cooper Bone & Joint Institute New Jersey Firoz Miyanji, MD; BC Children’s Hospital Harry Shufflebarger, MD; Nicklaus Children's Hospital Jack Flynn, MD; Children’s Hospital of Philadelphia Jahangir Asghar, MD; Cantor Spine Institute Jean Marc Mac Thiong, MD; CHU Sainte-Justine Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad Keith Bachmann, MD; University of Virginia Larry Lenke, MD; Columbia University Mark Abel, MD; University of Virginia Michael Glotzbecker, MD; Boston Children’s Hospital Michael Kelly, MD; Washington University Michael Vitale, MD; Columbia University Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation Munish Gupta, MD; Washington University Nicholas Fletcher, MD; Emory University Patrick Cahill, MD; Children’s Hospital of Philadelphia Paul Sponseller, MD; Johns Hopkins Hospital Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children Peter Newton, MD; Rady Children’s Hospital Peter Sturm, MD; Cincinnati Children’s Hospital Randal Betz, MD; Institute for Spine & Scoliosis Ron Lehman, MD; Columbia University Stefan Parent, MD: CHU Sainte-Justine Stephen George, MD; Nicklaus Children's Hospital Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children Tom Errico, MD; Nicklaus Children's Hospital Vidyadhar Upasani, MD; Rady Children’s Hospital.
Compliance with ethical standards
Conflict of interest
All authors report grants to their institutions from the Setting Scoliosis Straight Foundation during the conduct of this study. The following conflicts of interest exist outside of the submitted work: Dr. Yaszay received grants and personal fees from K2M, grants and personal fees from DePuy Synthes Spine, personal fees from Nuvasive, personal fees from Medtronic, personal fees from Orthopediatrics, personal fees from Stryker, personal fees from Globus, grants from Setting Scoliosis Straight Foundation, and has a patent with K2M with royalties paid. Dr. Lonner reports received grants from Setting Scoliosis Straight Foundation, personal fees from DePuy Synthes Spine, personal fees from K2M, personal fees from Paradigm Spine, personal fees from Spine Search, personal fees from Ethicon, non-financial support from Spine Deformity Journal, grants from John and Marcella Fox Fund Grant, grants from OREF, personal fees from Zimmer Biomet, and personal fees from Apifix. Dr. Betz received personal fees and other from Abyrx, other from Advanced Vertebral Solutions, personal fees and other from ApiFix, personal fees from DePuy Synthes Spine, other from Electrocore, personal fees from Globus Medical, other from Medovex, personal fees from Medtronic, other from MiMedx, other from Orthobond, personal fees and other from SpineGuard, other from SpineMedica, personal fees from Thieme Medical Publishers, personal fees from Zimmer Biomet, and has an immediate family member who is an employee of DePuy Synthes Spine. Dr. Shah received personal fees from DePuy Synthes Spine and K2M. Dr. Asghar received personal fees and non-financial support from Omega innovative Technologies, and personal fees from Life Spine and Globus Medical. Dr. Samdani received personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Misonix, personal fees from Stryker, personal fees from Zimmer Biomet, other from Setting Scoliosis Straight Foundation, other from Scoliosis Research Society, and other from Children's Spine Study Group. Dr. Newton received grants and other from Setting Scoliosis Straight Foundation, other from Rady Children's Specialists, grants, personal fees and non-financial support from DePuy Synthes Spine, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, grants from NuVasive, other from Electrocore, personal fees from Cubist, other from International Pediatric Orthopedic Think Tank, grants, non-financial support and other from Orthopediatrics, grants, personal fees and non-financial support from K2M, grants and non-financial support from Alphatech, and has the following patents: Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) licensed to DePuy Spine, Inc., a patent Screw placement guide (7981117) licensed to DePuy Spine, Inc., a patent Compressor for use in minimally invasive surgery (7189244) licensed to DePuy Spine, Inc., and a patent Posterior spinal fixation pending to K2M.
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