International Orthopaedics

, Volume 42, Issue 10, pp 2383–2388 | Cite as

Prediction of respiratory function in patients with severe scoliosis on the basis of the novel individualized spino-pelvic index

  • Zhi-hui Zhao
  • Hong-da Bao
  • Chang-chun Tseng
  • Ze-zhang Zhu
  • Yong Qiu
  • Zhen Liu
Original Paper



Our study aimed to evaluate the pulmonary function of patients with severe scoliosis after correcting standing height with spino-pelvic index (SPI).


Inclusion criteria: (1) with a coronal Cobb angle of more than 90°; (2) diagnosed as congenital (CS) or idiopathic scoliosis (IS); (3) aged between ten and 20 years; (4) with pulmonary function test (PFT) at the primary consultation. Patients with previous surgical intervention, with angular kyphosis, and with neuromuscular disease were excluded. Length of spine (LOS), height of spine (HOS), and height of pelvis (HOP) were measured on coronal films. SPI was defined as the ratio between LOS and HOP. The corrected body height was calculated: corrected body height = body height + (SPI × HOP − HOS). The PFTs included the following parameters: VCmax, FVC, FVC% predicted, FEV1, FEV1% predicted, PEF, and MVV. PFT results were recalculated using the corrected body height.


Thirty patients were diagnosed as IS and 27 as CS with average Cobb angles of 99.88° ± 11.83 and 98.06° ± 14.27, respectively. Significant differences were observed in VCmax and FVC between IS and CS patients (P < 0.05). All the corrected PFT parameters were significantly lower than the original PFT parameters (P < 0.05).


For the first time, this study proposed a method to predict pulmonary function of patients with severe scoliosis using SPI, as an age-independent parameter in normal adolescents. After body height correction, pulmonary function of patients with severe scoliosis was found to be significantly decreased, indicating that pulmonary function impairment was underestimated in patients with severe scoliosis when evaluating pulmonary function with arm span.


Scoliosis Pulmonary function Spino-pelvic index Spinal deformity 



This study was funded by the Nanjing Clinical Medical Center, Jiangsu Provincial Key Medical Center, and supported by the health bureau of Jiangsu (Q201510).

Compliance with ethical standards

All methods were performed in accordance with the relevant guidelines and regulations. Informed consent has been obtained from each participant in this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Day G, Upadhyay S, Ho E, Leong J, Ip M (1994) Pulmonary functions in congenital scoliosis. Spine 19(9):1027–1031CrossRefGoogle Scholar
  2. 2.
    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 87(7):1534–1541Google Scholar
  3. 3.
    Payo J, Perez-Grueso FS, Fernandez-Baillo N, Garcia A (2009) Severe restrictive lung disease and vertebral surgery in a pediatric population. Euro Spine J : Off Pub Euro Spine Soc Euro Spinal Deformity Soc Euro Section Cervical Spine Res Soc 18(12):1905–1910. CrossRefGoogle Scholar
  4. 4.
    Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl ME (1987) Results of surgical treatment of adults with idiopathic scoliosis. J Bone Joint Surg Am 69(5):667–675CrossRefGoogle Scholar
  5. 5.
    Cooper DM, Rojas JV, Mellins RB, Keim HA, Mansell AL (1984) Respiratory mechanics in adolescents with idiopathic scoliosis. Am Rev Respir Dis 130(1):16–22PubMedGoogle Scholar
  6. 6.
    Tsiligiannis T, Grivas T (2012) Pulmonary function in children with idiopathic scoliosis. Scoliosis 7(1):7. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    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. Euro Spine J : Off Pub Euro Spine Soc Euro Spinal Deformity Soc Euro Section of the Cervical Spine Res Soc 21(3):514–529. CrossRefGoogle Scholar
  8. 8.
    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 (Phila Pa 1976) 39(24):2024–2033. CrossRefGoogle Scholar
  9. 9.
    Bumpass DB, Lenke LG, Bridwell KH, Stallbaumer JJ, Kim YJ, Wallendorf MJ, Min WK, Sides BA (2014) Pulmonary function improvement after vertebral column resection for severe spinal deformity. Spine (Phila Pa 1976) 39(7):587–595. CrossRefGoogle Scholar
  10. 10.
    Sancho-Chust JN, Chiner E, Camarasa A, Senent C (2010) Differences in pulmonary function based on height prediction obtained by using alternative measures. Respir Int Rev Thor Dis 79(6):461–468. CrossRefGoogle Scholar
  11. 11.
    Golshan M, Crapo RO, Amra B, Jensen RL, Golshan R (2007) Arm span as an independent predictor of pulmonary function parameters: validation and reference values. Respirology (Carlton, Vic) 12(3):361–366. CrossRefGoogle Scholar
  12. 12.
    Hibbert ME, Lanigan A, Raven J, Phelan PD (1988) Relation of armspan to height and the prediction of lung function. Thorax 43(8):657–659CrossRefGoogle Scholar
  13. 13.
    Tyrakowski M, Kotwicki T, Czubak J, Siemionow K (2014) Calculation of corrected body height in idiopathic scoliosis: comparison of four methods. Euro Spine J : Off Publ Euro Spine Soc Euro Spinal Deform Soc Euro Section of the Cervical Spine Res Soc 23(6):1244–1250. CrossRefGoogle Scholar
  14. 14.
    Capderou A, Berkani M, Becquemin MH, Zelter M (2011) Reconsidering the arm span-height relationship in patients referred for spirometry. Eur Respir J 37(1):157–163. CrossRefPubMedGoogle Scholar
  15. 15.
    Bao H, Liu Z, Yan P, Qiu Y, Zhu F (2015) Disproportionate growth between the spine and pelvis in patients with thoracic adolescent scoliosis. Bone Joint J 97(12):1668–1674CrossRefGoogle Scholar
  16. 16.
    Tay KS, Bassi A, Yeo W, Yue WM (2017) Associated lumbar scoliosis does not affect outcomes in patients undergoing focal minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF) for neurogenic symptoms-a minimum 2-year follow-up study. Spine J : Off J North Am Spine Soc 17(1):34–43. CrossRefGoogle Scholar
  17. 17.
    Chong HS, Padua MR, Kim JS, Lee HM, Moon SH, Suk KS, Hak Sun K (2015) Usefulness of noninvasive positive-pressure ventilation during surgery of flaccid neuromuscular scoliosis. J Spinal Disord Tech. CrossRefGoogle Scholar
  18. 18.
    Nepple JJ, Lenke LG (2009) Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy. Spine J : Off J North Am Spine Soc 9(7):e9–e13. CrossRefGoogle Scholar
  19. 19.
    Harrison RA, Siminoski K, Vethanayagam D, Majumdar SR (2007) Osteoporosis-related kyphosis and impairments in pulmonary function: a systematic review. J Bone and Miner Res : Off J Am Soc Bone and Miner Res 22(3):447–457. CrossRefGoogle Scholar
  20. 20.
    Emans JB, Ciarlo M, Callahan M, Zurakowski D (2005) Prediction of thoracic dimensions and spine length based on individual pelvic dimensions in children and adolescents: an age-independent, individualized standard for evaluation of outcome in early onset spinal deformity. Spine (Phila Pa 1976) 30(24):2824–2829CrossRefGoogle Scholar
  21. 21.
    Gold M, Dombek M, Miller PE, Emans JB, Glotzbecker MP (2014) Prediction of thoracic dimensions and spine length on the basis of individual pelvic dimensions: validation of the use of pelvic inlet width obtained by radiographs compared with computed tomography. Spine (Phila Pa 1976) 39(1):74–80. CrossRefGoogle Scholar
  22. 22.
    Glotzbecker M, Johnston C, Miller P, Smith J, Perez-Grueso FS, Woon R, Flynn J, Gold M, Garg S, Redding G, Cahill P, Emans J (2014) Is there a relationship between thoracic dimensions and pulmonary function in early-onset scoliosis? Spine (Phila Pa 1976) 39(19):1590–1595. CrossRefGoogle Scholar
  23. 23.
    Kjensli A, Ryg M, Falch JA, Armbrecht G, Diep LM, Eriksen EF, Ellingsen I (2010) Does body height reduction influence interpretation of lung function in COPD patients? Eur Respir J 36(3):540–548. CrossRefPubMedGoogle Scholar
  24. 24.
    Krege JH, Kendler D, Krohn K, Genant H, Alam J, Berclaz PY, Coffey B, Loghin C (2015) Relationship between vertebral fracture burden, height loss, and pulmonary function in postmenopausal women with osteoporosis. J Clin Densitometry : Off J Int Soci Cli Densitometry. CrossRefGoogle Scholar
  25. 25.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Koumbourlis AC (2014) Chest wall abnormalities and their clinical significance in childhood. Paediatr Respir Rev 15(3):246–254; quiz 254–245. CrossRefPubMedGoogle Scholar
  27. 27.
    Leong JC, Lu WW, Luk KD, Karlberg EM (1999) Kinematics of the chest cage and spine during breathing in healthy individuals and in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 24(13):1310–1315CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Zhi-hui Zhao
    • 1
  • Hong-da Bao
    • 1
  • Chang-chun Tseng
    • 1
  • Ze-zhang Zhu
    • 1
  • Yong Qiu
    • 1
  • Zhen Liu
    • 1
  1. 1.Department of Spine SurgeryThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjingChina

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