Progressive decline in pulmonary function 5years post-operatively in patients who underwent anterior instrumentation for surgical correction of adolescent idiopathic scoliosis

摘要

PurposeTo evaluate changes in pulmonary function tests (PFT) at 5years post-operatively in patients with adolescent idiopathic scoliosis (AIS) and to determine whether these changes are progressive or static after 2years.MethodsAIS surgical patients with pre-operative and 5year post-operative forced expiratory volume (FEV) and forced vital capacity (FVC) were included. The percentage of patients with pulmonary impairment at 5years was calculated. Repeated measures ANOVA was used to evaluate changes between pre-operative PFT and 5years post-operative PFT and to determine whether the changes differed between curve types and approach. A sub-analysis of patients with 2year data was performed to determine whether PFT changes were static or progressive.ResultsTwo hundred and sixty-two patients had undergone pre-operative and 5year post-operative PFTs. At 5years, 42% were normal, 41% had mild impairment, and 17% had moderate-severe impairment. Overall, there was a decline in % predicted FVC (p 0.05). Anterior instrumentation cases declined significantly between pre-operative PFT and 5years post-operative PFT (FEV: -10% open, -6% thoracoscopic; FVC: -13% open, -8% thoracoscopic) (p0.02). The posterior cases remained stable (2% FEV, p=0.7; -0.6% FVC, p=0.06). A subgroup of 90 patients with 2year post-operative PFTs demonstrated that changes were progressive between 2 and 5years post-operatively. The average change in FVC from 2 to 5years was significantly different between the anterior open (-9%) and posterior-only (0.7%) groups (p=0.015).ConclusionIn 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 2years post-operatively. Patients who underwent posterior instrumentation remained stable.