Ventilator weaning after staged anteroposterior spine fusion in a ventilator-dependent patient with congenital scoliosis: a case report.
METHODS
Ventilator weaning after staged revision anteroposterior spine fusion in a ventilator-dependent child with congenital scoliosis is reported.


OBJECTIVE
To describe the improvement of pulmonary performance after deformity correction in a patient with severe deformity and severe restrictive lung disease.


BACKGROUND
The effect of scoliotic deformity correction on postoperative pulmonary function is debatable. Recent prospective studies suggest that corrective surgery, especially that involving violation of the chest cage, adversely affect pulmonary function in patients with adolescent idiopathic scoliosis. For patients with severe deformity and severely compromised preoperative pulmonary function, the effect of deformity correction has not been well studied.


METHODS
A 15-year-old ventilator-dependent girl with progressive congenital thoracic scoliosis of 130 degrees and a forced vital capacity of 18% underwent staged revision anteroposterior spine fusion. Anterior release, multiple vertebral osteotomies, apical vertebrectomy, and multiple internal thoracoplasties were performed. Five weeks later, when she was medically stable, she underwent posterior reconstruction with multiple vertebral osteotomies, apical vertebrectomy, and translation and cantilever corrective techniques using Isola instrumentation.


RESULTS
The patient's pulmonary function was stable 6 months after surgery, and her forced vital capacity was 19%. Currently, 1 year after surgery, she has been weaned to night-only ventilation. Her walking ability has improved. Her spine is well balanced with a thoracic scoliosis of 40 degrees, and she is neurologically intact.


CONCLUSIONS
Surgical correction of a severe thoracic spinal deformity in the setting of severe restrictive lung disease can be performed successfully with stabilization of pulmonary volumes and improvement in pulmonary performance.
Lim
Moe
M
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Wazeka
April
A
Boachie-Adjei
Oheneba
O
D000015:Abnormalities, Multiple; D000293:Adolescent; D018450:Disease Progression; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012600:Scoliosis / Q000150:complications / Q000151:congenital / Q000601:surgery*; D013123:Spinal Fusion / Q000534:rehabilitation*; D013905:Thoracoplasty / Q000534:rehabilitation; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*