Pulmonary function and scoliosis in children with spinal muscular atrophy types II and III.
OBJECTIVE
The objectives were to evaluate the clinical course of spinal muscular atrophy (SMA) types II and III patients necessitating scoliosis surgery at the National University Hospital, Singapore.


METHODS
A retrospective review of SMA types II and III patients, born over a 10-year period between 1983 and 1992, was conducted.


RESULTS
There were eight patients: four with SMA type II and four with SMA type III. The mean age at scoliosis surgery was 9 years 7 months (range 7 years 6 months-12 years 4 months). The mean preoperative Cobb angle was 65.4 degrees (range 43-90 degrees ) and the mean postoperative Cobb angle was 22.6 degrees (range 12-45 degrees ), with a mean correction of 64.8% (range 47.7-77.8%). The decline in percentage predicted forced vital capacity (FVC) was 7.7% (95% CI: 12.4% to 3.0%) per year preoperatively and this was reduced to 3.8% (95% CI: 5.8% to 1.9%) per year postoperatively. The mean length of preoperative and postoperative lung function follow-up was 6.3 months (range 0.03-31 months) and 44 months (range 0-110 months), respectively.


CONCLUSIONS
This study suggests that pulmonary function in SMA types II and III continues to decline after scoliosis surgery, though the rate of decline is less marked. Overall, the combined results from this study and all other previously published studies are conflicting in regard to the effect of scoliosis surgery on pulmonary function in SMA types II and III, though half of the studies (3 of 6) did demonstrate a continued decline in lung function postoperatively. This decline in pulmonary function despite spinal stabilization is likely secondary to the progressive neuromuscular weakness of the disease.
Chng
S Y
SY
Department of Paediatrics, The Children's Medical Institute, and Department of Orthopaedic Surgery, National University Hospital, Singapore.
Wong
Y Q
YQ
Hui
J H
JH
Wong
H K
HK
Ong
H T
HT
Goh
D Y
DY
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011336:Probability; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012600:Scoliosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D012720:Severity of Illness Index; D012846:Singapore; D013123:Spinal Fusion / Q000379:methods*; D014897:Spinal Muscular Atrophies of Childhood / Q000175:diagnosis* / Q000453:epidemiology; D014109:Total Lung Capacity; D016896:Treatment Outcome