Correction of neuromuscular scoliosis in patients with preexisting respiratory failure.
METHODS
A prospective observational study in scoliosis patients who were on noninvasive night ventilation for respiratory failure.


OBJECTIVE
To report the results of spinal deformity correction in a group of patients with progressive scoliosis and rare forms of muscular dystrophy/myopathy with respiratory failure who were on nocturnal ventilatory support at the time of surgery.


BACKGROUND
This is the first study on the results of deformity correction in a series of patients on ventilatory support.


METHODS
Eight patients (6 males, 2 females) presented with progressive scoliosis and respiratory failure. The mean age at surgery was 12 years (range, 8-15 years). The mean follow-up was 48 months (range, 12-80 months). Outcome measures include lung function (spirometry), overnight pulse oximetry, Cobb angles, duration of stay in Intensive care (ICU), and the total hospital stay.


RESULTS
The mean stay in the ICU was 2.7 days (range, 2-5 days). The mean hospital stay was 14.2 days (range, 10-21 days). The mean preoperative Cobb angle was 70.2 degrees (55 degrees -85 degrees ). This changed to 32 degrees (16 degrees -65 degrees ) after surgery (P = 0.0002). The mean vital capacity at the time of surgery was 20% (range, 13%-28%). The mean vital capacity of patients at last follow-up was 18% (range, 10%-31%). The desaturation noted on the preventilation overnight oximetry was reversed by nocturnal ventilation. All patients recovered well following surgery with no major cardiac or pulmonary complications.


CONCLUSIONS
Patients with preexisting respiratory failure on nocturnal noninvasive ventilation can be safely operated for deformity correction. This can help to significantly improve their quality of life.
Gill
Inder
I
Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, U.K. ipgill@yahoo.com
Eagle
Michelle
M
Mehta
Jwalant S
JS
Gibson
Michael J
MJ
Bushby
K
K
Bullock
R
R
D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D009136:Muscular Dystrophies / Q000503:physiopathology / Q000601:surgery; D009468:Neuromuscular Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012600:Scoliosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*