Structure-respiration function relationships before and after surgical treatment of early-onset scoliosis.
BACKGROUND
Spine and chest wall deformities in children with early onset scoliosis (EOS) frequently impair respiratory function and postnatal growth of the lung. While a relationship between deformity and such impairment has been reported in children with adolescent idiopathic scoliosis it is not well understood in children with early-onset scoliosis (EOS).


OBJECTIVE
We therefore describe (1) the preoperative relation between Cobb angle and forced vital capacity (FVC) in infants with EOS; (2) how changes in Cobb angle before and after surgery relate to changes in lung ventilation and perfusion in the right and left lungs.


METHODS
We measured FVC in 10 children with EOS < 3 years old using the raised volume rapid thoracic compression (RVRTC) technique and correlated them with Cobb angles. We then measured right lung contributions to total lung ventilation and perfusion using lung scans before and 4 to 57 months after placement of vertical expandable prosthetic titanium ribs (VEPTRs) in 15 children with EOS and correlated changes in right lung function with postoperative changes in Cobb angles.


RESULTS
In children 4 to 57 months of age, preoperative FVC (mean value, 83%; range, 63%-109% of predicted values) did not correlate with Cobb angles (mean value, 56º; range, 14°-120º). In children 1.8 to 11.5 years old, right lung ventilation and perfusion were abnormal in eight and seven children, respectively, but neither ventilation nor perfusion predictably normalized despite reductions in Cobb angle postoperatively.


CONCLUSIONS
The data extend the age range of children with EOS whose Cobb angles correlate poorly with FVC preoperatively. The data are also consistent with reports that reduced Cobb angles after VEPTR insertion do not correlate with postoperative changes in respiratory function.
Pediatric Pulmonary Division, Room A-5937, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98145, USA. gredding@u.washington.edu
Gregory J
GJ
Redding
Oscar H
OH
Mayer
D017668:Age of Onset; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008168:Lung / Q000254:growth & development / Q000503:physiopathology*; D008297:Male; D019637:Orthopedic Procedures / Q000295:instrumentation; D055420:Perfusion Imaging; D011474:Prosthesis Design; D011859:Radiography; D012119:Respiration; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000295:instrumentation; D013909:Thorax / Q000254:growth & development*; D014025:Titanium; D016896:Treatment Outcome; D014797:Vital Capacity
D014025:Titanium