title: Value of preoperative pulmonary function test in flaccid neuromuscular scoliosis surgery.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To evaluate the prognostic value of preoperative pulmonary function test (PFT) for postoperative pulmonary complications and to identify the operability associated with severely decreased forced vital capacity (FVC) (<30%) status in flaccid neuromuscular scoliosis.
  
  
  BACKGROUND
  The preoperative PFT, especially more than 30% FVC, is known as a critical factor for the operability of flaccid neuromuscular scoliosis. But only one study reported that patients with pre-existing respiratory failure on nocturnal noninvasive ventilation can undergo an operation for deformity correction without mortality and severe complications.
  
  
  METHODS
  A total of 74 patients (45 male and 29 female) presented with flaccid neuromuscular scoliosis. For all patients, preoperative PFTs were evaluated and subdivided into three groups (<30% FVC, 30%-50% FVC, and >50% FVC). Then postoperative pulmonary complications, pneumothorax, pneumonia, atelectasis, prolonged ventilator care in the intensive care unit (more than 72 hours), and postoperative tracheostomy were evaluated.
  
  
  RESULTS
  Among these patients, 59 had muscular dystrophy; 5, spinal muscular atrophy; 2, cerebral palsy; and 8, others. The mean age at surgery was 16.8 years (range, 5-32 years). The mean preoperative Cobb angle was 54.6° (16°-135°). The overall postoperative pulmonary complication rate was 31% (23 complications in 74 patients). The less than 30% FVC group had 6 complications among 18 patients; the 30% to 50% FVC group had 7 complications among 18 patients; and the more than 50% FVC group had 10 complications among 38 patients. There were no deaths during the perioperative period. There is no statistical difference between the three groups (P = 0.6195).
  
  
  CONCLUSIONS
  Patients with flaccid neuromuscular scoliosis can undergo an operation for deformity correction regardless of the severely decreased pulmonary function.
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyon Su
authors.initials: HS
authors.lastname: Chong
authors.forename: Eun Su
authors.initials: ES
authors.lastname: Moon
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Park
authors.forename: Do Yeon
authors.initials: DY
authors.lastname: Kim
authors.forename: Phillip Anthony B
authors.initials: PA
authors.lastname: Kho
authors.forename: Hwan Mo
authors.initials: HM
authors.lastname: Lee
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Moon
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Kim
authors.forename: Hak Sun
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D018579:Patient Selection; D011014:Pneumonia / Q000209:etiology / Q000503:physiopathology; D011030:Pneumothorax / Q000209:etiology / Q000503:physiopathology; D011300:Preoperative Care; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000503:physiopathology; D056910:Republic of Korea; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult