title: Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To assess long-term pulmonary function after surgical correction of adolescent idiopathic scoliosis.
  
  
  BACKGROUND
  Pulmonary function is known to decline with increasing age. Although there are published reports on 2- and 5-year pulmonary function test outcomesafter various surgical approaches for adolescent idiopathic scoliosis, 10-year pulmonary function tests of these patients is unknown.
  
  
  METHODS
  Forty-nine patients were divided into two groups who underwent surgery for adolescent idiopathic scoliosis at a single institution. There were 46 female patients and three male patients. All group one patients (n = 38) had some form of chest wall disruption during their spinal fusion: group 1A (n = 17) underwent open anterior spinal fusion/instrumentation, group 1B (n = 9) had a combined open anteroposterior spinal fusion, and group 1C (n = 12) had a posterior spinal fusion/instrumentation with thoracoplasty. Group 2 patients (n = 11) underwent posterior spinal fusion/instrumentation with iliac crest bone graft and no chest cage disruption. We evaluated preoperative and 10-year pulmonary function test values.
  
  
  RESULTS
  Within-group comparison revealed that group 1 experienced no change in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV(1)), but demonstrated a significant decrease in percent-predicted FVC (85% vs. 79%, P = 0.00086) and FEV(1) values (80% vs. 76%, P = 0.038). Conversely, group 2 experienced a significant increase in both FVC (3.25L vs. 3.66L, P = 0.011) and FEV(1) (2.77L vs. 3.10L, P = 0.0019), but no changes in percent-predicted values from baseline to 10 years. No changes were noted in percent-predicted values between 5 and 10 years in either group.
  
  
  CONCLUSIONS
  Intraoperative chest wall violation produced detrimental pulmonary effects, as reflected by reduced percent-predicted values at 10-year follow-up. Posterior-only procedures, which spared the chest wall, showed significant improvements in FVC and FEV(1) absolute values without any change in percent-predicted values.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Gitelman
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Auerbach
authors.forename: Brenda A
authors.initials: BA
authors.lastname: Sides
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012600:Scoliosis / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D055815:Young Adult