title: Scoliosis associated with airflow obstruction due to endothoracic vertebral hump.
abstract: METHODS
  A retrospective clinical study of scoliosis-associated airflow obstruction due to endothoracic vertebral hump.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate and present anatomical features of patients with scoliosis who showed airflow obstruction caused by endothoracic vertebral hump.
  
  
  BACKGROUND
  It is well known that severe scoliosis causes airflow restriction due to thoracic cage deformity. There have been few reports of clinical data and anatomical features on scoliosis associated with airflow obstruction due to endothoracic vertebral hump.
  
  
  METHODS
  The subjects were 6 patients. The diagnoses were idiopathic scoliosis in 3 patients, symptomatic scoliosis in 2 patients, and thoracogenic scoliosis in 1 patient. The radiological outcome, comorbidities, pre- and postoperative respiratory function, and surgical complication were analyzed.
  
  
  RESULTS
  Four patients had preoperative atelectasis on the convex side of the lower lobe and improved after the operations. All patients showed main thoracic curves and their apex was located at T7-T9. All patients had lordoscoliosis except 1, who demonstrated kyphosing scoliosis. The correction rate was 78% (62.8%-83.5%). Preoperative thoracic lordosis within the range of -5° to -47° was postoperatively corrected to a substantially normal kyphosis within the range of 9° to 24°. The average vital capacity, percent VC improved from 0.72 L (0.33-1.17 L) to 1.21 L (0.82-1.71 L) and 45.5% (37.3%- 50.8%) to 63.7% (41.0%-88.6%) relatively. Spine Penetration Index improved from 23% (18%-35%) to 16% (13%-19%). Endothoracic hump ratio improved from 1.34 (0.98-1.93) to 1.12 (0.86-1.28).
  
  
  CONCLUSIONS
  Each patient with symptomatic scoliosis and thoracogenic scoliosis required relatively long periods of respiration management. Patients having lordoscoliosis with an apex located between T7 and T9 may develop airflow obstruction due to an endothoracic vertebral hump. Correction of lordoscoliosis through anterior and posterior approaches successfully improved endothoracic hump ratio and atelectasis in all patients.
authors.affiliation: Department of Orthopaedic Surgery and Spine Center, Meijo Hospital, Nagoya, Japan.
authors.forename: Kenyu
authors.initials: K
authors.lastname: Ito
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kawakami
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Miyasaka
authors.forename: Taichi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ohara
authors.forename: Ayato
authors.initials: A
authors.lastname: Nohara
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007738:Kyphosis / Q000150:complications; D008141:Lordosis / Q000150:complications; D008168:Lung / Q000503:physiopathology*; D008297:Male; D019637:Orthopedic Procedures; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000503:physiopathology; D020127:Recovery of Function; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult