title: Pulmonary function improvement after vertebral column resection for severe spinal deformity.
abstract: METHODS
  Retrospective review of prospectively accrued cohorts.
  
  
  OBJECTIVE
  We hypothesized that posterior-only vertebral column resection (PVCR) would result in improved postoperative pulmonary function, avoiding pulmonary insults from combined anterior/posterior approaches.
  
  
  BACKGROUND
  Pulmonary function after PVCR for severe spinal deformity has not been previously studied. Previous studies have demonstrated impaired pulmonary performance after combined anterior/posterior fusions.
  
  
  METHODS
  Serial pulmonary function testing (PFTs) in 49 patients (27 pediatric, 22 adult) who underwent PVCR at a single institution was reviewed. Mean age at surgery was 28.7 years (range, 8-74 yr), and mean follow-up was 32 months (range, 23-64 mo). Thoracic PVCRs (T5-T11) were performed in 31 patients and thoracolumbar PVCRs (T12-L5) in 18 patients.
  
  
  RESULTS
  Pediatric patients who underwent PVCR experienced both increased mean forced vital capacity (FVC) (2.10-2.43 L, P = 0.0005) and forced expiratory volume in 1 second (FEV1) (1.71-1.98 L, P = 0.001). There were no significant differences in percent-predicted values for FVC (69%-66%, P = 0.51) or FEV1 (64%-63%, P = 0.77). In adult patients, there were no significant changes in FVC (2.73-2.61 L, P = 0.35) or FEV1 (2.22-2.07 L, P = 0.51) after PVCR; also, changes in adult percent-predicted values for FVC (79%-76%, P = 0.47) and FEV1 (78%-74%, P = 0.40) were not significant. In pediatric patients who underwent PVCR, improved PFTs were correlated with younger age (P = 0.02), diagnosis of angular kyphosis (P ≤ 0.0001), no previous spine surgery (P = 0.04), and preoperative halo-gravity traction (P = 0.02). Comparison of PFT changes between patients who underwent PVCR and a control group who underwent combined anterior/posterior approaches revealed no significant differences.
  
  
  CONCLUSIONS
  In pediatric patients, PVCR resulted in small but significant improvements in postoperative FVC and FEV1. In adult patients, no significant increases in PFTs were found. Patients who have the greatest potential for lung and thoracic cage growth after spinal correction are most likely to have improved pulmonary function after PVCR.
authors.affiliation: *Department of Orthopaedic Surgery, Washington University, Saint Louis, MO †Department of Orthopaedic Surgery, Columbia University, New York, NY ‡Division of Biostatistics, Washington University, Saint Louis, MO; and §Department of Orthopaedic Surgery, Kyungpook National University, Daegu, South Korea.
authors.forename: David B
authors.initials: DB
authors.lastname: Bumpass
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Stallbaumer
authors.forename: Yongjung J
authors.initials: YJ
authors.lastname: Kim
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallendorf
authors.forename: Woo-Kie
authors.initials: WK
authors.lastname: Min
authors.forename: Brenda A
authors.initials: BA
authors.lastname: Sides
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008168:Lung / Q000502:physiology*; D008297:Male; D011184:Postoperative Period; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult