The lifetime risk of pneumonia in patients with neuromuscular scoliosis at a mean age of 21 years: the role of spinal deformity surgery.
BACKGROUND
Patients with neuromuscular disorders often have an increased risk of pneumonia and decreased lung function, which may further be compromised by scoliosis. Scoliosis surgery may improve pulmonary function in otherwise healthy patients, but no study has evaluated its effect on the risk of pneumonia in patients with neuromuscular scoliosis (NMS).


METHODS
The patient charts of 42 patients (mean age 14.6 years) who had undergone surgery for severe NMS (mean scoliosis 86°) were retrospectively reviewed from birth to a mean of 6.1 years (range 2.8-9.5) after scoliosis surgery. The main outcome was radiographically confirmed pneumonia as a primary cause for hospitalization. We excluded postoperative (3 months) pneumonia from the analyses.


RESULTS
The lifetime annual incidence of pneumonia was 8.0/100 before and 13.4/100 after scoliosis surgery (p > 0.10). The mean number of hospital days per year due to pneumonia were 0.59 (SD 2.3) before scoliosis surgery and 2.24 (SD 6.9) after surgery (p > 0.10). Multivariate analysis demonstrated that lifetime risk factors for pneumonia were epilepsy (RR 15.2, 95 % CI 1.3-176.8, p = 0.027), non-cerebral palsy (CP) etiology (RR = 10.2, 95 % CI 3.2-32.7, p < 0.001) and major scoliosis (main curve >70°; RR = 11.3, 95 % CI 1.8-70.7, p = 0.01).


CONCLUSIONS
Epilepsy, non-CP etiology and major scoliosis are significant risk factors for pneumonia in patients with NMS. Scoliosis surgery does not decrease the incidence of pneumonia in patients with severe NMS.


METHODS
Retrospective comparative study, Level III.
Department of Paediatric Orthopaedic Surgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland. heli.keskinen@fimnet.fi.
Heli
H
Keskinen
Department of Paediatrics, Turku University Central Hospital, Turku, Finland.
Heikki
H
Lukkarinen
University of Helsinki, Helsinki, Finland.
Katariina
K
Korhonen
Department of Paediatric Orthopaedic Surgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.|Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
Tuomas
T
Jalanko
Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
Antti
A
Koivusalo
Department of Paediatric Orthopaedic Surgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
Ilkka
I
Helenius
Cerebral palsy; Epilepsy; Neuromuscular; Pneumonia; Scoliosis