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The effect of surgical approaches on pulmonary function in adolescent idiopathic scoliosis.

STUDY DESIGN: Retrospective study.

OBJECTIVE: To evaluate the effects of 4 surgical approaches for adolescent idiopathic scoliosis on pulmonary function and document their trend across a 2-year period.

SUMMARY OF BACKGROUND DATA: Understanding the effects of surgical approaches on pulmonary function is critical in the treatment of adolescent idiopathic scoliosis. Depending on the surgical approach, studies have demonstrated improvement, decline, or no effect on pulmonary function.

METHODS: Sixty-one patients were evaluated for vital capacity (VC) and peak flow (PF) before and following surgery at 1, 3, 6, 12, and 24 months. Patients were separated into the following groups: group 1-posterior fusion only, group 2-posterior fusion with thoracoplasty, group 3-thoracoscopic anterior fusion, group 4-open anterior thoracolumbar fusion.

RESULTS: Between groups, no difference was found in age, preoperative curve magnitude, percent curve correction or baseline VC and PF. At 1-month postoperatively, group 3 had lower VC than group 1 (P<0.01). After 1 month, no difference was seen between groups. Compared with before surgery, group 2 demonstrated a significant decline in VC and PF at 1 month and returned to baseline at 3 months (P<0.01). Group 3 had a significant decline in VC and PF at 1, 3, and 6 months whereas group 4 had a decline in VC at 1 month (P<0.01).

CONCLUSIONS: Scoliosis approaches that violate the chest wall demonstrate a significant decline in postoperative pulmonary function. Documented return of pulmonary function did not occur until 3 months for posterior fusion with thoracoplasty, 3 months for open anterior fusion and 1 year for video-assisted thoracoscopic surgery.

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