RECONSTRUCTIVE SPINE SURGERY IN PEDIATRIC-PATIENTS WITH MAJOR LOSS INVITAL CAPACITY

Thirty-two pediatric patients with severe restrictive lung disease ide ntified with vital capacities <40% of predicted, who had undergone maj or reconstructive spine surgery, were reviewed. There were 18 boys and 14 girls, the mean age was 13 years (range, 7-17), and the mean vital capacity was 31% of predicted (range, 16-39%). Fifty-four procedures were performed, 13 posterior only, one of which was staged, and 19 ant erior and posterior procedures, of which 15 were staged and four were sequential. The incidence of pulmonary complications (pneumonia, reint ubation, pneumothorax, respiratory arrest, or the need for tracheostom y) was 19% (six patients), and only three patients required tracheosto my. The surgical and perioperative mortality rate was zero. Patients w ho had a thoracotomy or a thoracoabdominal approach had a significantl y higher number of pulmonary complications. The use of preoperative de creased vital capacity as a measure of inoperability excludes the youn g patient most in need of surgical intervention. With improved preoper ative, intraoperative, and postoperative techniques, careful monitorin g, and the cooperation of pediatric pulmonologists and intensivists, r econstructive spine surgery can be performed in the pediatric patient with severe decreased vital capacity with very acceptable morbidity an d mortality.