Lg. Lenke et al., ANALYSIS OF PULMONARY-FUNCTION AND CHEST CAGE DIMENSION CHANGES AFTERTHORACOPLASTY IN IDIOPATHIC SCOLIOSIS, Spine (Philadelphia, Pa. 1976), 20(12), 1995, pp. 1343-1350
Study Design. A prospective study of 19 adolescents and seven adults w
ith idiopathic scoliosis undergoing posterior spinal fusion with segme
ntal spinal instrumentation and a concomitant thoracoplasty had pulmon
ary function evaluation before surgery and at selected time points up
to a minimum 2 years after surgery. Objectives. The objectives were to
determine the effects thoracoplasty had on pulmonary function and che
st cage dimension changes ata minimum 2-year follow-up in idiopathic s
coliosis patients. Summary of Background Data. The cosmetic benefits o
f thoracoplasty on the rib hump deformity are well accepted. The rib r
esection procedure allowed for procurement of autogenous bone used for
the arthrodesis. Short- and long-term pulmonary function evaluation w
as necessary to determine proper patient selection and any potential s
equelae from the rib resection procedure. Methods. All patients had pu
lmonary function tests consisting of forced vital capacity, forced exp
iratory volume in 1 second, and total lung capacity performed before s
urgery and 3 months, 1 year, and 2 years after surgery. Ten adolescent
s also had computed tomographic scans before and after surgery to eval
uate chest cage dimension changes after the procedure. Results. The 3-
month postoperative pulmonary function test values of the 19 adolescen
ts experienced a statistically significant decline, averaging 16% (P <
0.05), however, the mean values for each parameter turned to just sli
ghtly below the preoperative value at 2-years follow-up. The pulmonary
function test values of the seven adults experienced a 27% initial de
cline 3 months after surgery and a residual 23% decline 2 years after
surgery; both values were statistically significant (P < 0.05). Conclu
sions. We reserve the thoracoplasty procedure for adolescents and adul
ts with preoperative pulmonary function values that will tolerate the
morbidity associated with the rib resection. Adolescent patients appea
r to normalize their pulmonary function tests by 2 years follow-up, wh
ereas long-term pulmonary function in the adult patient remains a conc
ern.