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      Preoperative and Postoperative Pulmonary Function in Elderly Patients with Thoracolumbar Kyphoscoliosis

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          Abstract

          Study Design

          Case series.

          Purpose

          The objective of this study was to investigate the change in pulmonary function in adult patients with a spinal deformity who underwent spinal corrective surgery.

          Overview of Literature

          Degenerative lumbar and/or thoraco-lumbar deformities are is often prominent in adult spinal deformity cases, whereas a thoracic deformity involving the chest wall is inconspicuous. A lumbar spine deformity could affect the pulmonary function; however, few reports have investigated pulmonary function in adult patients with a spinal deformity.

          Methods

          This study included 14 adult patients with a spinal deformity who underwent posterior corrective fusion (3 males, 11 females; mean age, 67.4 years). We measured percent vital capacity (%VC) and percent forced expiratory volume in 1 second (%FEV1) before surgery and six months after surgery. We investigated the change in pulmonary function after corrective surgery and the correlation between radiographic parameters and pulmonary function.

          Results

          Mean preoperative %VC and %FEV1 values were 99.9% and 79.3%, respectively. Two cases were diagnosed with restrictive impairment, and two cases were diagnosed with obstructive impairment before surgery. %VC improved in the restrictive impairment cases six months after surgery. However, %FEV1 did not improve significantly after surgery in the obstructive impairment cases.

          Conclusions

          Restrictive impairment was improved in adult patients with a spinal deformity by corrective spinal surgery. However, spinal surgery did not improve obstructive impairment.

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          Most cited references9

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          Postnatal human lung growth.

          Standard morphometric methods were applied to the lungs of 36 boys and 20 girls aged from 6 weeks to 14 years, dying as a result of trauma or after short illnesses. Individual lung units, alveolar dimensions, and number of alveoli per unit area and volume did not differ between boys and girls, but boys had bigger lungs than girls for the same stature. This resulted in a larger total number of alveoli and a larger aveolar surface area in boys than in girls for a given age and stature. There may be more respiratory bronchioles in boys than girls. There was rapid alveolar multiplication during the first two years of life and alveolar dimensions and number of alveoli per unit area and volume did not change much during this period. There was little or no increase in the total number of alveoli after the age of 2 years but the data are hard to interpret. There is a wide scatter of the total number of alveoli in the growing lung, in keeping with the observation that the total number of alveoli is very variable in adults. Prediction data are given for the various morphometric variables studied.
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            Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters.

            Prospective study of 131 patients and volunteers recruited for an analysis of spinal alignment and gravity line (GL) assessment by force plate analysis. To determine relationships between GL, foot position, and spinopelvic landmarks in subjects with varying sagittal alignment. Additionally, the study sought to analyze the role of the pelvis in the maintenance of GL position. Force plate technology permits analysis of foot position and GL in relation to radiographically obtained landmarks. Previous investigation noted fixed GL-heel relationship across a wide age range despite changes in thoracic kyphosis. The pelvis as balance regulator has not been studied in the setting of sagittal spinal deformity. The 131 subjects were grouped by sagittal vertical axis (SVA) offset from the sacrum: sagittal forward (>2.5 cm), neutral (-2.5 cm
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              Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment.

              Pulmonary function in patients with adolescent idiopathic scoliosis many years after posterior spinal surgery or brace treatment has not been documented. A consecutive group of patients treated by posterior fusion or a brace at least 20 years previously was investigated. 90% attended a clinical follow up. Lung volumes were determined before treatment in 251 patients, 1.4 years after surgery in 141 patients, and 25 years after surgery or start of brace treatment in 110 patients. Vital capacity (VC) was calculated as percentage predicted according to height and age and the results were corrected for loss of height due to scoliosis. Scoliosis angles were measured and smoking habits were recorded. An age and sex matched control group was also examined with the same questionnaire and pulmonary function tests. VC increased from 67% predicted immediately before surgery to 73% (p<0.001) after surgery and to 84% (p<0.001) at the present follow up, mean change 10.8% (95% CI 9.5 to 12.1). In the brace treated patients VC increased from 77% predicted before treatment to 89% (p<0.001) 25 years after start of treatment, mean change 12.3% (95% CI 10.5 to 14.1). The mean Cobb angle at the present follow up study was 40 degrees in both surgically and brace treated patients. The present results of lung volumes did not correlate with pretreatment or post-treatment Cobb angles or smoking habits. Patients treated by posterior fusion or a brace gradually increase their pulmonary function up to 25 years after treatment. Smoking and curve size are not risk factors for reduced pulmonary function.
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                Author and article information

                Journal
                Asian Spine J
                Asian Spine J
                ASJ
                Asian Spine Journal
                Korean Society of Spine Surgery
                1976-1902
                1976-7846
                December 2015
                08 December 2015
                : 9
                : 6
                : 923-927
                Affiliations
                Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
                Author notes
                Corresponding author: Tatsuya Yasuda. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan. Tel: +81-53-435-2299, Fax: +81-53-435-2296, t.yasuda@ 123456hama-med.ac.jp
                Article
                10.4184/asj.2015.9.6.923
                4686399
                f1633410-f319-4780-bead-59af567024f2
                Copyright © 2015 by Korean Society of Spine Surgery

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 February 2015
                : 10 March 2015
                : 22 March 2015
                Categories
                Clinical Study

                Orthopedics
                adult spinal deformity,pulmonary function,restrictive impairment,obstructive impairment

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