Abstract
Background
Change in total lung volume after surgical correction in adolescent idiopathic scoliosis (AIS), measured by computed tomography (CT), has not been studied previously. The primary objective of this study was to measure the change in lung volume between pre and postoperative AIS using low-dose CT and secondary objective was to investigate its relationship to postoperative pulmonary complications.
Materials and Methods
55 AIS patients underwent surgery for correction and fusion using a posterior only approach and pedicle screws. Pre and postoperative lung volumes were measured using a 3-dimensional (3D) whole spine CT (low dose protocol: Tube current, 60 mA; tube voltage 120 kV). Postoperative low dose CT was undertaken at 4 weeks after operation to evaluate the acute changes of postoperative lung volumes and pulmonary complications. The software that was used recognizes the “air density shade” of the lung and the volume of every section of the lung. The software then automatically calculates total lung volume by summation of all section volumes. The relationships between postoperative pulmonary complications and changes in lung volume on low dose CT as well as preoperative forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were calculated using logistic regression analysis.
Results
There was a decrease of 12% ± 23.2% in total lung volume postoperatively on 3D low dose CT (P < 0.001). Thirteen patients had increased lung volume while 42 had decreased lung volume postoperatively. Pulmonary complications were treated without severe sequale. Lung volume increased by 19.65% ± 19.84% in 13 patients and decreased by 21.85% ± 13.32% in 42 patients (P = 0.647). Lung volume was increased in patients whose preoperative lung volume, FEV1 and FVC were lower than in patients whose values were higher (r = −0.273, −0.291 and − 0.348; P = 0.044, 0.045 and 0.015, respectively). Postoperative lung volume was also increased when intraoperative fluid administration was larger and operative time was longer (r = 0.354, 0.417 and P = 0.008, 0.002, respectively). There was a statistically significant negative correlation in the change of lung volume in female patients when compared with male patients (r = −0.294, P = 0.03).
Conclusion
Patients with AIS who have preoperative reduced lung volumes or lung functions can achieve further increased lung volume after surgical correction. Pulmonary complications during perioperative period were mostly treated with proper management without severe sequale. Therefore, although surgery for AIS is considered to be a high risk procedure, we can recommend to correct spine deformity in patients with severe AIS in order to improve lung function and long term prognosis.
Similar content being viewed by others
References
Jones RS, Kennedy JD, Hasham F, Owen R, Taylor JF. Mechanical inefficiency of the thoracic cage in scoliosis. Thorax 1981;36:456–61.
Smith J, King T, Weber B, Cole J, Briscoe W, Levine D. Lung function in idiopathic scoliosis: Adolescence to old age. J Bone Joint Surg Am 1974;56-A:440.
Tsiligiannis T, Grivas T. Pulmonary function in children with idiopathic scoliosis. Scoliosis 2012;7:7.
Redding G, Song K, Inscore S, Effmann E, Campbell R. Lung function asymmetry in children with congenital and infantile scoliosis. Spine J 2008;8:639–44.
Upadhyay SS, Ho EK, Gunawardene WM, Leong JC, Hsu LC. Changes in residual volume relative to vital capacity and total lung capacity after arthrodesis of the spine in patients who have adolescent idiopathic scoliosis. J Bone Joint Surg Am 1993;75:46–52.
Holbert JM, Brown ML, Sciurba FC, Keenan RJ, Landreneau RJ, Holzer AD. Changes in lung volume and volume of emphysema after unilateral lung reduction surgery: Analysis with CT lung densitometry. Radiology 1996;201:793–7.
Kauczor HU, Heussel CP, Fischer B, Klamm R, Mildenberger P, Thelen M. Assessment of lung volumes using helical CT at inspiration and expiration: Comparison with pulmonary function tests. AJR Am J Roentgenol 1998;171:1091–5.
Koumbourlis AC. Scoliosis and the respiratory system. Paediatr Respir Rev 2006;7:152–60.
Gollogly S, Smith JT, White SK, Firth S, White K. The volume of lung parenchyma as a function of age: A review of 1050 normal CT scans of the chest with three-dimensional volumetric reconstruction of the pulmonary system. Spine (Phila Pa 1976) 2004;29:2061–6.
Kearon C, Viviani GR, Kirkley A, Killian KJ. Factors determining pulmonary function in adolescent idiopathic thoracic scoliosis. Am Rev Respir Dis 1993;148:288–94.
Upadhyay SS, Mullaji AB, Luk KD, Leong JC. Relation of spinal and thoracic cage deformities and their flexibilities with altered pulmonary functions in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1995;20:2415–20.
Lin MC, Liaw MY, Chen WJ, Cheng PT, Wong AM, Chiou WK. Pulmonary function and spinal characteristics: Their relationships in persons with idiopathic and postpoliomyelitic scoliosis. Arch Phys Med Rehabil 2001;82:335–41.
Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients. J Bone Joint Surg Am 2005;87:1937–46.
Chun EM, Suh SW, Modi HN, Kang EY, Hong SJ, Song HR. The change in ratio of convex and concave lung volume in adolescent idiopathic scoliosis: A 3D CT scan based cross sectional study of effect of severity of curve on convex and concave lung volumes in 99 cases. Eur Spine J 2008;17:224–9.
Chung JW, Yoon CJ, Jung SI, Kim HC, Lee W, Kim YI, et al. Acute iliofemoral deep vein thrombosis: Evaluation of underlying anatomic abnormalities by spiral CT venography. J Vasc Interv Radiol 2004;15:249–56.
Lee W, Kim HS, Kim SJ, Kim HH, Chung JW, Kang HS, et al. CT arthrography and virtual arthroscopy in the diagnosis of the anterior cruciate ligament and meniscal abnormalities of the knee joint. Korean J Radiol 2004;5:47–54.
Wood KB, Schendel MJ, Dekutoski MB, Boachie-Adjei O, Heithoff KH. Thoracic volume changes in scoliosis surgery. Spine (Phila Pa 1976) 1996;21:718–23.
Won HJ, Choi BI, Kim SH, Kim YI, Youn BJ, Han JK. Protocol optimization of multidetector computed tomography colonography using pig colonic phantoms. Invest Radiol 2005;40:27–32.
Aaro S, Ohlund C. Scoliosis and pulmonary function. Spine (Phila Pa 1976) 1984;9:220–2.
Nash C, Nevins K. A lateral hook at pulmonary functions in scoliosis. J Bone Joint Surg Am 1974;56-A: 440.
Ogilvie JW, Schendel MJ. Calculated thoracic volume as related to parameters of scoliosis correction. Spine (Phila Pa 1976) 1988;13:39–42.
Gollogly S, Smith JT, Campbell RM. Determining lung volume with three-dimensional reconstructions of CT scan data: A pilot study to evaluate the effects of expansion thoracoplasty on children with severe spinal deformities. J Pediatr Orthop 2004;24:323–8.
Lonstein J, Bradford D, Winter R, Ogilvie J. Natural history of spinal deformity. In: Moe’s Textbook of Scoliosis and Other Spinal Deformities. 3rd ed. Philadelphia, PA: WB Saunders Company; 1995. p. 87–93.
Yuan N, Fraire JA, Margetis MM, Skaggs DL, Tolo VT, Keens TG. The effect of scoliosis surgery on lung function in the immediate postoperative period. Spine (Phila Pa 1976) 2005;30:2182–5.
Lin HY, Nash CL, Herndon CH, Andersen NB. The effect of corrective surgery on pulmonary function in scoliosis. J Bone Joint Surg Am 1974;56:1173–9.
Izatt MT, Harvey JR, Adam CJ, Fender D, Labrom RD, Askin GN. Recovery of pulmonary function following endoscopic anterior scoliosis correction: Evaluation at 3, 6, 12, and 24 months after surgery. Spine (Phila Pa 1976) 2006;31:2469–77.
Gagnon S, Jodoin A, Martin R. Pulmonary function test study and after spinal fusion in young idiopathic scoliosis. Spine (Phila Pa 1976) 1989;14:486–90.
Lenke LG, Bridwell KH, Baldus C, Blanke K. Analysis of pulmonary function and axis rotation in adolescent and young adult idiopathic scoliosis patients treated with Cotrel-Dubousset instrumentation. J Spinal Disord 1992;5:16–25.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, D.K., Chun, E.M., Suh, S.W. et al. Evaluation of postoperative change in lung volume in adolescent idiopathic scoliosis. IJOO 48, 360–365 (2014). https://doi.org/10.4103/0019-5413.136223
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.136223
Key words
- 3-dimensional low dose computed tomography
- adolescent idiopathic scoliosis
- lung volume
- surgical correction