Surgical correction of paralytic neuromuscular scoliosis with poor pulmonary functions

Hitesh N. Modi, Seung-Woo Suh, Jae-Young Hong, Young Hwan Park, Jae Hyuk Yang

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate clinical and functional success by all pedicle screw construct in paralytic neuromuscular scoliosis (NMS) with poor pulmonary functions (PFT). SUMMARY OF BACKGROUND: Duchene muscular dystrophy and spinal muscular atrophy are often associated with poor PFT and the development of scoliosis simultaneously. Poor PFT often make surgeons reluctant to operate. METHODS: Eighteen paralytic NMS patients who had preoperative forced vital capacity (FVC) <30% were operated with all pedicle screw construct. Average preoperative, postoperative, and final follow-up Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis, PFT (FVC% and forced expiratory volume 1%), and preoperative and follow-up functional status were analyzed. Perioperative and postoperative complications were also noted. RESULTS: The average follow-up was 31.6±7.7 months. There was significant improvement in Cobb angle (61.7%) and pelvic obliquity (56.7%), postoperatively (P<0.001). All corrections were maintained at final follow-up. FVC was decreased from 25.2±4.7% preoperatively to 24.2±5.0%, 6 weeks postoperatively (P=0.067); and on follow-up it further decreased to 20.6±3.9% (P<0.0001) (1.8%/y). Forced Expiratory Volume 1 also decreased from 22.7±4.5% preoperatively to 21.8±4.2% postoperatively (P=0.037) and was 19.8±3.8% at final follow-up (P<0.0001) (1.1%/y). However, none of the patients had any respiratory complications postoperatively. Functional status was improved in 6 patients and they were able to sit without support (P=0.027). Eight (44.4%) perioperative complications (5 pulmonary, 1 intraoperative death, and 2 others) were noticed. Postoperatively, 4 patients (23.5%) had complications; coccygodynia, back sore because of screw prominence, impingement of iliac screw, and loosening of the rod from L5 screw. All the patients were satisfied with the treatment. There were no major pulmonary complications requiring admission postoperatively. CONCLUSIONS: Although complications are associated with the treatment of paralytic NMS, a good clinical and function outcome suggests that poor PFT should not be considered as a contraindication of scoliosis surgery.

Original languageEnglish
Pages (from-to)325-333
Number of pages9
JournalJournal of Spinal Disorders and Techniques
Volume24
Issue number5
DOIs
Publication statusPublished - 2011 Jul 1

Fingerprint

Scoliosis
Lung
Vital Capacity
Forced Expiratory Volume
Spinal Muscular Atrophy
Lordosis
Kyphosis
Muscular Dystrophies
Thorax
Retrospective Studies
Therapeutics

Keywords

  • all pedicle screw
  • paralytic neuromuscular scoliosis
  • poor pulmonary functions
  • surgical correction

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Surgical correction of paralytic neuromuscular scoliosis with poor pulmonary functions. / Modi, Hitesh N.; Suh, Seung-Woo; Hong, Jae-Young; Park, Young Hwan; Yang, Jae Hyuk.

In: Journal of Spinal Disorders and Techniques, Vol. 24, No. 5, 01.07.2011, p. 325-333.

Research output: Contribution to journalArticle

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abstract = "STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate clinical and functional success by all pedicle screw construct in paralytic neuromuscular scoliosis (NMS) with poor pulmonary functions (PFT). SUMMARY OF BACKGROUND: Duchene muscular dystrophy and spinal muscular atrophy are often associated with poor PFT and the development of scoliosis simultaneously. Poor PFT often make surgeons reluctant to operate. METHODS: Eighteen paralytic NMS patients who had preoperative forced vital capacity (FVC) <30{\%} were operated with all pedicle screw construct. Average preoperative, postoperative, and final follow-up Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis, PFT (FVC{\%} and forced expiratory volume 1{\%}), and preoperative and follow-up functional status were analyzed. Perioperative and postoperative complications were also noted. RESULTS: The average follow-up was 31.6±7.7 months. There was significant improvement in Cobb angle (61.7{\%}) and pelvic obliquity (56.7{\%}), postoperatively (P<0.001). All corrections were maintained at final follow-up. FVC was decreased from 25.2±4.7{\%} preoperatively to 24.2±5.0{\%}, 6 weeks postoperatively (P=0.067); and on follow-up it further decreased to 20.6±3.9{\%} (P<0.0001) (1.8{\%}/y). Forced Expiratory Volume 1 also decreased from 22.7±4.5{\%} preoperatively to 21.8±4.2{\%} postoperatively (P=0.037) and was 19.8±3.8{\%} at final follow-up (P<0.0001) (1.1{\%}/y). However, none of the patients had any respiratory complications postoperatively. Functional status was improved in 6 patients and they were able to sit without support (P=0.027). Eight (44.4{\%}) perioperative complications (5 pulmonary, 1 intraoperative death, and 2 others) were noticed. Postoperatively, 4 patients (23.5{\%}) had complications; coccygodynia, back sore because of screw prominence, impingement of iliac screw, and loosening of the rod from L5 screw. All the patients were satisfied with the treatment. There were no major pulmonary complications requiring admission postoperatively. CONCLUSIONS: Although complications are associated with the treatment of paralytic NMS, a good clinical and function outcome suggests that poor PFT should not be considered as a contraindication of scoliosis surgery.",
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N2 - STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate clinical and functional success by all pedicle screw construct in paralytic neuromuscular scoliosis (NMS) with poor pulmonary functions (PFT). SUMMARY OF BACKGROUND: Duchene muscular dystrophy and spinal muscular atrophy are often associated with poor PFT and the development of scoliosis simultaneously. Poor PFT often make surgeons reluctant to operate. METHODS: Eighteen paralytic NMS patients who had preoperative forced vital capacity (FVC) <30% were operated with all pedicle screw construct. Average preoperative, postoperative, and final follow-up Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis, PFT (FVC% and forced expiratory volume 1%), and preoperative and follow-up functional status were analyzed. Perioperative and postoperative complications were also noted. RESULTS: The average follow-up was 31.6±7.7 months. There was significant improvement in Cobb angle (61.7%) and pelvic obliquity (56.7%), postoperatively (P<0.001). All corrections were maintained at final follow-up. FVC was decreased from 25.2±4.7% preoperatively to 24.2±5.0%, 6 weeks postoperatively (P=0.067); and on follow-up it further decreased to 20.6±3.9% (P<0.0001) (1.8%/y). Forced Expiratory Volume 1 also decreased from 22.7±4.5% preoperatively to 21.8±4.2% postoperatively (P=0.037) and was 19.8±3.8% at final follow-up (P<0.0001) (1.1%/y). However, none of the patients had any respiratory complications postoperatively. Functional status was improved in 6 patients and they were able to sit without support (P=0.027). Eight (44.4%) perioperative complications (5 pulmonary, 1 intraoperative death, and 2 others) were noticed. Postoperatively, 4 patients (23.5%) had complications; coccygodynia, back sore because of screw prominence, impingement of iliac screw, and loosening of the rod from L5 screw. All the patients were satisfied with the treatment. There were no major pulmonary complications requiring admission postoperatively. CONCLUSIONS: Although complications are associated with the treatment of paralytic NMS, a good clinical and function outcome suggests that poor PFT should not be considered as a contraindication of scoliosis surgery.

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