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Kim KH, Sohn MJ, Park CG. Conformity assessment of a computer vision-based posture analysis system for the screening of postural deformation. BMC Musculoskelet Disord 2022; 23:799. [PMID: 35996105 PMCID: PMC9394031 DOI: 10.1186/s12891-022-05742-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 08/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background This study evaluates the conformity of using a computer vision-based posture analysis system as a screening assessment for postural deformity detection in the spine that is easily applicable to clinical practice. Methods One hundred forty participants were enrolled for screening of the postural deformation. Factors that determine the presence or absence of spinal deformation, such as shoulder height difference (SHD), pelvic height difference (PHD), and leg length mismatch (LLD), were used as parameters for the clinical decision support system (CDSS) using a commercial computer vision-based posture analysis system. For conformity analysis, the probability of postural deformation provided by CDSS, the Cobb angle, the PHD, and the SHD was compared and analyzed between the system and radiographic parameters. A principal component analysis (PCA) of the CDSS and correlation analysis were conducted. Results The Cobb angles of the 140 participants ranged from 0° to 61°, with an average of 6.16° ± 8.50°. The postural deformation of CDSS showed 94% conformity correlated with radiographic assessment. The conformity assessment results were more accurate in the participants of postural deformation with normal (0–9°) and mild (10–25°) ranges of scoliosis. The referenced SHD and the SHD of the CDSS showed statistical significance (p < 0.001) on a paired t-test. SHD and PHD for PCA were the predominant factors (PC1 SHD for 79.97%, PC2 PHD for 19.86%). Conclusion The CDSS showed 94% conformity for the screening of postural spinal deformity. The main factors determining diagnostic suitability were two main variables: SHD and PHD. In conclusion, a computer vision-based posture analysis system can be utilized as a safe, efficient, and convenient CDSS for early diagnosis of spinal posture deformation, including scoliosis.
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Affiliation(s)
- Kwang Hyeon Kim
- Department of Neurosurgery, Neuroscience and Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, 170 Juhwa-ro Ilsanseo-gu, Gyeonggi province, 10380, Goyang, South Korea
| | - Moon-Jun Sohn
- Department of Neurosurgery, Neuroscience and Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, 170 Juhwa-ro Ilsanseo-gu, Gyeonggi province, 10380, Goyang, South Korea.
| | - Chun Gun Park
- Department of Mathematics, Kyonggi University, Gwanggyosan-ro, Yeongtong-gu, 16227, Suwon, South Korea
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Dassios T, Rüdiger M, McCurnin D, Seidner SR, Williams EE, Greenough A, Möbius MA. Functional morphometry to estimate the alveolar surface area using a premature baboon model. J Appl Physiol (1985) 2022; 132:209-215. [PMID: 34882028 DOI: 10.1152/japplphysiol.00644.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The main respiratory pathophysiological process following premature birth is the delayed or arrested alveolar development that translates to a smaller alveolar surface area (SA). Histological morphometry is the gold standard method to measure the SA but requires invasive tissue sampling or the removal of the whole organ for analysis. Alternatively, the SA could be measured in living subjects by "functional morphometry" using Fick's first law of diffusion and noninvasive measurements of the ventilation to perfusion ratio (V̇a/Q̇). We herein aim to describe a novel functional morphometric method to measure SA using a premature baboon model. We used both functional morphometry and postmortem histological morphometry to measure SA in 11 premature baboons born at 135 days who received intensive care treatment for 14 days. For the calculation of the SA by functional morphology, we measured the septal wall thickness using microscopy, the alveolar arterial oxygen gradient using concurrent measurements of arterial pressure of O2 and CO2, and pulmonary perfusion using echocardiography and integrated Doppler signals. The median [interquartile range (IQR)] SA using functional morphometry was 3,100 (2,080-3,640) cm2 and using histological morphometry was 1,034 (634-1,210) cm2 (left lung only). The SA measured by functional morphometry was not related to the SA measured by histological morphometry. Following linear regression analysis, the V̇a/Q̇ significantly predicted the histologically measured SA (R2 = 0.659, P = 0.002). In conclusion, functional measurements of ventilation to perfusion ratio could be used to estimate the alveolar surface area in prematurely born baboons and the ventilation perfusion ratio was the main determinant of the alveolar surface area.NEW & NOTEWORTHY The main morphological characteristic of chronic respiratory disease in prematurely born infants is the impaired/arrested alveolar growth that corresponds to a smaller aggregated alveolar surface area (SA). This decreased SA might be the limiting factor later in life affecting exercise capacity and quality of life. There is paucity of sensitive, noninvasive biomarkers to monitor the evolution of neonatal respiratory disease. Our noninvasive functional morphometric SA might help to bridge the gap between pathophysiology and clinical monitoring.
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Affiliation(s)
- Theodore Dassios
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom.,Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College, London, United Kingdom
| | - Mario Rüdiger
- Neonatology and Pediatric Critical Care Medicine, Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Donald McCurnin
- Division of Neonatology, Department of Pediatrics, University of Texas Health, San Antonio, Texas
| | - Steven R Seidner
- Division of Neonatology, Department of Pediatrics, University of Texas Health, San Antonio, Texas
| | - Emma E Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College, London, United Kingdom
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College, London, United Kingdom.,The Asthma UK Centre in Allergic Mechanisms of Asthma, King's College, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College, London, United Kingdom
| | - Marius Alexander Möbius
- Neonatology and Pediatric Critical Care Medicine, Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Hisaund A, Pietton R, Vialle R, Skalli W, Vergari C. Feasibility of Rib Kinematics and Intercostal-Space Biomechanical Characterization by Ultrasound in Adolescent Idiopathic Scoliosis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1957-1963. [PMID: 33926755 DOI: 10.1016/j.ultrasmedbio.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
The aim of this work was to determine the feasibility of combined ultrasonography and elastography measurement to characterize the mechanical properties of the intercostal space during breathing. Eighteen asymptomatic participants (ages 13 ± 2 y) and six participants with adolescent idiopathic scoliosis (AIS) were included (Cobb angle 60° ± 12°). Ultrasonographic and elastographic clips were acquired of T8-T9 ribs and the intercostal space. The two adjacent ribs were tracked to infer the breathing cycle. Shear-wave speed (SWS) was measured in the intercostal space at different stages of the breathing cycle. SWS was symmetric in the control group, during both expiration and inspiration. In AIS, the SWS during inspiration was higher in the convex side than in the concave one (p = 0.02). Furthermore, SWS was higher during inspiration than expiration in the control group and in the AIS convex side, but not in the AIS concave side (p > 0.05). This new method combining echography and shear-wave elastography allowed measurement of the mechanical characteristics of the intercostal space at different phases of the breathing cycle and highlighted differences between the AIS and control groups. This approach opens the way to further analyses of the biomechanical characteristics of breathing in severe AIS.
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Affiliation(s)
- Alisa Hisaund
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Raphaël Pietton
- Department of Pediatric Orthopaedics, Sorbonne Université, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Raphaël Vialle
- Department of Pediatric Orthopaedics, Sorbonne Université, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France.
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There's More to Consider Than Thoracic Spine Height-The Case for Primary Spine Fusion in Older Early-onset Scoliosis Patients. Spine (Phila Pa 1976) 2021; 46:139-142. [PMID: 33181778 DOI: 10.1097/brs.0000000000003802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Perioperative Transthoracic Lung Ultrasound for Assessment of Pulmonary Outcome in Adolescent Idiopathic Scoliosis Patients: Prospective, Observational Pilot Study. Sci Rep 2019; 9:17840. [PMID: 31780758 PMCID: PMC6883053 DOI: 10.1038/s41598-019-54437-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/12/2019] [Indexed: 11/24/2022] Open
Abstract
The purpose of study was to evaluate the perioperative lung ultrasound findings of patients undergoing scoliosis correction. LUS examination was performed examined three 3 times for each patient: 20 min after starting mechanical ventilation of the lungs(preoperative), after surgery when the patient was placed in the supine position(postoperative), and 20 min after arrival in the post-anaesthesia care unit. Arterial blood gas analyses, mechanical ventilation parameters, peripheral oxygen saturation(SpO2) were also checked. Twenty-six patients completed the study. The changes of LUS score(20 min) was significantly negatively correlated with the partial pressure of arterial oxygen(PaO2)/fraction of inspired oxygen(FiO2) ratio change(P = 0.039, r = −0.40). The change in mean convex side LUS score was significantly greater than that of the concave side as determined by two-factor repeated measures analysis of variance(p = 0.001). Multiple regression analysis revealed perioperative LUS change was the significant factor related to the oxygen index change (p = 0.042). One case of pneumothorax was diagnosed and pleural thickening more than 5 mm was detected in 8 patients and five patients of those were diagnosed pleural effusion and performed thoracentesis after surgery. Postoperative increase of LUS score was related with deteriorating of oxygenation at one day after surgery, and it suggests that lung ultrasound allows prediction of postoperative hypoxia and facilitates the diagnosis of pulmonary complications at operation room in AIS patients.
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LaMont LE, Jo C, Molinari S, Tran D, Caine H, Brown K, Wittenbrook W, Schochet P, Johnston CE, Ramo B. Radiographic, Pulmonary, and Clinical Outcomes With Halo Gravity Traction. Spine Deform 2019; 7:40-46. [PMID: 30587319 DOI: 10.1016/j.jspd.2018.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 06/10/2018] [Accepted: 06/23/2018] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Single-center retrospective chart review. OBJECTIVES AND SUMMARY Halo gravity traction (HGT) is a safe and effective intervention to improve spinal deformity prior to corrective instrumentation. Our study aimed to report on a large series of patients undergoing HGT, demonstrate the correlation between thoracic height achieved and pulmonary function, and evaluate the efficacy of nutritional assessment and intervention while in HGT for these often malnourished or nutritionally compromised patients. METHODS 107 patients underwent HGT for severe spinal deformity. Major coronal and sagittal Cobb angles, T1-T12 ht, and T1-S1 ht were collected pre-HGT, during HGT, postoperation, and 2 years postoperation. Pulmonary function tests (PFTs) recorded forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Nutritional interventions such as formal nutrition consult, resulting nutritional supplementation, or interventions were recorded. RESULTS Patients were in HGT for mean of 82.1 days and mean maximum percentage body weight in traction was 49.5%. Mean major coronal Cobb angle prior to HGT was 92.6°, improving to 65.8° in maximal traction and to 47° after surgical intervention. Traction accounted for 78% of T1-T12 height and 79% of T1-S1 length gains from pre- to postoperation. We showed a positive correlation between gain in T1-T12 height and percentage predicted changes in FVC and FEV1. Weight Z score for the entire cohort of patients improved from -2.8 pretraction to -2.4 in traction and then to -2.3 postoperative. CONCLUSIONS Our study again demonstrated that HGT achieves radiographic improvement safely and effectively in severe spinal deformity. We demonstrated a positive correlation between improvement in PFTs and increase in thoracic height seen with HGT. Additionally, improvement in weight Z score was seen in the entire population and the most at risk patients for malnutrition, results that have not been shown before. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lauren E LaMont
- Cook Children's Hospital, 801 7th Ave, Fort Worth, TX 76104, USA.
| | - ChanHee Jo
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Sarah Molinari
- University of Florida Health, Gainesville, FL 32608, USA
| | - Dong Tran
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Heather Caine
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Kaitlyn Brown
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Wendy Wittenbrook
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Peter Schochet
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Charles E Johnston
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Brandon Ramo
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
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Singrakhia M, Malewar N, Jangle A. Intraspinal Anomalies in Early Onset Scoliosis: Current Concepts. J Pediatr Neurosci 2018; 13:294-301. [PMID: 30271460 PMCID: PMC6144598 DOI: 10.4103/jpn.jpn_100_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Early onset scoliosis (EOS) is deformity of the spine below the age of 5 years. Children with EOS are at risk of impaired thoracic cage development and pulmonary maturation. Initial evaluation consists of determining the etiological cause for EOS, i.e., congenital, neurogenic, idiopathic, or syndromic. The advent of magnetic resonance imaging in recent times has lead to increased awareness of neurogenic causes leading to EOS. Evaluation of spinal cord anomalies in EOS is very important as early diagnosis and treatment can help in deformity stabilization and regression. Also, any surgical or nonsurgical intervention to correct the deformity without prior treatment of spinal cord anomalies can lead to disastrous neurological complications.
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Affiliation(s)
- Manoj Singrakhia
- Spine Surgery Department, Shanta Spine Institute, Nagpur, Maharashtra, India
| | - Nikhil Malewar
- Spine Surgery Department, Shanta Spine Institute, Nagpur, Maharashtra, India
| | - Ajit Jangle
- Spine Surgery Department, Shanta Spine Institute, Nagpur, Maharashtra, India
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Abstract
BACKGROUND Scoliosis has been shown to have detrimental effects on pulmonary function, traditionally measured by pulmonary function tests, which is theorized to be correlated to the distortion of the spine and thorax. The changes in thoracic volume with surgical correction have not been well quantified. This study seeks to define the effect of surgical correction on thoracic volume in patients with adolescent idiopathic scoliosis. METHODS Images were obtained from adolescents with idiopathic scoliosis enrolled in a multicenter database (Prospective Pediatric Scoliosis Study). A convenience sample of patients with Lenke type 1 curves with a complete data set meeting specific parameters was used. Blender v2.63a software was used to construct a 3-dimensional (3D) computational model of the spine from 2-dimensional calibrated radiographs. To accomplish this, the 3D thorax model was deformed to match the calibrated radiographs. The thorax volume was then calculated in cubic centimeters using Mimics v15 software. RESULTS The results using this computational modeling technique demonstrated that surgical correction resulted in decreased curve measurement as determined by Cobb method, and increased postoperative thoracic volume as expected. Thoracic volume significantly increased by a mean of 567 mm (P<0.001). The percent change in thoracic volume after surgical correction averaged 40% (range, 3% to 87%). The smaller the baseline volume, the greater the change in volume postoperatively (r=-0.86).Evaluation of postoperative data demonstrated that spinal curve measurement as determined by Cobb method was significantly reduced from a mean of 69 degrees (range, 50 to 96 degrees) preoperatively to 27 degrees (range, 13 to 33 degrees) postoperatively (P<0.001). CONCLUSIONS This pilot study demonstrates methodologic plausibility for measuring 3D changes in thoracic volumes using 2-dimensional imaging. This is an assessment of the novel modeling technique, to be used in larger future studies to assess clinical significance. LEVEL OF EVIDENCE Level 3-retrospective comparison of prospectively collected data.
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Rahman NNAA, Singh DKA, Lee R. Correlation between thoracolumbar curvatures and respiratory function in older adults. Clin Interv Aging 2017; 12:523-529. [PMID: 28352165 PMCID: PMC5358964 DOI: 10.2147/cia.s110329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aging is associated with alterations in thoracolumbar curvatures and respiratory function. Research information regarding the correlation between thoracolumbar curvatures and a comprehensive examination of respiratory function parameters in older adults is limited. The aim of the present study was to examine the correlation between thoracolumbar curvatures and respiratory function in community-dwelling older adults. Thoracolumbar curvatures (thoracic and lumbar) were measured using a motion tracker. Respiratory function parameters such as lung function, respiratory rate, respiratory muscle strength and respiratory muscle thickness (diaphragm and intercostal) were measured using a spirometer, triaxial accelerometer, respiratory pressure meter and ultrasound imaging, respectively. Sixty-eight community-dwelling older males and females from Kuala Lumpur, Malaysia, with mean (standard deviation) age of 66.63 (5.16) years participated in this cross-sectional study. The results showed that mean (standard deviation) thoracic curvature angle and lumbar curvature angles were -46.30° (14.66°) and 14.10° (10.58°), respectively. There was a significant negative correlation between thoracic curvature angle and lung function (forced expiratory volume in 1 second: r=-0.23, P<0.05; forced vital capacity: r=-0.32, P<0.05), quiet expiration intercostal thickness (r=-0.22, P<0.05) and deep expiration diaphragm muscle thickness (r=-0.21, P<0.05). The lumbar curvature angle had a significant negative correlation with respiratory muscle strength (r=-0.29, P<0.05) and diaphragm muscle thickness at deep inspiration (r=-0.22, P<0.05). However, respiratory rate was correlated neither with thoracic nor with lumbar curvatures. The findings of this study suggest that increase in both thoracic and lumbar curvatures is correlated with decrease in respiratory muscle strength, respiratory muscle thickness and some parameters of lung function. Clinically, both thoracic and lumbar curvatures, respiratory muscles and lung function should be taken into consideration in the holistic management of respiratory function among older adults.
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Affiliation(s)
- Nor Najwatul Akmal Ab Rahman
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Raymond Lee
- School of Applied Sciences, London South Bank University, London, UK
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Guo F, Svenningsen S, Eddy RL, Capaldi DPI, Sheikh K, Fenster A, Parraga G. Anatomical pulmonary magnetic resonance imaging segmentation for regional structure-function measurements of asthma. Med Phys 2017; 43:2911-2926. [PMID: 27277040 DOI: 10.1118/1.4948999] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Pulmonary magnetic-resonance-imaging (MRI) and x-ray computed-tomography have provided strong evidence of spatially and temporally persistent lung structure-function abnormalities in asthmatics. This has generated a shift in their understanding of lung disease and supports the use of imaging biomarkers as intermediate endpoints of asthma severity and control. In particular, pulmonary (1)H MRI can be used to provide quantitative lung structure-function measurements longitudinally and in response to treatment. However, to translate such biomarkers of asthma, robust methods are required to segment the lung from pulmonary (1)H MRI. Therefore, their objective was to develop a pulmonary (1)H MRI segmentation algorithm to provide regional measurements with the precision and speed required to support clinical studies. METHODS The authors developed a method to segment the left and right lung from (1)H MRI acquired in 20 asthmatics including five well-controlled and 15 severe poorly controlled participants who provided written informed consent to a study protocol approved by Health Canada. Same-day spirometry and plethysmography measurements of lung function and volume were acquired as well as (1)H MRI using a whole-body radiofrequency coil and fast spoiled gradient-recalled echo sequence at a fixed lung volume (functional residual capacity + 1 l). We incorporated the left-to-right lung volume proportion prior based on the Potts model and derived a volume-proportion preserved Potts model, which was approximated through convex relaxation and further represented by a dual volume-proportion preserved max-flow model. The max-flow model led to a linear problem with convex and linear equality constraints that implicitly encoded the proportion prior. To implement the algorithm, (1)H MRI was resampled into ∼3 × 3 × 3 mm(3) isotropic voxel space. Two observers placed seeds on each lung and on the background of 20 pulmonary (1)H MR images in a randomized dataset, on five occasions, five consecutive days in a row. Segmentation accuracy was evaluated using the Dice-similarity-coefficient (DSC) of the segmented thoracic cavity with comparison to five-rounds of manual segmentation by an expert observer. The authors also evaluated the root-mean-squared-error (RMSE) of the Euclidean distance between lung surfaces, the absolute, and percent volume error. Reproducibility was measured using the coefficient of variation (CoV) and intraclass correlation coefficient (ICC) for two observers who repeated segmentation measurements five-times. RESULTS For five well-controlled asthmatics, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) was 83% ± 7% and FEV1 was 86 ± 9%pred. For 15 severe, poorly controlled asthmatics, FEV1/FV C = 66% ± 17% and FEV1 = 72 ± 27%pred. The DSC for algorithm and manual segmentation was 91% ± 3%, 92% ± 2% and 91% ± 2% for the left, right, and whole lung, respectively. RMSE was 4.0 ± 1.0 mm for each of the left, right, and whole lung. The absolute (percent) volume errors were 0.1 l (∼6%) for each of right and left lung and ∼0.2 l (∼6%) for whole lung. Intra- and inter-CoV (ICC) were <0.5% (>0.91%) for DSC and <4.5% (>0.93%) for RMSE. While segmentation required 10 s including ∼6 s for user interaction, the smallest detectable difference was 0.24 l for algorithm measurements which was similar to manual measurements. CONCLUSIONS This lung segmentation approach provided the necessary and sufficient precision and accuracy required for research and clinical studies.
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Affiliation(s)
- F Guo
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5B7, Canada and Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Ontario N6A 5B9, Canada
| | - S Svenningsen
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5B7, Canada and Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - R L Eddy
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5B7, Canada and Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - D P I Capaldi
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5B7, Canada and Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - K Sheikh
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5B7, Canada and Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - A Fenster
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5B7, Canada; Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Ontario N6A 5B9, Canada; and Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - G Parraga
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5B7, Canada and Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Ontario N6A 5B9, Canada
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Yaszay B, Bastrom TP, Bartley CE, Parent S, Newton PO. The effects of the three-dimensional deformity of adolescent idiopathic scoliosis on pulmonary function. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1658-1664. [DOI: 10.1007/s00586-016-4694-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 05/23/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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Lung volume change after pedicle subtraction osteotomy in patients with ankylosing spondylitis with thoracolumbar kyphosis. Spine (Phila Pa 1976) 2015; 40:233-7. [PMID: 25423303 DOI: 10.1097/brs.0000000000000717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective clinical study. OBJECTIVE To investigate the lung volume (LV) change in patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis after the pedicle subtraction osteotomy procedure. SUMMARY OF BACKGROUND DATA Thoracolumbar kyphosis with respiratory impairment is the consequence of most untreated AS patients. Restrictive pulmonary function is prevalent in these patients. The ideal evidence for restrictive pulmonary function impairment is to investigate the LV. A computed tomography (CT)-based method can help to obtain accurate LV change during the osteotomy. METHOD Twenty-eight patients with AS with thoracolumbar kyphosis were included. All of these patients underwent pedicle subtraction osteotomy to correct their sagittal deformity. Pre- and postoperative full-length radiographs and CT scans were reviewed. The sagittal correction of the spine was measured. CT scans were used to estimate the pre- and postoperative LV with software. The relationship between the sagittal correction and the LV change was investigated. All the patients were followed up for 2 years at least. RESULTS The pedicle subtraction osteotomy procedure was performed safely on each patient without serious complications. The average preoperative T1-S1 Cobb was 67.7° (42°∼88°) and the postoperative was 7.6° (-11°∼21°). T1-S1 Cobb change was 60.0° in average (P < 0.05). The LV increased by 396 mL in average. Significant correlation was found between the percentage of LV change and T1-S1 Cobb change (r = 0.7219, P < 0.05). The location we selected for pedicle subtraction osteotomy varied from T12 to L3. No relationship was found between the osteotomy location and the LV change. CONCLUSION The pedicle subtraction osteotomy effectively corrected the sagittal deformity of patients with AS. LV increased significantly after the osteotomy. LEVEL OF EVIDENCE 4.
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Fu J, Liu C, Zhang Y, Zheng G, Zhang G, Song K, Tang X, Wang Y. Three-dimensional computed tomography for assessing lung morphology in adolescent idiopathic scoliosis following posterior spinal fusion surgery. Orthop Surg 2015; 7:43-9. [PMID: 25708035 PMCID: PMC6583253 DOI: 10.1111/os.12151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the changes in lung morphology in subjects with adolescent idiopathic scoliosis (AIS) following posterior spinal fusion surgery. METHODS From April 2009 to August 2013, 30 AIS patients (nine males and 21 females) were enrolled in this study. All scans were obtained with the patient in the supine position and the breath held in deep inspiration and performed both before and after surgery. Syngo software was used to manage the computed tomography scan imaging and to calculate the lung volume, lung height and pulmonary cross-sectional area in the apical vertebral plane. RESULTS Left lung, right lung and total lung volumes and convex to concave lung volume ratio did not change significantly after corrective surgery. There was a statistically significant improvement in left lung and right lung heights after posterior spinal fusion surgery. However, the pulmonary cross-sectional area in the apical vertebrae plane was smaller postoperatively than preoperatively. CONCLUSIONS This study showed that lung height in AIS patients increased significantly immediately postoperatively whereas lung volume did not change significantly. Thoracic symmetry was improved postoperatively in these patients.
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Affiliation(s)
- Jun Fu
- Department of OrthopaedicsChinese People's Liberation Army General HospitalBeijingChina
| | - Chao Liu
- Department of OrthopaedicsChinese People's Liberation Army General HospitalBeijingChina
| | - Yong‐gang Zhang
- Department of OrthopaedicsChinese People's Liberation Army General HospitalBeijingChina
| | - Guo‐quan Zheng
- Department of OrthopaedicsChinese People's Liberation Army General HospitalBeijingChina
| | - Guo‐ying Zhang
- Department of OrthopaedicsChinese People's Liberation Army General HospitalBeijingChina
| | - Kai Song
- Department of OrthopaedicsChinese People's Liberation Army General HospitalBeijingChina
| | - Xiang‐yu Tang
- Department of OrthopaedicsChinese People's Liberation Army General HospitalBeijingChina
| | - Yan Wang
- Department of OrthopaedicsChinese People's Liberation Army General HospitalBeijingChina
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Scoliosis surgery in patients with adolescent idiopathic scoliosis does not alter lung volume: a 3-dimensional computed tomography-based study. Spine (Phila Pa 1976) 2014; 39:E399-405. [PMID: 24430713 DOI: 10.1097/brs.0000000000000203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of surgically treated patients with adolescent idiopathic scoliosis. OBJECTIVE To determine the change in lung volume after the surgical correction of scoliosis using a volumetric reconstruction of lung volume from computed tomographic (CT) scans. SUMMARY OF BACKGROUND DATA Previously published studies have shown that pulmonary function tests improve after scoliosis correction; however, these results are not consistent. CT-based volumetric studies in patients with scoliosis have previously shown differences in lung volume and lung volume ratio when compared with a normal population. To date, no study exists that analyzes changes in these parameters after scoliosis surgery. METHODS A total of 29 patients with adolescent idiopathic scoliosis who had pre- and postoperative CT scans on file were included in this study. Three-dimensional lung volume reconstruction was performed (TeraRecon software, TeraRecon, Inc., Foster City, CA). Appropriate masking methods were used to isolate the lung tissue. Total lung volumes, left and right lung volumes, and left/right lung volume ratio were obtained from the pre- and postoperative CT scans. Hemithoracic symmetry, pre- and postoperative Cobb angle, and kyphosis were also calculated. RESULTS Neither total lung volume nor left/right lung volume ratio changed significantly postoperatively. Surgery did not significantly change total lung volume (P = 0.87), right lung volume (P = 0.69), left lung volume (P = 0.70), or the ratio between right and left lung volumes (P = 0.87). Hemithoracic asymmetry was significantly improved (P < 0.001). Median preoperative major Cobb angle was 53.2° and median preoperative kyphosis was 32.8°. Postoperatively, the median major Cobb angle was 15.0°, resulting in a 70% Cobb correction, and mean postoperative kyphosis was 31.1°. CONCLUSION Corrective scoliosis surgery does not alter total lung volume or the ratio of right-to-left lung volume. Deformity correction leads to an improvement in the symmetry of the thoracic architecture and costovertebral joint mechanics, as evidenced by the improved hemithoracic asymmetry. Thus, the change in pulmonary function tests, which has been previously documented, may be a dynamic rather than a static phenomenon. LEVEL OF EVIDENCE 4.
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15
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Lee DK, Chun EM, Suh SW, Yang JH, Shim SS. Evaluation of postoperative change in lung volume in adolescent idiopathic scoliosis: Measured by computed tomography. Indian J Orthop 2014; 48:360-5. [PMID: 25143638 PMCID: PMC4137512 DOI: 10.4103/0019-5413.136223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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.
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Affiliation(s)
- Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Scoliosis Research Institute, Korea University, Guro Hospital, Seoul, Republic of Korea
| | - Eun Mi Chun
- Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Seoul, Republic of Korea,Address for correspondence: Prof. Eun Mi Chun, Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Republic of Korea. E-mail:
| | - Seung Woo Suh
- Department of Orthopedics, Scoliosis Research Institute, Korea University, Guro Hospital, Seoul, Republic of Korea
| | - Jae Hyuk Yang
- Department of Orthopedics, Scoliosis Research Institute, Korea University, Guro Hospital, Seoul, Republic of Korea
| | - Sung Shine Shim
- Department of Radiology, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
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Moal B, Schwab F, Demakakos J, Lafage R, Riviere P, Patel A, Lafage V. The impact of a corrective tether on a scoliosis porcine model: a detailed 3D analysis with a 20 weeks follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1800-9. [PMID: 23503934 DOI: 10.1007/s00586-013-2743-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/25/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Non-fusion treatment for adolescent idiopathic scoliosis generates interest due to the potential for growth preservation and mobility. Using an established porcine scoliotic model, this study aims to evaluate the global alignment and the morphology of the spine with and without application of a non-fusion corrective tether. METHODS At 12 weeks of age, 21 immature Yorkshire pigs had an induction of scoliosis. Once a 50° Cobb angle was obtained; animals were placed into one of the following groups: a scoliosis model group (SM, n = 11) where animals were euthanized, tether release group (TR, n = 5) where the inducing tether was removed, and an anterior correction group (AC, n = 5) where the inducing tether was removed and non-fusion corrective tether was applied. TR and AC were observed for a further 20 weeks and then euthanized. Post-mortem CT scans were used to create 3D spinal reconstructions to obtain global and morphologic parameters. RESULTS Maximal Cobb angle of the scoliotic deformity was significantly lower for AC (27.9° ± 12.0°) than for the two other groups (TR 52.7° ± 10.0°, SM 48.3° ± 7.6°). AC experienced an increase in kyphosis (24.2° ± 15.9°) compared to TR (7.1° ± 6.4°). Correction in the axial plane was also observed in AC versus TR. Correction of vertebral wedging was found for AC compared to SM and TR in the three apical vertebrae. CONCLUSIONS 3D realignment of scoliotic curves was observed with application of the corrective tether. The correction was the product of both mechanical action and growth modulation. These findings are encouraging for future development of a non-fusion device for the treatment of immature scoliotic curves.
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Affiliation(s)
- Bertrand Moal
- NYU Hospital for Joint Diseases, 306 E. 15th St, Suite 1F, New York, NY 10003, USA
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Schmidt C, Liljenqvist U, Lerner T, Schulte TL, Bullmann V. Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1118-26. [PMID: 21468646 DOI: 10.1007/s00586-011-1784-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 03/13/2011] [Accepted: 03/25/2011] [Indexed: 12/01/2022]
Abstract
Posterior pedicle screw fixation is now the standard treatment for surgical correction of idiopathic scoliosis and has largely replaced anterior techniques, but there have been reports describing a lordogenic effect of segmental pedicle screw instrumentation in the thoracic spine. This clinical study compared anterior dual rod instrumentation with posterior pedicle screw fixation for idiopathic thoracic lordoscoliosis, including 42 patients (7 male, 35 female; average age 16 years, range 12-34) who underwent posterior pedicle screw fixation (n = 20) or anterior dual rod instrumentation (n = 22) at two centers. The average follow-up period was 33 months (24-108 months). Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis with a structural thoracic curve (Lenke 1-3) and thoracic hypokyphosis (T4-T12 < 20°). The main thoracic curve magnitude and sagittal profile on standing radiographs were evaluated. Thoracic kyphosis was significantly restored from preoperatively 10.2° to 23.4° postoperatively in the anterior group and from 7.6° to 12.9° in the posterior group (P < 0.005). Kyphosis improved significantly better in the anterior group than in the posterior group (P < 0.005). The preoperative and postoperative main thoracic curve values were 63° (48-80°) and 25.2° in the anterior group and 60.6° (50-88°) and 23.6° in the posterior group, with no significant differences between the groups. No neurological or other severe complications were observed. Anterior dual rod instrumentation in patients with thoracic lordoscoliosis allows significantly better restoration of thoracic kyphosis than posterior pedicle screw instrumentation.
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Affiliation(s)
- Carolin Schmidt
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer-Str. 33, 48149 Muenster, Germany.
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Quantitative measurement of lung reexpansion in malignant pleural mesothelioma patients undergoing pleurectomy/decortication. Acad Radiol 2011; 18:294-8. [PMID: 21145765 DOI: 10.1016/j.acra.2010.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 10/14/2010] [Accepted: 10/23/2010] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES Malignant pleural mesothelioma (MPM) is a neoplasm that grows circumferentially along the pleura. The tumor and concurrent pleural effusion may reduce lung function by restricting or preventing lung expansion. The purpose of this study was to provide objective evidence that pleurectomy/decortication (P/D) allows trapped lung to reexpand, quantify the reexpansion based on computed tomography (CT) scans, and investigate whether the expansion persists after surgery. MATERIALS AND METHODS A database of 12 patients demonstrating unilateral MPM was collected. Each patient underwent a presurgical CT scan, surgical debulking by P/D, and two postsurgical CT scans (at 1 and 4 months). The lung volume was measured in each scan using an automated algorithm and compared for each patient across time. RESULTS An increase in the ipsilateral postsurgical lung volume was observed for 10 of 12 patients (83%) 1 month after surgery. The median ipsilateral volume increase was 44% relative to the presurgical ipsilateral volume and 21% relative to the contralateral volume. A statistically significant change in ipsilateral lung volume was not observed between 1‑month and 4‑month postsurgical scans, implying that the volume improvement persisted months after surgery. CONCLUSIONS Debulking of MPM with P/D substantially increased the ipsilateral lung volume relative to both the presurgical ipsilateral volume and the contralateral lung volume. This improvement persisted months after surgery.
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Brooks WJ, Krupinski EA, Hawes MC. Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review. SCOLIOSIS 2009; 4:27. [PMID: 20003501 PMCID: PMC2808297 DOI: 10.1186/1748-7161-4-27] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 12/15/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously. CASE PRESENTATION A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature. CONCLUSION This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis.
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Affiliation(s)
| | | | - Martha C Hawes
- Division of Plant Pathology and Microbiology, School of Plant Sciences, University of Arizona, Tucson AZ 85721, USA
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Abstract
STUDY DESIGN Case series. OBJECTIVE We report the treatment of 2 children with right main bronchus obstruction complicating thoracic lordoscoliosis. SUMMARY OF BACKGROUND DATA The preoperative investigation and treatment of large airway obstruction caused by lordoscoliosis has not been reported in the literature. METHODS Obstruction of the right main bronchus was confirmed before surgery by ventilation-perfusion scans, bronchogram, and computed tomography scan. Deformity correction was achieved using a submuscular growth rod construct in one child, and posterior spinal fusion in the other. Clinical examination and repeat ventilation-perfusion scans were performed 8 weeks after surgery. RESULTS In both children, ventilation to the right "convex" lung was reestablished after surgery. Lung function improved in both patients after surgery. CONCLUSION This is the first report of large airway obstruction associated with thoracic lordoscoliosis in which ventilation was reestablished after spinal deformity correction. Early deformity correction is indicated in such cases because of the risk of irreversible compromise to lung ventilation and perfusion.
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