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Lin Y, Shen J, Chen L, Yuan W, Cong H, Luo J, Kwan KYH. Cardiopulmonary Function in Patients with Congenital Scoliosis: An Observational Study. J Bone Joint Surg Am 2019; 101:1109-1118. [PMID: 31220028 DOI: 10.2106/jbjs.18.00935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with congenital scoliosis often have restrictive pulmonary dysfunction on static pulmonary function testing (PFT). Although frequently asymptomatic during daily activities, these patients are generally assumed to have reduced exercise capacity. The aim of this study was to use dynamic cardiopulmonary exercise testing (CPET) to investigate exercise capacity and its association with spinal deformity in patients with congenital scoliosis. METHODS Sixty patients with congenital scoliosis who underwent preoperative spinal radiography, PFT, and CPET were included from January 2014 to November 2017. The impact of thoracic spinal deformity and rib anomalies on pulmonary function and physical capacity was investigated. RESULTS A significant deterioration in pulmonary function with increases in the severity of the major thoracic curve was demonstrated by the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (all p < 0.001). The ratio of FEV1 to FVC was similar regardless of thoracic curve severity. A smaller tidal volume during exercise testing reflected restrictive dysfunction in the patients with the most severe curves. CPET also revealed a significant trend of faster breathing by patients with a severe thoracic curve (p < 0.001). Exercise capacity indicators such as work rate (p = 0.019), heart rate (p = 0.015), and oxygen saturation (p = 0.006) were significantly reduced only in patients with a thoracic curve of >100°. Pulmonary dysfunction was the major contributor to exercise intolerance. Compared with mild pulmonary dysfunction, moderate and severe dysfunction was associated with an abnormal breathing pattern and lower work rate (p = 0.032) and peak oxygen intake (p = 0.042), indicating worse exercise tolerance. CONCLUSIONS Congenital scoliosis leads to restrictive pulmonary dysfunction, which reduces the tidal volume and forces patients to accelerate respiratory rates during exercise. Patients with a thoracic curve of >100° are unable to compensate and have significantly reduced exercise capacity. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Youxi Lin
- Departments of Orthopedics (Y.L. and J.S.), Physical Medicine and Rehabilitation (L.C., W.Y., and H.C.), and Respiratory Medicine (J.L.), Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Jianxiong Shen
- Departments of Orthopedics (Y.L. and J.S.), Physical Medicine and Rehabilitation (L.C., W.Y., and H.C.), and Respiratory Medicine (J.L.), Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Lixia Chen
- Departments of Orthopedics (Y.L. and J.S.), Physical Medicine and Rehabilitation (L.C., W.Y., and H.C.), and Respiratory Medicine (J.L.), Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Wangshu Yuan
- Departments of Orthopedics (Y.L. and J.S.), Physical Medicine and Rehabilitation (L.C., W.Y., and H.C.), and Respiratory Medicine (J.L.), Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Hui Cong
- Departments of Orthopedics (Y.L. and J.S.), Physical Medicine and Rehabilitation (L.C., W.Y., and H.C.), and Respiratory Medicine (J.L.), Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Jinmei Luo
- Departments of Orthopedics (Y.L. and J.S.), Physical Medicine and Rehabilitation (L.C., W.Y., and H.C.), and Respiratory Medicine (J.L.), Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Kenny Yat Hong Kwan
- Department of Orthopedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
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Mackel CE, Jada A, Samdani AF, Stephen JH, Bennett JT, Baaj AA, Hwang SW. A comprehensive review of the diagnosis and management of congenital scoliosis. Childs Nerv Syst 2018; 34:2155-2171. [PMID: 30078055 DOI: 10.1007/s00381-018-3915-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To provide the reader with a comprehensive but concise understanding of congenital scoliosis METHODS: We have undertaken to summarize available literature on the pathophysiology, epidemiology, and management of congenital scoliosis. RESULTS Congenital scoliosis represents 10% of pediatric spine deformity and is a developmental error in segmentation, formation, or a combination of both leading to curvature of the spine. Treatment options are complicated by balancing growth potential with curve severity. Often associated abnormalities of cardiac, genitourinary, or intraspinal systems are concurrent and should be evaluated as part of the diagnostic work-up. Management balances the risk of progression, growth potential, lung development/function, and associated risks. Surgical treatment options involve growth-permitting systems or fusions. CONCLUSION Congenital scoliosis is a complex spinal problem associated with many other anomalous findings. Treatment options are diverse but enable optimization of management and care of these children.
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Affiliation(s)
- Charles E Mackel
- Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, 800 Washington St, Boston, 02111, MA, USA
| | - Ajit Jada
- Department of Neurological Surgery, Weill Cornell Medical College, Box 99, 525 E 68th St, New York, 10065, NY, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - James H Stephen
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, 19104, PA, USA
| | - James T Bennett
- Department of Orthopaedic Surgery, Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, 19140, PA, USA
| | - Ali A Baaj
- Department of Neurological Surgery, Weill Cornell Medical College, Box 99, 525 E 68th St, New York, 10065, NY, USA
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA.
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