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Is impaired lung function related to spinal deformities in patients with adolescent idiopathic scoliosis? A systematic review and meta-analysis-SOSORT 2019 award paper. 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 2023; 32:118-139. [PMID: 36509885 DOI: 10.1007/s00586-022-07371-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/08/2022] [Accepted: 08/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Some teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients remains unclear, which affects clinical management. This systematic review and meta-analysis aimed to summarize the associations between various lung function parameters and radiographic features in teenagers with AIS. METHODS A search of PubMed, Embase, PEDro, SPORTDiscus, CINAHL, Cochrane Library, and PsycINFO (from inception to March 14, 2022) without language restriction. Original studies reporting the associations between lung function and spinal deformity in patients with AIS were selected. Independent reviewers extracted data and evaluated the methodological quality of the included studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pearson correlation and 95% confidence intervals were calculated using random-effects meta-analysis. RESULTS Twenty-seven studies involving 3162 participants were included. Limited-quality evidence supported that several spinal parameters were significantly related to lung function parameters (e.g., absolute value and percent of the predicted forced vital capacity (FVC; %FVC), forced expiratory volume in one second (FEV1; %FEV1), and total lung capacity (TLC; %TLC)) in AIS patients. Specifically, meta-analyses showed that main thoracic Cobb angles in the coronal plane were significantly and negatively related to FVC (r = - 0.245), %FVC (r = - 0.302), FEV1 (r = - 0.232), %FEV1 (r = - 0.348), FEV1/FVC ratio (r = - 0.166), TLC (r = - 0.302), %TLC (r = - 0.183), and percent predicted vital capacity (r = - 0.272) (p < 0.001). Similarly, thoracic apical vertebral rotation was negatively associated with %FVC (r = - 0.215) and %TLC (r = - 0.126) (p < 0.05). Conversely, thoracic kyphosis angles were positively related to %FVC (r = 0.180) and %FEV1 (r = 0.193) (p < 0.05). CONCLUSION Larger thoracic Cobb angles, greater apical vertebral rotation angle, or hypokyphosis were significantly associated with greater pulmonary impairments in patients with AIS, although the evidence was limited. From a clinical perspective, the results highlight the importance of minimizing the three-dimensional spinal deformity in preserving lung function in these patients. More research is warranted to confirm these results.
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Oba H, Ikegami S, Uehara M, Hatakenaka T, Kamanaka T, Miyaoka Y, Kurogouchi D, Fukuzawa T, Mimura T, Koseki M, Takahashi J. Impact of Physical Flexibility Changes on Respiratory Function after Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Surgery. Spine Surg Relat Res 2022; 7:52-59. [PMID: 36819624 PMCID: PMC9931405 DOI: 10.22603/ssrr.2022-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Corrective scoliosis surgery in patients with adolescent idiopathic scoliosis (AIS) increases thoracic volume but does not improve respiratory function (RF). This study evaluates the effect of physical flexibility (PF) improvement after scoliosis surgery on RF. Methods This study reviewed the records of 61 consecutive patients with AIS (56 female and 5 male; mean±standard deviation age: 14.8±2.2 years, range: 11-20 years) who had undergone posterior spinal fusion (PSF) of the thoracic curve. PF evaluated as finger-floor distance (FFD) was measured preoperatively and one year after surgery. After dividing the cohort into the PF improvement group and the PF nonimprovement group, RF changes at two years postoperative were statistically compared. Using logistic regression analysis, we evaluated the impact of a PF improvement on % forced vital capacity (%FVC) two years after surgery. Results The rate of patients with increased FVC, %FVC, and forced expiratory volume 1.0 second two years after surgery was 79%, 51%, and 80%, respectively. The PF improvement group exhibited a significantly higher gain in %FVC versus the PF nonimprovement group (P=0.043). Moreover, PF improvement significantly prevented a %FVC decrease (odds ratio 8.43, 95% confidence interval 1.92-59.70; P<0.001), with an adjusted odds ratio of 11.86 (P<0.001). Conclusions Patients with diminished PF after PSF for AIS may be less likely to achieve postoperative %FVC improvement. As increased postsurgical %FVC had a positive effect on physical function, treatment strategies that focus on maintaining and increasing PF are desirable from an RF viewpoint.
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Affiliation(s)
- Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takayuki Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Daisuke Kurogouchi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takuma Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Michihiko Koseki
- Faculty of Textile Science and Technology, Shinshu University, Ueda, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Wang Y, Yang F, Wang D, Zhao H, Ma Z, Ma P, Hu X, Wang S, Kang X, Gao B. Correlation analysis between the pulmonary function test and the radiological parameters of the main right thoracic curve in adolescent idiopathic scoliosis. J Orthop Surg Res 2019; 14:443. [PMID: 31842920 PMCID: PMC6915929 DOI: 10.1186/s13018-019-1451-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/31/2019] [Indexed: 01/09/2023] Open
Abstract
Background Scoliosis causes thoracic deformities, and it is necessary to assess these changes in pulmonary function test (PFT). To determine how measurements of spinal and thoracic cage deformities are related to pulmonary function. Methods Seventy-two patients with main right thoracic curvature in adolescent idiopathic scoliosis (AIS) underwent a PFT and a radiological parameter evaluation of spinal and thoracic cage deformities. Simple and multiple linear regressions were also used to note whether a combination of variables might better predict PFT values. Means were compared using the two-sample t test or one-way ANOVA with Tukey’s multiple comparison methods. Results Forced vital capacity (FVC)% predicted had significantly negative correlations with main thoracic curve Cobb (MT-Cobb) (R2 = 0.648, p < 0.001), main thoracic curve-rib hump (MT-RH) (R2 = 0.522, p < 0.001), main thoracic curve apical vertebral body-to-rib ratio (MT-AVB-R) (R2 = 0.536, p < 0.001), and main thoracic curve apical vertebra translation (MT-AVT) (R2 = 0.383, p < 0.001). Multiple regression analysis was performed with FVC% predicted as the dependent variable and MT-Cobb, MT-RH, MT-AVB-R, and MT-AVT as the independent variables. MT-Cobb, MT-RH, MT-AVB-R, and MT-AVT were factors with a significant effect on FVC% predicted (p < 0.001). For 45 patients who had preoperative FVC impairment (FVC% predicted < 80%), their MT-Cobb averaged 76.71°. Twenty-seven patients with normal preoperative FVC (FVC% predicted ≥ 80%) had a smaller mean MT-Cobb of 52.03° (p < 0.001). In other radiological parameters, the impaired FVC group had a MT-AVT of 54.29 mm compared to 38.06 mm for the normal FVC group (p < 0.001). MT-AVB-R averaged 2.92 for the impaired FVC group and 1.78 for the normal FVC group (p < 0.001). MT-RH averaged 28.79 mm for the impaired group and 16.62 mm for the normal group (p < 0.001). Further stratification of preoperative PFT results is divided into three groups. The three groups also showed significant differences in MT-Cobb, MT-RH, MT-AVB-R, and MT-AVT (p < 0.001). Conclusion Severe scoliosis leads to an increased degree of thoracic deformity, which increases the risk of lung damage in AIS. Moreover, a more accurate assessment of pulmonary function is achieved through radiological parameters and PFTs.
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Affiliation(s)
- Yonggang Wang
- Department of Orthopedics, Orthopedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China.,Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China.,The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China
| | - Fengguang Yang
- Department of Orthopedics, Orthopedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China.,Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China.,The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China
| | - Dongmin Wang
- Medical College of Northwest Minzu University, No. 1 Northwest xincun, Lanzhou, 730030, Gansu Province, China
| | - Haiyan Zhao
- Department of Orthopedics, The First Hospital of Lanzhou University, No.1 Donggang West Road, Lanzhou, 730000, Gansu Province, China
| | - Zhanjun Ma
- Department of Orthopedics, Orthopedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China.,Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China.,The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China
| | - Peifen Ma
- Department of Orthopedics, Orthopedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China.,Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China.,The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China
| | - Xuchang Hu
- Department of Orthopedics, Orthopedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China.,Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China.,The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China
| | - Shixiong Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China.,Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China
| | - Xuewen Kang
- Department of Orthopedics, Orthopedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China. .,Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China. .,The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China.
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China. .,Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, China.
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