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Heyer JH, Wisch JL, Nagra KK, Thakur A, Hillstrom HJ, Groisser BN, Zucker CP, Cunningham ME, Hresko MT, Haddas R, Blanco JS, Di Maio MF, Widmann RF. Novel Surface Topographic Assessment of Lung Volume and Pulmonary Function Tests in Idiopathic Scoliosis: A Preliminary Study. J Pediatr Orthop 2024; 44:366-372. [PMID: 38595095 DOI: 10.1097/bpo.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Severe spinal deformity results in restrictive pulmonary disease from thoracic distortions and lung-volume limitations. Though spirometry and body plethysmography are widely accepted tests for pulmonary function tests (PFTs), they are time-consuming and require patient compliance. This study investigates whether surface topographic [surface topography (ST)] measurements of body volume difference (BVD) and torso volume difference between maximum inhale and exhale correlate to values determined on PFTs. METHODS This study included patients with idiopathic scoliosis and thoracic/thoracolumbar curves ≥40 degrees. Patients received ST scans, clinical examinations, and EOS biplanar radiographs on the same day. PFTs were performed within 3 months of ST/radiographic analysis. Univariate linear regression analysis was used to examine relationships between BVD, PFT values, and mean curves. RESULTS Sixteen patients (14.6 ± 2.2 y, 69% females) with idiopathic scoliosis and mean thoracic/thoracolumbar curves of 62 degrees ± 15˚ degrees (45 degrees to 93 degrees) were assessed. BVD displayed statistically high-positive positive correlations with forced vital capacity ( R = 0.863, P < 0.0001), forced expiratory volume in 1 second ( R = 0.870, P < 0.001), vital capacity ( R = 0.802, P < 0.0001), and TLC ( R = 0.831, P < 0.0001. Torso volume difference showed similarly high positive correlations to forced vital capacity, forced expiratory volume in 1 second, vital capacity, and TLC, but not residual volume. No correlations emerged between the mean thoracic/thoracolumbar curve and BVD or PFT values. CONCLUSION This study strongly endorses further investigation into ST scanning as an alternative to traditional PFTs for assessing pulmonary volumes. The noncontact and noninvasive nature of ST scanning presents a valuable alternative method for analyzing thoracic volume, particularly beneficial for patients unable to cooperate with standard PFTs. LEVEL OF EVIDENCE Level II-prognostic.
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Affiliation(s)
- Jessica H Heyer
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Jenna L Wisch
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Kiran K Nagra
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Ankush Thakur
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Howard J Hillstrom
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | | | - Colson P Zucker
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | | | | | - Ram Haddas
- Rochester, Department of Orthopaedics, Center for Musculoskeletal Research
| | - John S Blanco
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Mary F Di Maio
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Roger F Widmann
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
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Chan WWY, Fu SN, Chong TF, Singh G, Tsai DSJ, Wong MCY, Zheng YP, Parent EC, Cheung JPY, Wong AYL. Associations between paraspinal muscle characteristics and spinal curvature in conservatively treated adolescent idiopathic scoliosis: a systematic review. Spine J 2024; 24:692-720. [PMID: 38008187 DOI: 10.1016/j.spinee.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 10/08/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND CONTEXT Children with adolescent idiopathic scoliosis (AIS) may show asymmetrical paraspinal muscle characteristics. PURPOSE To summarize the evidence regarding: (1) the associations between various paraspinal muscle characteristics and spinal curvature; (2) whether paraspinal muscle properties significantly differed between children with and without AIS; and (3) whether baseline paraspinal muscle characteristics predicted curve progression. STUDY DESIGN/SETTING Systematic literature review. METHODS Five databases (CINAHL, Academic Search Premier, MEDLINE, Scopus, and PubMed) were searched from inception to May 2022. This protocol was registered in the PROSPERO database of systematic reviews CRD 42020171263. The Critical appraisal skills program, the Appraisal Tool for Cross-Sectional Studies and Quality In Prognosis Studies tool were used to evaluate the risk of bias of the included studies. The strength of evidence of each identified association was determined by the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). RESULTS Of 1,530 identified citations, four cohort, 17 cross-sectional, and 23 case-control studies including 31 with low, nine with moderate and four with high risk of bias were included. Low to very low-strength evidence supported that the convex side of the curve had more type I muscle fibers, higher muscle volume and paraspinal muscle activity, while the concavity had more intramuscular fatty infiltration. Very low-strength evidence substantiated greater side-to-side surface electromyography signals during left trunk bending in prone lying, standing, and standing with perturbation between people with and without AIS. Also, low to very low-strength evidence supported that a larger side-to-side surface electromyography ratio at the lower end vertebra predicted curve progression. CONCLUSIONS Our review highlights that paraspinal muscles on the concavity of the curve demonstrate consistent changes (ie, altered muscle-related gene expression, muscle atrophy, increased fatty infiltration, reduced type I fibers, and reduced muscle activity), which may be the cause or consequence.
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Affiliation(s)
- Winnie W Y Chan
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Siu-Ngor Fu
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Tsz-Fung Chong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Gurjiven Singh
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Desmond S J Tsai
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Mathew C Y Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 St NW, Edmonton, Alberta T6G 2G4, Canada
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China.
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Orellana KJ, Lee J, Yang D, Hauth L, Flynn JM. Impact of Social Determinants of Health on Adolescent Idiopathic Scoliosis Curve Severity. J Pediatr Orthop 2024; 44:e168-e173. [PMID: 37796167 DOI: 10.1097/bpo.0000000000002529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Social determinants of health have been shown to influence the health and outcomes of pediatric patients. Adolescent idiopathic scoliosis (AIS) may be particularly sensitive to such factors as early diagnosis and treatment can obviate the need for surgical intervention. The purpose of this study was to analyze the effect that social determinants of health have on the severity of AIS at presentation and at the time of surgery. METHODS A retrospective review was conducted for consecutive patients who underwent posterior spinal fusion for AIS from 2020 to 2022. Demographic data was collected, while insurance status (private vs. public) and childhood opportunity index (COI) categories (LOW vs. HIGH) were used as a proxy for socioeconomic status. Curve magnitude at the initial presentation and at the latest preoperative visit were recorded with a threshold of 25 to 40 degrees considered within the bracing range. Univariate and multivariate analysis was done to compare differences between subgroups as appropriate. RESULTS A total of 180 patients with mean initial and preoperative major curve angles of 48 and 60 degrees were included. Statistically significant differences in race and insurance types were appreciated, with the LOW COI group having a higher proportion of underrepresented minority and publicly insured patients than the HIGH COI group ( P <0.001). Patients within the LOW COI group presented with an initial curve that was, on average, 6 degrees more severe than those within the HIGH group ( P =0.009) and a preoperative curve that was 4 degrees larger than those within the HIGH group ( P =0.015). Similarly, only 13% of patients within the LOW COI group presented with curves within the bracing threshold, compared with 31% in the HIGH COI group ( P =0.009). CONCLUSION Socioeconomic status plays a significant role in the severity of AIS. Specifically, patients with lower COI tend to present with curve magnitudes beyond what is responsive to nonsurgical treatment, leading to larger curves at the time of surgery. Future work should focus on addressing social inequalities to optimize the treatment and outcomes of AIS patients. LEVEL OF EVIDENCE Level III- Retrospective Comparative Study.
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Affiliation(s)
- Kevin J Orellana
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julianna Lee
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel Yang
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lucas Hauth
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - John M Flynn
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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Raimondi L, De Luca A, Gallo A, Perna F, Cuscino N, Cordaro A, Costa V, Bellavia D, Faldini C, Scilabra SD, Giavaresi G, Toscano A. Investigating the Differential Circulating microRNA Expression in Adolescent Females with Severe Idiopathic Scoliosis: A Proof-of-Concept Observational Clinical Study. Int J Mol Sci 2024; 25:570. [PMID: 38203740 PMCID: PMC10779108 DOI: 10.3390/ijms25010570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Adolescent Idiopathic Scoliosis (AIS) is the most common form of three-dimensional spinal disorder in adolescents between the ages of 10 and 18 years of age, most commonly diagnosed in young women when severe disease occurs. Patients with AIS are characterized by abnormal skeletal growth and reduced bone mineral density. The etiology of AIS is thought to be multifactorial, involving both environmental and genetic factors, but to date, it is still unknown. Therefore, it is crucial to further investigate the molecular pathogenesis of AIS and to identify biomarkers useful for predicting curve progression. In this perspective, the relative abundance of a panel of microRNAs (miRNAs) was analyzed in the plasma of 20 AIS patients and 10 healthy controls (HC). The data revealed a significant group of circulating miRNAs dysregulated in AIS patients compared to HC. Further bioinformatic analyses evidenced a more restricted expression of some miRNAs exclusively in severe AIS females. These include some members of the miR-30 family, which are considered promising regulators for treating bone diseases. We demonstrated circulating extracellular vesicles (EVs) from severe AIS females contained miR-30 family members and decreased the osteogenic differentiation of mesenchymal stem cells. Proteomic analysis of EVs highlighted the expression of proteins associated with orthopedic disease. This study provides preliminary evidence of a miRNAs signature potentially associated with severe female AIS and suggests the corresponding vesicular component may affect cellular mechanisms crucial in AIS, opening the scenario for in-depth studies on prognostic differences related to gender and grade.
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Affiliation(s)
- Lavinia Raimondi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (L.R.)
| | - Angela De Luca
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (L.R.)
| | - Alessia Gallo
- Dipartimento di Ricerca, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy
| | - Fabrizio Perna
- Ortopedia Generale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy (A.T.)
| | - Nicola Cuscino
- Dipartimento di Ricerca, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy
| | - Aurora Cordaro
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (L.R.)
| | - Viviana Costa
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (L.R.)
| | - Daniele Bellavia
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (L.R.)
| | - Cesare Faldini
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy
| | - Simone Dario Scilabra
- Fondazione Ri.MED, Dipartimento di Ricerca IRCCS ISMETT, Via Ernesto Tricomi 5, 90145 Palermo, Italy
| | - Gianluca Giavaresi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; (L.R.)
| | - Angelo Toscano
- Ortopedia Generale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy (A.T.)
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Sousa C, Pessoa A, Carelli L, Ribeiro C, Lopes A, Melo P. Respiratory oscillometry and functional analyses in patients with idiopathic scoliosis. Braz J Med Biol Res 2023; 56:e12898. [PMID: 37937601 PMCID: PMC10695157 DOI: 10.1590/1414-431x2023e12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/06/2023] [Indexed: 11/09/2023] Open
Abstract
Scoliosis is a condition that affects the spine and causes chest rotation and trunk distortion. Individuals with severe deformities may experience dyspnea on exertion and develop respiratory failure. Respiratory oscillometry is a simple and non-invasive method that provides detailed information on lung mechanics. This work aims to investigate the potential of oscillometry in the evaluation of respiratory mechanics in patients with scoliosis and its association with physical performance. We analyzed 32 volunteers in the control group and 32 in the scoliosis group. The volunteers underwent traditional pulmonary function tests, oscillometry, and the 6-minute walk test (6MWT). Oscillometric analysis showed increased values of resistance at 4 Hz (R4, P<0.01), 12 Hz (R12, P<0.0001), and 20 Hz (R20, P<0.01). Similar analysis showed reductions in dynamic compliance (Cdyn, P<0.001) and ventilation homogeneity, as evaluated by resonance frequency (fr, P<0.001) and reactance area (Ax, P<0.001). Respiratory work, described by the impedance modulus, also showed increased values (Z4, P<0.01). Functional capacity was reduced in the group with scoliosis (P<0.001). A significant direct correlation was found between Cobb angle and R12, AX, and Z4 (P=0.0237, P=0.0338, and P=0.0147, respectively), and an inverse correlation was found between Cdyn and Cobb angle (P=0.0190). These results provided new information on respiratory mechanics in scoliosis and are consistent with the involved pathophysiology, suggesting that oscillometry may improve lung function tests for patients with scoliosis.
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Affiliation(s)
- C.M.S. Sousa
- Laboratório de Instrumentação Biomédica, Instituto de Biologia, Faculdade de Engenharia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A.L.C. Pessoa
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - L.E. Carelli
- Instituto Nacional de Traumatoortopedia, Rio de Janeiro, RJ, Brasil
| | - C.O. Ribeiro
- Laboratório de Instrumentação Biomédica, Instituto de Biologia, Faculdade de Engenharia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A.J. Lopes
- Laboratório de Função Pulmonar, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - P.L. Melo
- Laboratório de Instrumentação Biomédica, Instituto de Biologia, Faculdade de Engenharia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Laboratório de Pesquisa Clínica e Experimental em Biologia Vascular, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Yankey KP, Owusu DN, Sackeyfio A, Wulff I, Duah HO, Gross LF, Lenke LG, Sponseller P, Shah S, Erickson MA, Sides B, Newton P, Bumpass D, Gupta M, Ravinsky R, Boachie-Adjei O. Medical complications and health-related quality of life in complex pediatric spine deformities exceeding 100 degrees or treated by 3CO. Spine Deform 2023; 11:833-840. [PMID: 36826693 DOI: 10.1007/s43390-023-00660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To determine the incidence of medical complications in the pediatric population aged 10-20 years with baseline deformities exceeding 100 degrees or who had 3CO at surgery. Severe pediatric spine deformity poses a great challenge to the treating physician and carries a high complication rate. Pulmonary complications are among the most life threatening. The onus is on the treating surgeon to identify patients who are high risk and institute measures to mitigate the risk for successful outcomes. METHOD Data of 251/311pts from FOX pediatric database from 17 international sites was queried for incidence of major medical complications. Comparative analysis was done to determine the impact of such complications on HRQoL using paired t-test. Risk factors associated with medical complications were assessed using Firth logistic regression. RESULTS 251/311pts had min 2 year f/u. 142F/109 M, average age 14.61years (10-20). Etiologies included 96 Cong,94 Idiopathic, 14-Post TB, 12-NM,12-NF,10-syndromic,8 others. Curve types included Scoliosis-121, Kyphoscoliosis 72, Kyphosis 58. Coronal and sag cobb avg 88° ± 41.47 and 91.92° ± 39.17, respectively. Deformity apices were in the thoracic region in 88% of patients. Pre-op co-morbidities included 54 (21.5%) cardiopulmonary; 7(2.79%) Genitounrinary;13 (5.18%) GI;13 (5.18%) Anxiety/depression; neurological 24 (9.56%). HGT was utilized in 103pts (41%) at an average duration of 68 days. Mean OR time was 459 min, blood loss averaged 1465 ml. VCR was performed in 120(47.81%), PSO in 16 pts (6.37%), SPO in 145pts (57.77%), Thoracoplasty in 132 pts (52.8%). 96% had blood and other blood products transfusion (FFP and platelets). There were 35 post-op medical complications occurring in 29pts (11.6%). Event-specific cumulative incidence was 24 (9.6%) pulmonary, 5(2.0%) gastrointestinal, 3(1.2%) cardiovascular, 1(0.4%) genitourinary and 1(0.4%) other complication. There was no mortality. Osteotomy grade was found to be an independent predictor of pulmonary complication. Despite significant improvement in baseline SRS total and Domain scores at 2 year FU irrespective of medical complication, the improvement in SRS scores were blunted in the complication group. CONCLUSION Medical complications are common among pediatric patients undergoing complex spine surgery for severe deformity. However, medical complications can be managed successfully. Although baseline HRQoL improved irrespective of medical complication status, clinical differences in the magnitude of the changes in HRQoL were observed in some domains.
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Affiliation(s)
| | | | - Arthur Sackeyfio
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | - Irene Wulff
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | - Henry Ofori Duah
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | | | | | | | - Suken Shah
- Spine and Scoliosis Center, Nemours/Alfred I. du Pont Pediatrics, Wilmington, DE, USA
| | | | - Brenda Sides
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter Newton
- Rady Children's Hospital-San Diego, San Diego, CA, USA
| | | | - Munish Gupta
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
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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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Kumar V, Vatkar AJ, Baburaj V, Najjar E, Bansal P. Pulmonary function after thoracoplasty for adolescent idiopathic scoliosis: a systematic review and meta-analysis. 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 2022; 31:2972-2986. [PMID: 36069937 DOI: 10.1007/s00586-022-07375-9] [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: 03/29/2022] [Revised: 07/28/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Thoracoplasty is a procedure which involves rib resection from the costovertebral junction to the apex of the rib hump deformity to address the cosmetic concerns of patients of scoliosis. There is conflicting literature on its effect on pulmonary function. The present meta-analysis was conducted to review and analyze the available literature and ascertain the effect of thoracoplasty on pulmonary function. METHODS Search was conducted according to PRISMA guidelines on three databases. After analysis of all the search results by title, abstracts and full texts-10 studies were identified for inclusion in the review. We included studies which had analyzed preoperative and postoperative pulmonary function tests (PFTs) after thoracoplasty. Pooled estimates were calculated for pulmonary function, and effect of other factors was analyzed by subgroup analysis and meta-regression. RESULTS The included studies were published between 1998 and 2019. A total of 385 patients were included in these studies, with a mean age of 15.01 years, with a female preponderance. Apprehension over appearance of rib hump was the most common indication for thoracoplasty. Percent-predicted forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV-1) were significantly decreased on follow-up. Anterior approach to corrective surgery and lower age were found to be associated with worse pulmonary function. Preoperative Cobb's angle was found to have significant impact on decrease in FEV-1 only, but not on other PFT parameters. CONCLUSION Overall decrease in pulmonary function after thoracoplasty necessitates the need of adequate preoperative pulmonary function to mitigate its effect on patient well-being. Use of a posterior approach for corrective surgery when thoracoplasty is planned might lead to better outcomes. More research is needed to study effect of preoperative Cobb's angle on pulmonary function.
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Affiliation(s)
- Vishal Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | | | | | | | - Parth Bansal
- Department of Orthopaedics, PGIMER, Chandigarh, India.
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Hing Yin N, Kin Ping F, Chor Man L. Diversity for diversity: A “fast track” nursing service model to complement conventional emergency medicine service in a busy urban area emergency department. HONG KONG J EMERG ME 2022. [DOI: 10.1177/1024907920931709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In a busy local emergency department, patients with certain non-life-threatening conditions which only require relatively quick and straightforward management may encounter long waiting times. A new service model called the “Fast Track” Nursing Service attempts to lessen the service load of the regular service queues and to improve patient outcomes. Objectives: This article reports the service outcomes of the Fast Track Nursing Service. Methods: Nurses at our department are selected and trained under clinical protocols specially developed for this service. Assessments and quality assurance audits ensure the quality of service. Results: This service resulted in comparatively shorter waiting times for patients included in predetermined clinical protocols. There was also a high level of patient satisfaction with this service. Conclusion: Our Fast Track Enhanced Nursing service is a model of tailored service diversification to shorten waiting times, thus improving patient satisfaction and outcome.
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Affiliation(s)
- Ng Hing Yin
- Department of Accident and Emergency, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Fan Kin Ping
- Department of Accident and Emergency, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Lo Chor Man
- Department of Accident and Emergency, Kwong Wah Hospital, Kowloon, Hong Kong
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Qi K, Fu H, Yang Z, Bao L, Shao Y. Effects of Core Stabilization Training on the Cobb Angle and Pulmonary Function in Adolescent Patients with Idiopathic Scoliosis. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:4263393. [PMID: 35958375 PMCID: PMC9357678 DOI: 10.1155/2022/4263393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
Objective To observe the effects of core stabilization training on the Cobb angle, respiratory muscle strength (maximum inspiratory pressure, MIP; maximal expiratory pressure, MEP), and pulmonary function (forced vital capacity, FVC; forced expiratory volume, FEV1.0; FEV1.0/FVC%) in adolescent patients with idiopathic scoliosis (AIS) and offer practical-based evidence for the rehabilitation treatment for AIS patients. Methods 36 AIS patients were assigned to the core stability training (CST) group (n = 18) and control group (n = 18); the CST group participated in three sessions of core stabilization exercise per week for 12 weeks and the control group did not perform regular physical training during 12 weeks of study. Then, the Cobb angle, respiratory muscle strength (MIP and MEP), and pulmonary function (FVC, FEV1.0, and FEV1.0/FVC%) were measured before and after core stabilization training. Results After 12 weeks of core stabilization training, compared with the pretest, the Cobb angle showed a significant decrease, FVC, FEV1, MIP, and MEP a significant increase (P < 0.01 respectively), and there was no statistical difference in FEV1/FVC in the CST group; there was no significant difference (P > 0.05 respectively) before and after an experiment in the control group except MEP decreased significantly (P < 0.01, P < 0.05). After 12 weeks of core stabilization training, compared with the control group, the Cobb angle significantly decreased (P < 0.01), FVC, FEV1, MIP, and MEP significantly increased (P < 0.05 respectively) in the CST group, but there was no significant difference (P > 0.05, respectively) in FEV1/FVC between the control group and CST group. Conclusions Core stabilization exercise can be considered to have a positive effect on the normal physiological curvature of the spine in AIS patients, as it decreases the Cobb angle and strengthens respiratory muscle strength and pulmonary function.
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Affiliation(s)
- Kexin Qi
- Department of Physical Education and Research, Changchun University, Changchun 130000, China
| | - Haidong Fu
- Academic Affairs Office, Changchun University, Changchun 130000, China
| | - Zhen Yang
- Luoyang Institute of Science and Technology, LuoYang 471023, Henan, China
| | - Lingqi Bao
- Graduate School of Changchun University, Changchun 130000, China
| | - Yinxin Shao
- Graduate School of Changchun University, Changchun 130000, China
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Pulmonary function in children and adolescents with untreated idiopathic scoliosis: a systematic review with meta-regression analysis. Spine J 2022; 22:1178-1190. [PMID: 34963629 DOI: 10.1016/j.spinee.2021.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/21/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT One of the controversies in untreated idiopathic scoliosis is the influence of curve size on respiratory function. Whereas scoliosis patients with curves over 90 to 100 degrees are agreed to be at risk for cardiorespiratory failure in later life, the impairment of curves below 90 degrees is generally considered mild. Although various studies showed that pulmonary function is affected in patients with scoliosis, quantification of the relation between curve size and pulmonary function is lacking. PURPOSE This systematic review with meta-regression analysis aims to characterize the relation between pulmonary function tests and scoliosis severity in children and adolescents with idiopathic scoliosis. STUDY DESIGN Systematic review with meta-regression analysis. METHODS Pubmed, Embase, Cochrane, and CINAHL were systematically searched until November 3, 2020, for original articles that reported (1) severity of scoliosis quantified in Cobb angle, and (2) pulmonary function tests in children and adolescents with untreated idiopathic scoliosis. Exclusion criteria were other types of scoliosis, non-original data, post-treatment data, and case reports. All study designs were included, and relevant study details and patient characteristics were extracted. The primary outcome was the effect of Cobb angle on pulmonary function as expressed by the slope coefficient of a linear meta-regression analysis. RESULTS A total of 126 studies, including 8,723 patients, were retrieved. Meta-regression analysis revealed a statistically significant inverse relation between thoracic Cobb angle and absolute and predicted forced vital capacity in 1 second, forced vital capacity, vital capacity, and total lung capacity. For these outcomes, the slope coefficients showed a decrease of 1% of the predicted pulmonary function per 2.6 to 4.5 degrees of scoliosis. A multivariable meta-regression analysis of potential confounders (age, year of publication, and kyphosis) hardly affected the majority of the outcomes. CONCLUSION This meta-regression analysis of summary data (means) from 126 studies showed an inverse relationship between the thoracic Cobb angle and pulmonary function. In contrast to previous conclusions, the decline in pulmonary function appears to be gradual over the full range of Cobb angles between <20 and >120 degrees. These findings strengthen the relevance of minimizing curve progression in children with idiopathic scoliosis.
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Zhang Z, Song Z, Yang X, Li T, Bi N, Wang Y. Is There a Correlation Between Cobb Angle and Pulmonary Function Tests at 2-year Follow-up in Patients With Severe Spinal Deformity Treated by Posterior Vertebral Column Resection? Clin Spine Surg 2022; 35:E483-E489. [PMID: 34907929 PMCID: PMC9162077 DOI: 10.1097/bsd.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim was to evaluate the relationships of Cobb angle and pulmonary function tests (PFTs) changes in severe spinal deformity and underwent posterior vertebral column resection (PVCR). SUMMARY OF BACKGROUND DATA No previous study focused on the correlation of deformity correction and PFTs changes in patients with cobb angle >90 degrees. METHODS PFTs values [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and percent-predicted values FVC%, FEV1%] were evaluated preoperative and at 2 years after PVCR. FVC% <80% were defined as restrictive ventilation dysfunction (RVD), the severity of RVD were divided into mild (FEV1% ≥70%), moderate (70% > FEV1% ≥50%) and severe (FEV1% <50%). The relationships among PFTs values improvements and all possible impact factors (mainly correction cobb angle) collected in this study were analyzed. PFTs data were compared among the 3 RVD subgroups (mild vs. moderate vs. severe) and between residual >30 versus <30 degrees. RESULTS A total of 53 cases (28 male/25 female, mean ages 18.9 Y) underwent PVCR in one center from 2004 to 2016 were enrolled cobb angle. When 2 years after PVCR, average PFTs values showed significant improvements. PFTs values changes showed no correlation with correction rate and correction angle. The only significant impact factor in this study for FVC, FVC%, FEV1 improvements was preoperative FVC% and the only impact factor for FEV1% improvement was preoperative FEV1%, the relationships were negative. In accordance with the regression analysis, PFTs values improvements among the 3 RVD subgroups from high to low was severe>moderate>mild. However, patients with residual cobb angle <30 degrees had less PFTs values improvements than patients with residual cobb angle >30 degrees. CONCLUSIONS Two years after PVCR, PFTs values were significantly improved. There is no linear correlation between cobb angle change and PFTs values improvements. Lower preoperative FVC% and FEV1% indicate more PFTs values improvements at 2 years post-PVCR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Zhaoquan Zhang
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhibo Song
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaochen Yang
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Li
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ni Bi
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yingsong Wang
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Wound-Related Complication in Growth-Friendly Spinal Surgeries for Early-Onset Scoliosis-Literature Review. J Clin Med 2022; 11:jcm11092669. [PMID: 35566795 PMCID: PMC9101615 DOI: 10.3390/jcm11092669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/15/2023] Open
Abstract
Background: The treatment for early-onset scoliosis (EOS) is one of the most challenging for pediatric orthopedics. Surgical treatment is often necessary, and wound problems and surgical site infections (SSIs) are common, with potentially severe complications in these patients. The aim of the study was to review current literature according to this complication. Methods: PubMed, Cochrane Library, and Embase were systematically searched for relevant articles by two independent reviewers in January 2022. Every step of the review was done according to PRISMA guidelines. Results: A total of 3579 articles were found. Twenty four articles were included in this systematic review after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of wound-related problems (on average, 15.5%). Conclusion: The literature concerning the definitions, collection, and interpretation of data regarding EOS wound-related complications is often difficult to interpret. This causes problems in the comparison and analysis. Additionally, this observation indicates that data on the incidence of SSI may be underestimated. Awareness of the high rate of SSI of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.
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Çimen O, Öner A, Köksal A, Dirvar F, Mert M. Evaluation of the Parameters Affecting Respiratory Functions at Adolescent Idiopathic Scoliosis Patients. Clin Spine Surg 2022; 35:E236-E241. [PMID: 34039890 DOI: 10.1097/bsd.0000000000001206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective observational study. OBJECTIVE The objective of the study was to evaluate the spinal and extraspinal factors responsible for pulmonary dysfunction in adolescent idiopathic scoliosis patients. SUMMARY OF BACKGROUND DATA Development of thoracic deformity due to scoliosis results with the restrictive ventilatory pattern and the reduced pulmonary function. To prevent pulmonary function deterioration, it is imperative to understand which factors are causing the restrictive lung disease in adolescent idiopathic scoliosis patients. MATERIALS AND METHODS An online database search was conducted in a hospital computerized archive between 2008 and 2018 years. Cobb angle of >30 degrees, Lenke type 1 and 2 patients treated in a single spine unit were included. Coronal and sagittal Cobb angle, bending correction rate for evaluation of flexibility, Risser score, apical vertebra rotation (AVR), and pulmonary function test of patients were obtained. RESULTS There was a moderate negative correlation between forced expiratory volume in the first second, forced vital capacity, and AVR. There was no correlation between forced expiratory volume in the first second and forced vital capacity with age, sex, Cobb angle, Risser score, kyphosis, and bending correction rate. CONCLUSIONS When considering the results of the current study and the other studies in the literature there is not any strong correlation between the features of scoliotic curvature and respiratory functions. In the current study, 52 (72.22%) of 72 patients with moderate to severe scoliosis had mild to severe respiratory dysfunction. Considering the age-related physiological respiratory loss, to evaluate the necessity of surgical treatment in patients with moderate and severe scoliosis, especially in patients with high AVR, the respiratory functions of the patient should also be evaluated. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Osman Çimen
- Department of Orthopedics and Traumatology, Ministry of Health Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
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Dereli EE, Gong S, Çolak TK, Turnbull D. Guidelines for the conservative treatment of spinal deformities - Questionnaire for a Delphi consensus. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1587. [PMID: 34957343 PMCID: PMC8678962 DOI: 10.4102/sajp.v77i2.1587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background Spinal deformity is the oldest disease known to humankind. Many types of treatment methods, including both conservative and surgical, are in use. Objective We aimed to validate a published guideline protocol based on the conservative treatment of spinal deformities. Method A modified Delphi technique was used with a questionnaire sent out to professionals worldwide regarding the conservative treatment of spinal deformities. Results Our study was completed after two rounds. A strong level of agreement of 80% and more (consensus cut-off point) was achieved in most questions in the first round. Some statements were below this margin, and they were sent to the participants via email in the second round for re-evaluation. Consensus was achieved in almost all of the statements in the second round. Only two items did not reach the cut-off point but were close to this value. Conclusion This proposed Guideline Protocol was approved by the participants using the Delphi method and can be used as a valid tool for the conservative treatment of spinal deformities. Clinical implications A conservative treatment guideline in spinal deformity management, will provide consistency in treatment and will facilitate comparability with surgery. It will be useful in determining the cost-effectiveness of treatment and in choosing the right patient for the right method of treatment. This guideline might help in this context, and may also create a systematic method for clinicians to use as a reference in both research and clinical practice.
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Affiliation(s)
- Elif E Dereli
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Program, Istanbul Bilgi University, Istanbul, Turkey
| | - Shaopeng Gong
- Wuhan Schroth Scoliosis Service Center, Wuhan, Hubei, China
| | - Tuğba Kuru Çolak
- Faculty of Health Sciences, Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Deborah Turnbull
- School of Health and Social Care, University of Teesside, Middleborough, MA, United States of America.,The London Orthotic Consultancy, Kingston upon Thames, United Kingdom
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16
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Wulff I, Duah HO, Osei Tutu H, Ofori-Amankwah G, Yankey KP, Owiredu MA, Bidemi Yahaya H, Akoto H, Oteng-Yeboah A, Boachie-Adjei O. Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa. Global Spine J 2021; 11:1208-1214. [PMID: 32772734 PMCID: PMC8453676 DOI: 10.1177/2192568220942482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective review of consecutive series. OBJECTIVES This study sought to assess the incidence, risk factors, and outcomes of pulmonary complication following complex spine deformity surgery in a low-resourced setting in West Africa. METHODS Data of 276 complex spine deformity patients aged 3 to 25 years who were treated consecutively was retrospectively reviewed. Patients were categorized into 2 groups during data analysis based on pulmonary complication status: group 1: yes versus group 2: no. Comparative descriptive and inferential analysis were performed to compare the 2 groups. RESULTS The incidence of pulmonary complication was 17/276 (6.1%) in group 1. A total of 259 patients had no events (group 2). There were 8 males and 9 females in group 1 versus 100 males and 159 females in group 2. Body mass index was similar in both groups (17.2 vs 18.4 kg/m2, P = .15). Average values (group 1 vs group 2, respectively) were as follows: preoperative sagittal Cobb angle (90.6° vs 88.7°, P = .87.), coronal Cobb angle (95° vs 88.5°, P = .43), preoperative forced vital capacity (45.3% vs 62.0%, P = .02), preoperative FEV1 (forced expiratory volume in 1 second) (41.9% vs 63.1%, P < .001). Estimated blood loss, operating room time, and surgery levels were similar in both groups. Thoracoplasty and spinal osteotomies were performed at similar rates in both groups, except for Smith-Peterson osteotomy. Multivariate logistic regression showed that every unit increase in preoperative FEV1 (%) decreases the odds of pulmonary complication by 9% (OR = 0.91, 95% CI 0.84-0.98, P = .013). CONCLUSION The observed 6.1% incidence of pulmonary complications is comparable to reported series. Preoperative FEV1 was an independent predictor of pulmonary complications. The observed case fatality rate following pulmonary complications (17%) highlights the complexity of cases in underserved regions and the need for thorough preoperative evaluation to identify high-risk patients.
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Affiliation(s)
| | - Henry Ofori Duah
- FOCOS Orthopaedic Hospital, Accra, Ghana,Henry Ofori Duah, FOCOS Orthopaedic Hospital, No. 8 Teshie Street, Pantang, Accra. PO Box KD 779, Accra, Ghana.
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17
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Yurt Y, Yatar İ, Malkoç M, Yakut Y, Mıhçıoğlu S, Koltak C. The effect of brace treatment on pulmonary functions in adolescent idiopathic scoliosis: An 8-month follow-up study. J Back Musculoskelet Rehabil 2021; 34:887-893. [PMID: 34151821 DOI: 10.3233/bmr-200195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The instant effect of a brace on pulmonary functions of patients with adolescent idiopathic scoliosis (AIS) is known. However, the permanent effects of its regular use are still unclear. OBJECTIVE This study aimed to determine whether a brace in patients with AIS had a permanent effect on respiratory functions. METHODS Fifteen patients with a mean age of 13.2 ± 1.6 years, and a major Cobb angle of 25.8∘± 7.7∘ participated in this study. Lung volumes and respiratory muscle strength were measured with and without thoracolumbosacral brace, at the end of first month and follow-up period after the patients started using the brace for 23 hours daily. RESULTS When the brace was on, the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), ratio of FEV1/FVC, peak expiratory flow, and forced expiratory flow between 25% and 75% of vital capacity values were found to be lower at both first month and follow-up. After the follow-up, the measurement results did not differ from the results of the first month. CONCLUSIONS The brace had a momentary restrictive effect on patients with AIS. However, it did not cause a permanent change in pulmonary functions after the 8-month follow-up.
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Affiliation(s)
- Yasin Yurt
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Eastern Mediterranean University, Mersin, Turkey
| | - İlker Yatar
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Eastern Mediterranean University, Mersin, Turkey
| | - Mehtap Malkoç
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Eastern Mediterranean University, Mersin, Turkey
| | - Yavuz Yakut
- Institute of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Serpil Mıhçıoğlu
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Eastern Mediterranean University, Mersin, Turkey
| | - Cansu Koltak
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Eastern Mediterranean University, Mersin, Turkey
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Latalski M, Fatyga M, Sowa I, Wojciak M, Starobrat G, Danielewicz A. Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review. World J Orthop 2021; 12:584-603. [PMID: 34485105 PMCID: PMC8384615 DOI: 10.5312/wjo.v12.i8.584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications.
AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries.
METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed.
RESULTS A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries.
CONCLUSION The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.
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Affiliation(s)
- Michał Latalski
- Children Orthopaedic Department, Medical University of Lublin, Lublin 20-093, Poland
| | - Marek Fatyga
- Children Orthopaedic Department, University Hospital for Children, Lublin 20-093, Poland
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, Lublin 20-093, Poland
| | - Magdalena Wojciak
- Department of Analytical Chemistry, Medical University of Lublin, Lublin 20-093, Poland
| | - Grzegorz Starobrat
- Children Orthopaedic Department, University Hospital for Children, Lublin 20-093, Poland
| | - Anna Danielewicz
- Children Orthopaedic Department, Medical University of Lublin, Lublin 20-093, Poland
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Scaturro D, de Sire A, Terrana P, Costantino C, Lauricella L, Sannasardo CE, Vitale F, Mauro GL. Adolescent idiopathic scoliosis screening: Could a school-based assessment protocol be useful for an early diagnosis? J Back Musculoskelet Rehabil 2021; 34:301-306. [PMID: 33285626 DOI: 10.3233/bmr-200215] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis screening still needs a considerable implementation, particularly throughout a school-based assessment protocol. OBJECTIVE This study aims to evaluate the effectiveness of clinical examinations currently in use for the diagnosis of adolescent idiopathic scoliosis, through a survey carried out in secondary schools to standardize a screening protocol that could be generalized. METHODS In their classrooms, the adolescents underwent an idiopathic scoliosis screening through three examinations: Adam's test, axial trunk rotation (ATR) and plumb line. In case of single positivity to one of the three examinations, a column X-ray examination was recommended. RESULTS The sensitivity and diagnostic specificity of Adam's test or ATR were 56.3% and 92.7%, respectively. The positivity to at least one between ATR or plumb line showed that sensitivity was higher than specificity: 91.3% versus 80.8%; the positivity to at least one between Adams's test or plumb line showed a sensitivity of 95.2% and a specificity of 81.5%. Finally, the positivity to all three examinations showed an increase in specificity (99.7%). CONCLUSIONS Taken together, our findings show that this school-based screening protocol had a very high specificity in early diagnosis of adolescent idiopathic scoliosis.
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Affiliation(s)
- Dalila Scaturro
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Pietro Terrana
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Claudio Costantino
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", Università degli Studi di Palermo, Palermo, Italy
| | - Lorenza Lauricella
- Physical Medicine and Rehabilitation Unit, "P. Giaccone" University Hospital, Palermo, Italy
| | - Claudia Emilia Sannasardo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Francesco Vitale
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", Università degli Studi di Palermo, Palermo, Italy
| | - Giulia Letizia Mauro
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
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20
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Ahmed MM, Abdelhalim HA, Elamir RMM. Pulmonary function before and after surgical correction of scoliosis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
As one of the restrictive lung diseases, scoliosis can be treated by surgical intervention to enhance the pulmonary function of that group of patients. The purpose of the study was to determine the effects of scoliosis correction on pulmonary function after a 6-month duration. Around 30 patients with scoliosis were aged between 10 and 40 years old subjecting to posterior spinal fusion surgery who had been enrolled in the study; all of them were subjected to Cobb’s angle measuring and pulmonary function test before and 6 months after the operation.
Results
Cobb’s angle before the operation was 57.3 ± 13.6°, which significantly corrected and reached up to 21.2 ± 7.2° postoperatively with a mean difference of about 36.13°, P < 0.001. The correlation of Cobb’s angle, forced vital capacity (FVC%), and vital capacity (VC%) was significantly negative. Pulmonary function showed restrictive pattern; forced vital capacity “FVC”, forced expiratory volume 1 “FEV1”, vital capacity “VC”, and forced expiratory flow “FEF 25–75%” were 62.4± 18.06, 65.6±20, 60.7±17.8, and 79.6±28.5, respectively; after 6 months, the reading changed to 60.9± 17.9, 64.04±19.3, 59.16±17.5, and 80.26±28.02 respectively with an insignificant difference, P>0.05.
Conclusion
The pulmonary function showed insignificant changes after 6 months of operation, despite significant changes in Cobb’s angle while the preoperative FVC and VC were inversely correlated with it.
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21
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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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22
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Chilkoti GT, Jain N, Mohta M, Saxena AK. Perioperative concerns in Pott's spine: A review. J Anaesthesiol Clin Pharmacol 2021; 36:443-449. [PMID: 33840921 PMCID: PMC8022046 DOI: 10.4103/joacp.joacp_167_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/29/2019] [Accepted: 03/06/2020] [Indexed: 11/10/2022] Open
Abstract
Pott's disease is the most common granulomatous spine infection caused by tubercle bacilli and is a common site of osseous tuberculosis, accounting for 50–60% of cases. The delay in establishing diagnosis and management results in complications such as spinal cord compression and spinal deformity. The aim of this narrative review is to discuss the perioperative concerns in patients for spine surgery. The literature source for this review was obtained via PubMed, Medline, Google Scholar, Cochrane database of systematic reviews, and textbooks until December 2019. On the literature search, we could not retrieve any review article specifically discussing the perioperative concerns of spinal tuberculosis. Therefore, the aim of the present narrative review is to discuss the perioperative concerns of patients for spine surgery along with the specific concerns related to spinal tuberculosis.
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Affiliation(s)
- Geetanjali Tolia Chilkoti
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Nidhi Jain
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Medha Mohta
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Ashok K Saxena
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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Relationship Between Pulmonary Function and Thoracic Morphology in Adolescent Idiopathic Scoliosis: A New Index, the "Apical Vertebra Deviation Ratio", as a Predictive Factor for Pulmonary Function Impairment. Spine (Phila Pa 1976) 2021; 46:87-94. [PMID: 33079914 DOI: 10.1097/brs.0000000000003731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to investigate the relationship between thoracic morphology (TM) and pulmonary function (PF) in patients with adolescent idiopathic scoliosis (AIS) and the feasibility of the "apical vertebra deviation ratio (AVDR)" as a predictor of PF impairment. SUMMARY OF BACKGROUND The PF of AIS is one of the key focuses of clinicians' attention. Early identification of AIS patients who are at risk of developing impaired PF is important for improving patient management. METHODS Preoperative PF and radiographic examination data of 108 patients with thoracic AIS were collected. The following TM data were collected: the costophrenic angle distance (CAD), distance between T1 and mean diaphragm height (T1-diaphragm), T1-T12 height, and AVDR. The correlation coefficient between PF and TM measurements was analyzed, and univariable and multivariable linear regressions were used to determine whether the TM measurements could predict PF. RESULTS The CAD, T1-diaphragm, and T1-T12 height were significantly positively correlated with forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), vital capacity, and total lung capacity (r = 0.54-0.74, P < 0.01). A linear equation between CAD and pulmonary volume could be established: FVC (L) = -3.46 + CAD (cm) × 0.27 (R2 = 0.54). If T1-T12 height is included, the correlation is further enhanced (R2 = 0.68). There was a significant negative correlation between the AVDR and predicted values of forced vital capacity (FVC%), FEV1%, predicted values of vital capacity, and predicted values of total lung capacity (r = -0.46 to -0.52, P < 0.01). The AVDR could predict the value of each of these variables. One of the linear equations is as follows: FVC% = 110.70-99.73 × AVDR (R2 = 0.272). CONCLUSION The two novel, two-dimensional TM measurements, CAD and AVDR, can be used as moderate to strong predictors of PF outcome in statistical terms. An AVDR >0.2 suggests that the patient may suffer from moderate or severe PF damage.Level of Evidence: 4.
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Endo T, Ohba T, Oba H, Oda K, Tanaka N, Haro H. Prevalence and Key Radiographic Spinal Malalignment Parameters Associated with the Risk of Pulmonary Function Impairment in Patients Treated Surgically to Correct Adult Spinal Deformity. Spine Surg Relat Res 2020; 4:347-353. [PMID: 33195860 PMCID: PMC7661027 DOI: 10.22603/ssrr.2020-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/14/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction There is a significant relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae, and coronal imbalance in patients with childhood spinal deformity. By contrast, the pathophysiology, epidemiology, and influence of deformity on respiratory dysfunction in patients with adult spinal deformity (ASD) remain largely unknown. We sought to clarify and compare the prevalence of pulmonary function impairment in patients with ASD with that in patients with lumbar spinal stenosis (LSS), to determine radiographically which spinal malalignment parameters are associated with a risk of respiratory dysfunction, and to determine the association of respiratory dysfunction with corrective surgery. Methods We conducted a prospective study of consecutive patients with a diagnosis of ASD or LSS who underwent spinal surgery. We included data from 122 consecutive patients with ASD and 121 consecutive patients with LSS. Parameters were obtained from full-length lateral radiographs taken with the patients standing and in supine and prone positions. We compared respiratory dysfunction between a group of patients with ASD and LSS and determined correlations between respiratory dysfunction and spinopelvic parameters. Results Preoperative % forced vital capacity (FVC) of patients with ASD was significantly lower than that of patients with LSS, and the frequency of restrictive ventilatory impairment was significantly higher in those with ASD (15.7%) than those with LSS (7.4%). Thoracolumbar kyphotic curvature (TK) while the patients were in supine position was significantly greater in the group with restrictive ventilatory impairment, and a significant negative correlation was found between %FVC and TK with the patients in supine position. We found no significant improvement of respiratory dysfunction 1 year after surgery. Conclusions Spinal deformity is a potential risk factor for restrictive ventilatory impairment in the elderly. We propose that radiographs obtained when patients are in supine position are valuable for evaluating the flexibility of the TK. Rigid TK might be an etiology of restrictive ventilatory impairment in patients with ASD.
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Affiliation(s)
- Tomoka Endo
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto city, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Nobuki Tanaka
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
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Fuller S, Del Rivero J, Venzon D, Ilanchezhian M, Allen D, Folio L, Ling A, Widemann B, Fontana JR, Glod J. Pulmonary Function in Patients With Multiple Endocrine Neoplasia 2B. J Clin Endocrinol Metab 2020; 105:dgaa296. [PMID: 32448901 PMCID: PMC7365699 DOI: 10.1210/clinem/dgaa296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Multiple endocrine neoplasia type 2B (MEN2B) is a rare cancer predisposition syndrome resulting from an autosomal-dominant germline mutation of the RET proto-oncogene. No prior studies have investigated pulmonary function in patients with MEN2B. OBJECTIVE This study characterized the pulmonary function of patients with MEN2B. DESIGN This is a retrospective analysis of pulmonary function tests (PFTs) and chest imaging of patients enrolled in the Natural History Study of Children and Adults with MEN2A or MEN2B at the National Institutes of Health. RESULTS Thirty-six patients with MEN2B (18 males, 18 females) were selected based on the availability of PFTs; 27 patients underwent at least 2 PFTs and imaging studies. Diffusion abnormalities were observed in 94% (33/35) of the patients, with 63% (22/35) having moderate to severe defects. A declining trend in diffusion capacity was seen over time, with an estimated slope of -2.9% per year (P = 0.0001). Restrictive and obstructive abnormalities were observed in 57% (20/35) and 39% (14/36), respectively. Computed tomography imaging revealed pulmonary thin-walled cavities (lung cysts) in 28% (9/32) of patients and metastatic lung disease in 34% (11/32) of patients; patients with metastatic lung lesions also tended to have thin-walled cavities (P = 0.035). CONCLUSIONS This study characterized pulmonary function within a MEN2B cohort. Diffusion, restrictive, and obstructive abnormalities were evident, and lung cysts were present in 28% of patients. Further research is required to determine the mechanism of the atypical pulmonary features observed in this cohort.
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Affiliation(s)
- Sarah Fuller
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jaydira Del Rivero
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David Venzon
- Biostatistics and Data Management Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maran Ilanchezhian
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah Allen
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Les Folio
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Alexander Ling
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Brigitte Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph R Fontana
- Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - John Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Kazemi K, Rahmani N, Rahimi F, Ravanbakhsh M. The association between spinal column deformity and breathing function: A systematic review. J Bodyw Mov Ther 2020; 24:172-180. [PMID: 32825985 DOI: 10.1016/j.jbmt.2020.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/07/2019] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Khadijeh Kazemi
- Musculoskeletal Research Center, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd., PO Box 33133 -61357, Ahvaz, Iran
| | - Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rahimi
- Musculoskeletal Research Center, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd., PO Box 33133 -61357, Ahvaz, Iran
| | - Majid Ravanbakhsh
- Musculoskeletal Research Center, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd., PO Box 33133 -61357, Ahvaz, Iran.
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Marpole R, Blackmore AM, Gibson N, Cooper MS, Langdon K, Wilson AC. Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy. Front Pediatr 2020; 8:333. [PMID: 32671000 PMCID: PMC7326778 DOI: 10.3389/fped.2020.00333] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/21/2020] [Indexed: 12/15/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of disability in childhood. Respiratory illness is the most common cause of mortality, morbidity, and poor quality of life in the most severely affected children. Respiratory illness is caused by multiple and combined factors. This review describes these factors and discusses assessments and treatments. Oropharyngeal dysphagia causes pulmonary aspiration of food, drink, and saliva. Speech pathology assessments evaluate safety and adequacy of nutritional intake. Management is holistic and may include dental care, and interventions to improve nutritional intake, and ease, and efficiency of feeding. Behavioral, medical, and surgical approaches to drooling aim to reduce salivary aspiration. Gastrointestinal dysfunction, leading to aspiration from reflux, should be assessed objectively, and may be managed by lifestyle changes, medications, or surgical interventions. The motor disorder that defines cerebral palsy may impair fitness, breathing mechanics, effective coughing, and cause scoliosis in individuals with severe impairments; therefore, interventions should maximize physical, musculoskeletal functions. Airway clearance techniques help to clear secretions. Upper airway obstruction may be treated with medications and/or surgery. Malnutrition leads to poor general health and susceptibility to infection, and improved nutritional intake may improve not only respiratory health but also constipation, gastroesophageal reflux, and participation in activities. There is some evidence that children with CP carry pathogenic bacteria. Prophylactic antibiotics may be considered for children with recurrent exacerbations. Uncontrolled seizures place children with CP at risk of respiratory illness by increasing their risk of salivary aspiration; therefore optimal control of epilepsy may reduce respiratory illness. Respiratory illnesses in children with CP are sometimes diagnosed as asthma; a short trial of asthma medications may be considered, but should be discontinued if ineffective. Overall, management of respiratory illness in children with CP is complex and needs well-coordinated multidisciplinary teams who communicate clearly with families. Regular immunizations, including annual influenza vaccination, should be encouraged, as well as good oral hygiene. Treatments should aim to improve quality of life for children and families and reduce burden of care for carers.
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Affiliation(s)
- Rachael Marpole
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - A. Marie Blackmore
- Research, Ability Centre, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Noula Gibson
- Research, Ability Centre, Perth, WA, Australia
- Department of Physiotherapy, Perth Children's Hospital, Perth, WA, Australia
| | - Monica S. Cooper
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, VIC, Australia
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Perth Children's Hospital, Perth, WA, Australia
| | - Andrew C. Wilson
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
- Department of Paediatrics, The University of Western Australia, Perth, WA, Australia
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Al Qaroot B. Comments regarding "In-brace alteration of pulmonary functions in adolescents wearing a brace for idiopathic scoliosis" by Yagci et al. (2019). Prosthet Orthot Int 2020; 44:99. [PMID: 32238106 DOI: 10.1177/0309364619889481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Bashar Al Qaroot
- School of Rehabilitation Sciences, Prosthetics and Orthotics Department, University of Jordan, Amman, Jordan
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Xavier VB, Avanzi O, de Carvalho BDMC, Alves VLDS. Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: a randomised trial. J Physiother 2020; 66:33-38. [PMID: 31859153 DOI: 10.1016/j.jphys.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/25/2019] [Indexed: 11/17/2022] Open
Abstract
QUESTION In adolescents with idiopathic scoliosis, does combined aerobic and resistance training improve respiratory function, perceived exertion and functional exercise capacity more than aerobic training only? DESIGN Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS Forty adolescents with idiopathic scoliosis and formal indication for surgical correction (spinal curvature ≥ 45 deg). INTERVENTION Both groups undertook three 60-minute training sessions per week for 12 weeks. The experimental group performed combined aerobic and resistance training and the control group performed only aerobic training. OUTCOME MEASURES At baseline and upon completion of treatment, participants completed: a 6-minute walk test with Borg scale (0 to 10) rating of exertion, spirometry, maximal respiratory pressures and peak expiratory flow measurement. RESULTS After 12 weeks of training, the experimental group improved more than the control group on the 6-minute walk test (MD 22 m, 95% CI 4 to 40), with lower perceived exertion at the end of the test (MD -1.2, 95% CI -1.9 to -0.4). The experimental group also improved more than the control group on several respiratory measures, including: FEV1 (MD 270 ml, 95% CI 30 to 510), maximal inspiratory pressure (MD 4 cmH2O, 95% CI 1 to 8) and peak expiratory flow (MD 33 l/minute, 95% CI 7 to 58). CONCLUSION In adolescents with idiopathic scoliosis, combined aerobic and resistance training improves functional exercise capacity and several respiratory outcomes more than a similar training regimen with aerobic training only. It is unclear whether the magnitude of the benefits is large enough to be worthwhile. TRIAL REGISTRATION NCT02413788.
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Affiliation(s)
| | - Osmar Avanzi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Vera Lúcia Dos Santos Alves
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil; Universidade de Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil.
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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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Jonsson K, Peterson M. Peak expiratory flow rate and thoracic mobility in people with fibromyalgia. A cross sectional study. Scand J Pain 2019; 19:755-763. [PMID: 31343985 DOI: 10.1515/sjpain-2019-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/19/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Fibromyalgia (FM) is characterized by chronic widespread pain and affects approximately 1-3% of the general population. Respiratory function has not been given much consideration in people with FM. Few studies have been published concerning FM and respiratory function and conflicting data still exist. The aim of this study was to compare differences in forced expiration, but also to investigate chest expansion, spinal mobility and segmental pain intensity between a group with fibromyalgia and healthy controls. METHODS Forty-one women with diagnosed FM based on American College of Rheumatology 1990 criteria and forty-one controls without pain matched for age and gender participated in this cross-sectional study. For evaluation of forced expiration, a Wright peak expiratory flow rate meter was used. A tape measure was used to measure the mobility of the thorax at maximum inhalation and exhalation known as chest expansion. Spinal mobility was measured with the Cervico-thoracic ratio method. The spinal mobility was measured as range of motion from C7 to 15 cm below in flexion and manual palpation was conducted between C7-T5. For differences in pain intensity a palpation-index was defined for each level, respectively; C7-T1, T1-2, T2-3, T3-4 and T4-5 by calculating the mean value for the four different palpation points for each motion segment. A combined measure of expiration and thoracic mobility (expiratory/inspiratory ratio) was calculated by dividing peak expiratory flow rate (L/min) with chest expansion (cm). Statistical analyses included descriptive statistics to describe subjects and controls, means and standard deviation to compare differences between groups and student-t and Chi-square (χ2) tests, using SPSS 22 software. Confidence interval was set to 95%. RESULTS In the FM group 17 had the diagnosis for more than 5 years and 24 less than 5 years. The FM group demonstrated significantly lower forced expiration (p < 0.018), less thoracic expansion (p < 0.001), reduced spinal mobility (p < 0.029), higher expiratory-inspiratory ratio value (p < 0.001) and increased palpation pain over C7-T5 (p < 0.001) compared to healthy controls. There were more smokers in the FM group (n = 9) compared to the controls (n = 5) though this difference was not statistically significant (p < 0.24) and excluding the few smokers yielded similar result. No significant correlations for manual palpation, chest expansion, peak expiratory flow rate and spinal mobility were found in the FM group. CONCLUSIONS Women with FM demonstrated significantly lower forced expiration and thoracic mobility compared to healthy controls. IMPLICATIONS The results of this study point to a plausible restriction of respiratory function which in turn may have effect on physical endurance and work capacity in people with FM.
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Affiliation(s)
- Kent Jonsson
- Department of Geriatric and Rehabilitation Medicine, Nykoping Hospital, Nykoping, Sweden.,Department of Public Health and Caring Sciences, Section of Family Medicine, Uppsala University, Uppsala, Sweden
| | - Magnus Peterson
- Department of Public Health and Caring Sciences, Section of Family Medicine, Uppsala University, Uppsala, Sweden.,Samariterhemmet Academic Primary Health Care Centre, Region Uppsala, Sweden
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Villamor GA, Andras LM, Redding G, Chan P, Yang J, Skaggs DL. A Comparison of Maximal Voluntary Ventilation and Forced Vital Capacity in Adolescent Idiopathic Scoliosis Patients. Spine Deform 2019; 7:729-733. [PMID: 31495472 DOI: 10.1016/j.jspd.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/15/2019] [Accepted: 02/09/2019] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Prospective, single center. OBJECTIVE To compare maximal voluntary ventilation (MVV) and forced vital capacity (FVC) testing in the outpatient scoliosis clinic to determine their relative feasibility and sensitivity in assessing pulmonary function in the AIS population. SUMMARY OF BACKGROUND DATA Evidence of compromised pulmonary function in patients with severe AIS is well established. The American Thoracic Society (ATS) has established criteria for the reliability and accuracy of pulmonary function tests (PFTs), including MVV and FVC. METHODS A total of 91 AIS patients with thoracic curves of 20° or greater were enrolled in the orthopedic clinic. Patients performed PFTs using the CareFusion MicroLoop Spirometer. MVV and FVC values were collected. Results were considered reliable or "passing" when ATS spirometer guidelines were met. RESULTS Eighty-seven of the 91 patients (96%) met ATS criteria for the MVV test and 43 of the 91 patients (47%) met criteria for the FVC test. Both MVV (r = -0.41, p < .01) and FVC (r = -0.37, p = .01) were significantly correlated with thoracic Cobb angle. The percentile predicted (%predicted) MVV (r = -0.24, p = .03) and %predicted FVC (r = -0.32, p = .04) were also significantly correlated with thoracic Cobb angle. Of those who passed both tests (42/91 patients), 26% had abnormal MVV results with normal FVC results, and 5% had abnormal FVC results with normal MVV results. CONCLUSION MVV and FVC correlated closely with Cobb angle. Twice as many AIS patients could perform an MVV test compared with an FVC test. MVV seems to be a more practical and sensitive PFT than FVC for assessing the pulmonary function of AIS patients in the orthopedic clinic setting. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Gabriela A Villamor
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Lindsay M Andras
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Greg Redding
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Priscella Chan
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Joshua Yang
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - David L Skaggs
- Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
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Boel L, Pernet K, Toussaint M, Ides K, Leemans G, Haan J, Van Hoorenbeeck K, Verhulst S. Respiratory morbidity in children with cerebral palsy: an overview. Dev Med Child Neurol 2019; 61:646-653. [PMID: 30320434 DOI: 10.1111/dmcn.14060] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 12/15/2022]
Abstract
Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. WHAT THIS PAPER ADDS: Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.
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Affiliation(s)
- Lieve Boel
- Department of Paediatric Pulmonology, Antwerp University Hospital, Antwerp, Belgium
| | - Kurt Pernet
- Neuromuscular Reference Centre and Centre for Home Mechanical Ventilation, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Michel Toussaint
- Neuromuscular Reference Centre and Centre for Home Mechanical Ventilation, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Kris Ides
- Department of Pulmonology, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Glenn Leemans
- Department of Pulmonology, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jurn Haan
- Neuromuscular Reference Centre and Centre for Home Mechanical Ventilation, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Kim Van Hoorenbeeck
- Department of Paediatric Pulmonology, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Stijn Verhulst
- Department of Paediatric Pulmonology, Antwerp University Hospital, Antwerp, Belgium.,Neuromuscular Reference Centre and Centre for Home Mechanical Ventilation, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
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Liu ZJ, Qian BP, Qiu Y, Mao SH, Jiang J, Wang B. Does relocation of the apex after osteotomy affect surgical and clinical outcomes in patients with ankylosing spondylitis and thoracolumbar kyphosis? J Neurosurg Spine 2019; 31:27-34. [PMID: 30875683 DOI: 10.3171/2018.12.spine18752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Relocation of the apex is often found in patients with ankylosing spondylitis (AS)-associated thoracolumbar/lumbar kyphosis after corrective surgery. This study evaluates the influence of different postoperative apex locations on surgical and clinical outcomes of osteotomy for patients with AS and thoracolumbar kyphosis. METHODS Sixty-two patients with a mean age of 34.6 ± 9.7 years (range 17-59 years) and a minimum of 2 years of follow-up, who underwent 1-level lumbar pedicle subtraction osteotomy for AS-related thoracolumbar kyphosis, were enrolled in the study, as well as 62 age-matched healthy individuals. Patients were divided into 2 groups according to the postoperative location of the apex (group 1, T8 or above; group 2, T9 or below). Demographic data, radiographic measurements (including 3 postoperative apex-related parameters), and clinical outcomes were compared between the 2 groups preoperatively, postoperatively, and at the last follow-up. Furthermore, a subgroup analysis was performed among patients with a postoperative apex located at T6-11 and postoperatively the entire AS cohort was compared with normal controls regarding the apex location of the thoracic spine. RESULTS In the majority of the enrolled patients, the apex location changed from T12-L2 preoperatively to T6-9 postoperatively. The sagittal vertical axis (SVA) differed significantly both postoperatively (25.7 vs 59.0 mm, p = 0.001) and at the last follow-up (34.6 vs 59.9 mm, p = 0.003) between the 2 groups, and the patients in group 1 had significantly smaller horizontal distance between the C7-vertical line and the apex (DCA) than the patients in group 2 (67.5 vs 103.7 mm, p = 0.001). Subgroup analysis demonstrated similar results, showing that the patients with a postoperative apex located at T8 or above had an average SVA < 47 mm. Notably, a significant correlation was found between postoperative SVA and DCA (r = 0.642, p = 0.001). Patients who underwent an osteotomy at L3 had limited apex relocation but larger SVA correction than those at L1 or L2. However, no significant difference was found in health-related quality of life between the 2 groups. CONCLUSIONS AS patients with an apex located at T8 or above after surgery tended to have better SVA correction (within 47 mm) than those who had a more caudally located apical vertebra. For ideal postoperative apex relocation, a higher (closer to or at the preoperative apex) level of osteotomy is more likely to obtain the surgical goal.
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Drivers of Cost in Adult Thoracolumbar Spine Deformity Surgery. World Neurosurg 2018; 118:e206-e211. [DOI: 10.1016/j.wneu.2018.06.155] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
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Ran B, Fan Y, Yuan F, Guo K, Zhu X. Pulmonary function changes and its influencing factors after preoperative brace treatment in patients with adolescent idiopathic scoliosis: A retrospective case-control study. Medicine (Baltimore) 2016; 95:e5088. [PMID: 27787360 PMCID: PMC5089089 DOI: 10.1097/md.0000000000005088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of the study was to retrospectively investigate the changes in pulmonary function and its influencing factors in patients with adolescent idiopathic scoliosis (AIS) undergoing preoperative brace treatment or not. METHODS Total 237 AIS patients (43 boys, 194 girls) who underwent operations and had a complete record of pulmonary function tests were enrolled and were divided into preoperative brace treatment group (brace treatment group, n = 60) and without preoperative brace treatment group (control group, n = 177). The pulmonary function parameters were compared between the 2 groups. Multiple linear regression analysis was performed to explore whether the variables, including age at operation, height, coronal Cobb's angle of main curve, number of involved vertebrae, sagittal Cobb's angle of thoracic curve, brace treatment time per day and brace treatment duration, influenced pulmonary function in the brace treatment group. RESULTS No significant differences were observed in both predicted and actually measured value of forced vital capacity (FVC) and predicted value of forced expiratory volume in 1 s (FEV1) between 2 groups (P > 0.05), but actually measured FEV1, the percentage of actually measured and predicted value of FVC (FVC%) and FEV1 (FEV1%) were significantly lower in the brace treatment group than those in the control group (P < 0.05). Importantly, the above changes in actually measured FEV1 and FEV1% were obvious in AIS patients presented with a main thoracic curve (P < 0.05), but not in patients with a primary thoracolumbar/lumbar curve. Multiple linear regression analysis indicated that only the sagittal Cobb's angle of the thoracic curve was positively, but preoperative brace treatment duration was negatively associated with both the FVC% and FEV1% (P < 0.05). CONCLUSION Preoperative brace treatment may deteriorate pulmonary function in AIS patients with thoracic curve. The small sagittal Cobb angle and longer brace treatment duration may be risk factors for reduced pulmonary function.
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Affiliation(s)
- Bo Ran
- Department of Orthopedic, The Affiliated Hospital of Xuzhou Medical College, Xuzhou
| | - Yuxin Fan
- Department of Orthopedic, Xinyi Hospital of T.C.M, Xinyi
| | - Feng Yuan
- Department of Orthopedic, The Affiliated Hospital of Xuzhou Medical College, Xuzhou
| | - Kaijin Guo
- Department of Orthopedic, The Affiliated Hospital of Xuzhou Medical College, Xuzhou
- Correspondence: Kaijin Guo and Xiaodong Zhu, Department of Orthopedic, The Affiliated Hospital of Xuzhou Medical College, Quanshan District, Xuzhou, China (e-mail: ; )
| | - Xiaodong Zhu
- Department of Orthopedic, Changhai Hospital Affiliated to The Second Military Medical University, Shanghai, China
- Correspondence: Kaijin Guo and Xiaodong Zhu, Department of Orthopedic, The Affiliated Hospital of Xuzhou Medical College, Quanshan District, Xuzhou, China (e-mail: ; )
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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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