Sin Ying Lee, Zhi Sean Teng, Chee Kuan Wong, Chee Kidd Chiu, Chris Yin Wei Chan, Mun Keong Kwan
{"title":"后路脊柱融合术对严重青少年特发性脊柱侧凸患者肺功能的影响（主Cobb角≥90°）。","authors":"Sin Ying Lee, Zhi Sean Teng, Chee Kuan Wong, Chee Kidd Chiu, Chris Yin Wei Chan, Mun Keong Kwan","doi":"10.2106/JBJS.OA.25.00169","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Curve severity is a recognized factor associated with impaired pulmonary function in patients with severe adolescent idiopathic scoliosis (AIS). Despite significant curve correction achieved after posterior spinal fusion, reports on the extent of potential pulmonary function improvement in these patients remain inconsistent. Therefore, we aimed to evaluate the changes in pulmonary function test (PFT) parameters in patients with severe AIS after posterior spinal fusion.</p><p><strong>Methods: </strong>This study involved 18 severe AIS patients with major main thoracic curves (<i>major Cobb angle ≥90°</i>), who underwent posterior spinal fusion between 2019 and 2023, with a minimum 24-month follow-up. Primary PFT parameters measured preoperatively and at the most recent observation postoperatively were forced vital capacity (FVC), forced expiratory volume in one second (FEV<sub>1</sub>), and total lung capacity (TLC). Moderate to severe pulmonary impairment (<i>MSPI</i>) is defined as a predicted FVC/FEV<sub>1</sub> of ≤65%. Patients were classified into having <i>normal pulmonary function/mild pulmonary impairment</i> (<i>normal/mild PI</i>) and <i>MSPI</i>. Postoperatively, patients were further categorized into having <i>improved pulmonary function</i> or <i>stable pulmonary function</i> based on the transition of their pulmonary function classification.</p><p><strong>Results: </strong>The mean final follow-up duration was 37.9 ± 15.1 months. The major Cobb angle improved from 101.5° (93.0°-115.3°) to 45.0° (35.0°-58.0°) postoperatively (<i>p</i> < 0.001). There were increments of 14.7 ± 8.3% in predicted FVC and 15.2 ± 9.6% in predicted FEV<sub>1</sub> postoperatively. The predicted FVC and FEV<sub>1</sub> increased from 53.6 ± 11.9% and 50.1 ± 13.4% (preoperative) to 68.3 ± 7.9% and 65.3 ± 10.5% (postoperative), respectively (<i>p</i> < 0.001). Seven patients (50.0%) (<i>based on FVC classification</i>) and 6 patients (40.0%) (<i>based on FEV</i> <sub><i>1</i></sub> <i>classification</i>) with <i>MSPI</i> showed postoperative improvement in pulmonary function by transitioning to <i>normal/mild PI</i>. The remaining patients exhibited stable pulmonary function, and none experienced deterioration.</p><p><strong>Conclusions: </strong>Patients with severe AIS demonstrated significant improvements in pulmonary function parameters after posterior spinal fusion. None experienced postoperative deterioration, whereas approximately 40.0% to 50.0% of those with <i>MSPI</i> improved to the <i>normal/mild PI</i> category.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448169/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of Posterior Spinal Fusion on Pulmonary Function in Patients With Severe Adolescent Idiopathic Scoliosis (Major Cobb Angle ≥90°).\",\"authors\":\"Sin Ying Lee, Zhi Sean Teng, Chee Kuan Wong, Chee Kidd Chiu, Chris Yin Wei Chan, Mun Keong Kwan\",\"doi\":\"10.2106/JBJS.OA.25.00169\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Curve severity is a recognized factor associated with impaired pulmonary function in patients with severe adolescent idiopathic scoliosis (AIS). Despite significant curve correction achieved after posterior spinal fusion, reports on the extent of potential pulmonary function improvement in these patients remain inconsistent. Therefore, we aimed to evaluate the changes in pulmonary function test (PFT) parameters in patients with severe AIS after posterior spinal fusion.</p><p><strong>Methods: </strong>This study involved 18 severe AIS patients with major main thoracic curves (<i>major Cobb angle ≥90°</i>), who underwent posterior spinal fusion between 2019 and 2023, with a minimum 24-month follow-up. Primary PFT parameters measured preoperatively and at the most recent observation postoperatively were forced vital capacity (FVC), forced expiratory volume in one second (FEV<sub>1</sub>), and total lung capacity (TLC). Moderate to severe pulmonary impairment (<i>MSPI</i>) is defined as a predicted FVC/FEV<sub>1</sub> of ≤65%. Patients were classified into having <i>normal pulmonary function/mild pulmonary impairment</i> (<i>normal/mild PI</i>) and <i>MSPI</i>. Postoperatively, patients were further categorized into having <i>improved pulmonary function</i> or <i>stable pulmonary function</i> based on the transition of their pulmonary function classification.</p><p><strong>Results: </strong>The mean final follow-up duration was 37.9 ± 15.1 months. The major Cobb angle improved from 101.5° (93.0°-115.3°) to 45.0° (35.0°-58.0°) postoperatively (<i>p</i> < 0.001). There were increments of 14.7 ± 8.3% in predicted FVC and 15.2 ± 9.6% in predicted FEV<sub>1</sub> postoperatively. The predicted FVC and FEV<sub>1</sub> increased from 53.6 ± 11.9% and 50.1 ± 13.4% (preoperative) to 68.3 ± 7.9% and 65.3 ± 10.5% (postoperative), respectively (<i>p</i> < 0.001). Seven patients (50.0%) (<i>based on FVC classification</i>) and 6 patients (40.0%) (<i>based on FEV</i> <sub><i>1</i></sub> <i>classification</i>) with <i>MSPI</i> showed postoperative improvement in pulmonary function by transitioning to <i>normal/mild PI</i>. The remaining patients exhibited stable pulmonary function, and none experienced deterioration.</p><p><strong>Conclusions: </strong>Patients with severe AIS demonstrated significant improvements in pulmonary function parameters after posterior spinal fusion. None experienced postoperative deterioration, whereas approximately 40.0% to 50.0% of those with <i>MSPI</i> improved to the <i>normal/mild PI</i> category.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>\",\"PeriodicalId\":36492,\"journal\":{\"name\":\"JBJS Open Access\",\"volume\":\"10 3\",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448169/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JBJS Open Access\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2106/JBJS.OA.25.00169\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Open Access","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.OA.25.00169","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Impact of Posterior Spinal Fusion on Pulmonary Function in Patients With Severe Adolescent Idiopathic Scoliosis (Major Cobb Angle ≥90°).
Background: Curve severity is a recognized factor associated with impaired pulmonary function in patients with severe adolescent idiopathic scoliosis (AIS). Despite significant curve correction achieved after posterior spinal fusion, reports on the extent of potential pulmonary function improvement in these patients remain inconsistent. Therefore, we aimed to evaluate the changes in pulmonary function test (PFT) parameters in patients with severe AIS after posterior spinal fusion.
Methods: This study involved 18 severe AIS patients with major main thoracic curves (major Cobb angle ≥90°), who underwent posterior spinal fusion between 2019 and 2023, with a minimum 24-month follow-up. Primary PFT parameters measured preoperatively and at the most recent observation postoperatively were forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and total lung capacity (TLC). Moderate to severe pulmonary impairment (MSPI) is defined as a predicted FVC/FEV1 of ≤65%. Patients were classified into having normal pulmonary function/mild pulmonary impairment (normal/mild PI) and MSPI. Postoperatively, patients were further categorized into having improved pulmonary function or stable pulmonary function based on the transition of their pulmonary function classification.
Results: The mean final follow-up duration was 37.9 ± 15.1 months. The major Cobb angle improved from 101.5° (93.0°-115.3°) to 45.0° (35.0°-58.0°) postoperatively (p < 0.001). There were increments of 14.7 ± 8.3% in predicted FVC and 15.2 ± 9.6% in predicted FEV1 postoperatively. The predicted FVC and FEV1 increased from 53.6 ± 11.9% and 50.1 ± 13.4% (preoperative) to 68.3 ± 7.9% and 65.3 ± 10.5% (postoperative), respectively (p < 0.001). Seven patients (50.0%) (based on FVC classification) and 6 patients (40.0%) (based on FEV1classification) with MSPI showed postoperative improvement in pulmonary function by transitioning to normal/mild PI. The remaining patients exhibited stable pulmonary function, and none experienced deterioration.
Conclusions: Patients with severe AIS demonstrated significant improvements in pulmonary function parameters after posterior spinal fusion. None experienced postoperative deterioration, whereas approximately 40.0% to 50.0% of those with MSPI improved to the normal/mild PI category.
Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.
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