Does growth sparing techniques improve lung function tests in idiopathic Early Onset Scoliosis - A Retrospective Single Centre Analysis

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20-Dec-6121.pdf
Published Dec 24, 2024
DOI: https://doi.org/10.18103/mra.v12i12.6121

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Main Article Content

Sai Gautham Balasubramanian, MS(Ortho), DNB(Ortho), MRCSEd
Clinical Fellow – Spinal Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, L14 5AB, United Kingdom
Boresh Dhamija, MS, MCH(NS), FRCSEd (NS)
Clinical Fellow – Spinal Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, L14 5AB, United Kingdom
Colin Bruce, FRCS (T&O)
Consultant Spine Surgeon, Alder Hey Children’s NHS Foundation Trust, Liverpool, L14 5AB, United Kingdom
Neil Davidson, FRCS (T&O)
Consultant Paediatric and Adult Spine Surgeon, Alder Hey Children’s NHS Foundation Trust, Liverpool, L14 5AB, United Kingdom
Jayesh Trivedi, FRCS (T&O)
Consultant Paediatric and Adult Spine Surgeon, Alder Hey Children’s NHS Foundation Trust, Liverpool, L14 5AB, United Kingdom
Sudarshan Munigangaiah, MRCSI, MSc (T&Orth)
Consultant Paediatric and Adult Spine Surgeon, Alder Hey Children’s NHS Foundation Trust, Liverpool, L14 5AB, United Kingdom

Abstract

Introduction:  Growth-sparing surgical strategies are routinely employed in Early Onset Scoliosis to allow for thoracic cavity growth and lung development along with spinal growth. Pulmonary function tests (PFT) are measured pre- and post-operatively to assess improvement of respiratory functions. The general consensus is that growing rods are associated with an improvement in pulmonary function compared to early fusion. We aimed to analyse and compare the pre- and post-op PFTs to assess any statistically significant improvements in the lung functions.


Methods: We conducted a retrospective study of all surgically managed patients with idiopathic Early Onset Scoliosis with minimum 2 years follow up. Radiological parameters and Pulmonary function tests were observed and compared. The FEV1 and FVC were measured, and the age-predicted values were calculated along with z score change of FEV1 and FVC pre- and post-operatively. The correlation between thoracic height gain and change in PFTs was also calculated.


Results:  Overall, 28 patients had underwent growing rods insertion for EOS in 2016-2018 at Alder Hey Children’s Hospital, Liverpool, UK. 17 idiopathic EOS patients were included in the study, out of which 8 were included. The average T1-T12 height gain was 2.5 cm. Both the mean FEV1 and FVC increased with age(p<0.0001) due to the lung growth. However, the mean age predicted percentage values were decreased for both FEV1(p<0.05) and FVC (p<0.01). The z scores were also reduced/negative for both values (p<0.05). There were moderate negative correlations between FEV1 and FVC z score change with cobbs angle change indicating worsening of lung function tests at a short term follow up.


Conclusion:  This study suggests improvement in FEV1 and FVC with thoracic height gain. There was a negative impact on pulmonary function tests with greater change in cobb angle over a short period of time (2 years) or greater the acute distraction, as indicated by negative correlations between % predicted and z-score values of FEV1, FVC or FEV1/FVC ratios. Longer-term studies are essential to demonstrate the efficacy of treatment related to pulmonary functions in idiopathic Early Onset Scoliosis.

Article Details

How to Cite
BALASUBRAMANIAN, Sai Gautham et al. Does growth sparing techniques improve lung function tests in idiopathic Early Onset Scoliosis - A Retrospective Single Centre Analysis. Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/6121>. Date accessed: 06 jan. 2025. doi: https://doi.org/10.18103/mra.v12i12.6121.
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Issue
Vol 12 No 12 (2024): Vol.12 Issue 12 December 2024
Section
Research Articles

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References

1. Redding GJ, Waugh M, Patel S, et al. Persistence and progression of airway obstruction in children with early onset scoliosis. J Pediatr Orthop. 2020;40(3):190-195. doi:10.1097/BPO.0000000000001262.
2. Motoyama EK, Yang CI, Deeney VF. Thoracic malformation with early-onset scoliosis: effect of serial VEPTR expansion thoracoplasty on lung growth and function in children. Paediatr Respir Rev. 2009;10(1):12-17.
3. Thurlbeck WM. Lung growth and alveolar multiplication. Pathobiol Annu. 1975;5:1-34. PMID: 1105318.
4. Campbell RM Jr, Smith MD. Thoracic insufficiency syndrome and exotic scoliosis. J Bone Joint Surg Am. 2007;89(suppl 1):108-122. doi:10.2106/JBJS.F.00270.
5. Wang J, Zhang J, Xu J, et al. Effects of spinal deformities on lung development in children: a review. J Orthop Surg Res. 2023;18(1):246. doi:10.1186/s13018-023-03665-0.
6. Redding GJ, Mayer OH. Structure-respiratory function relationships before and after surgical treatment of early-onset scoliosis. Clin Orthop Relat Res. 2011;469(5):1330-1334. doi:10.1007/s11999-010-1621-0.
7. Wang J, Zhao Y, Li S, et al. Long-term radiographic and pulmonary function outcomes after dual growing-rod treatment for severe early-onset scoliosis. Bone Joint Surg Am. 2023;105(10):915-923. doi:10.2106/JBJS.22.01088.
8. Johnston CE, Tran DP, McClung A. Functional and radiographic outcomes following growth-sparing management of early-onset scoliosis. J Bone Joint Surg Am. 2017;99(12):1036-1042. doi:10.2106/JBJS.16.00796.
9. Karol LA. Early definitive spinal fusion in young children: what we have learned. Clin Orthop Relat Res. 2011;469(5):1323-1329.
10. Flynn JM, Tomlinson LA, Pawelek J, Thompson GH, McCarthy R, Akbarnia BA; Growing Spine Study Group. Growing-rod graduates: lessons learned from ninety-nine patients who completed lengthening. J Bone Joint Surg Am. 2013;95(19):1745-1750. doi:10.2106/JBJS.L.01386. PMID: 24088966.
11. Yoon WW, Sedra F, Shah S, et al. Improvement of pulmonary function in children with early-onset scoliosis using magnetic growth rods. Spine. 2014;39(15):1196-1202. doi:10.1097/BRS.0000000000000383.
12. Farber S, Gohil K, Szerlip R, et al. Impact of scoliosis surgery on pulmonary function in patients with muscular dystrophies and spinal muscular atrophy. Pediatr Pulmonol. 2020;55(1):1-6. doi:10.1002/ppul.24664.
13. Swarup I, McCulley D, De Silva M, et al. Pediatric Spine Study Group: Impact of growth friendly interventions on spine and pulmonary outcomes of patients with spinal muscular atrophy. Eur Spine J. 2021;30(4):768-774. doi:10.1007/s00586-020-06564-8.
14. Lenhart MK, Kruse A, Redding GJ. Radiographic and respiratory effects of growing rods in children with spinal muscular atrophy. J Pediatr Orthop. 2017;37(8):e500-e504. doi:10.1097/BPO.0000000000000867.
15. Chong HS, Moon ES, Park JO, et al. Value of preoperative pulmonary function tests in flaccid neuromuscular scoliosis surgery. Spine. 2011;36(24):E1391-E1394.
16. Jiang Y, Zhao Y, Wang Y, et al. Lung function after growing rod surgery for progressive early-onset scoliosis: a preliminary study. Chin Med J. 2011;124(23):3858-3863. doi:10.3760/cma.j.issn.0366-6999.2011.23.005.
17. Chang WC, Hsu KH, Feng CK. Pulmonary function and health-related quality of life in patients with early onset scoliosis after repeated traditional growing rod procedures. J Child Orthop. 2021;15(5):451-457. doi:10.1302/1863-2548.15.210021.
18. Koopman M, Zanen P, Kruitwagen CLJJ, et al. Reference values for paediatric pulmonary function testing: The Utrecht dataset. Respir Med. 2011;105(1):15-23. doi:10.1016/j.rmed.2010.07.020.
19. Quanjer PH, Stanojevic S, Cole TJ, et al; ERS Global Lung Function Initiative. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40(6):1324-1343. doi:10.1183/09031936.00080312. PMID: 22743675.
20. Cahill PJ, Flynn JM, Sponseller PD, et al. Autofusion in the immature spine treated with growing rods. Spine (Phila Pa 1976). 2010;35(22):E1199-E1203. doi:10.1097/BRS.0b013e3181e21b50.
21. Johnston CE, Tran DP, McClung A. The 18-cm thoracic-height threshold and pulmonary function in non-neuromuscular early-onset scoliosis. JB JS Open Access. 2021;6(4):e21.00093. doi:10.2106/JBJS.OA.21.00093.
22. Ruiz-Covarrubias R, Barrios-Rodríguez M, Pérez-López S, et al. Early-onset scoliosis: a narrative review. EFORT Open Rev. 2023;7(9):599-610. doi:10.1530/EOR-22-0040.
23. Romberg J, Kamper L, Daffner S, et al. Thoracic mobility and its relation to pulmonary function and rib-cage deformity in patients with early onset idiopathic scoliosis: a long-term follow-up. Spine Deformity. 2019;7(1):78-84. doi:10.1007/s43390-019-00018-y.
24. Glotzbecker M, Yazici M, Skaggs DL, et al. Is there a relationship between thoracic dimensions and pulmonary function in early-onset scoliosis? Spine. 2014;39(19):1590-1595. doi:10.1097/BRS.0000000000000449.
25. A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: An evaluation of patient outcomes after early spinal fusion. Spine. 2008;33(11):1242-1249. doi:10.1097/BRS.0b013e31817a84fa.