Abstract
Introduction: Endoscopic techniques are an established method for anterior correction and instrumentation of thoracic scoliosis. Deterioration in respiratory function for up to two years following a thoracotomy 1 has been cited as a disadvantage of anterior approaches and has led certain authors to recommend posterior approaches. 2 This prospective study establishes the pattern of change in respiratory function in patients during the first 12 months following endoscopic scoliosis surgery.
Methods: 67 patients have undergone endoscopic scoliosis correction performed by the senior author (GNA). The patients were intubated with a double lumen tube. The lung was deflated on the ipsilateral side to the spinal correction and instrumentation throughout the procedure. A chest drain was inserted per operatively and removed on day two post-operation. All the patients underwent respiratory function tests (RFTs) as part of the preoperative workup. These included absolute and predicted FVC, as well as absolute and predicted FEV1.Thirty patients underwent postoperative RFTs for the purpose of this study. 10 patients had RFTs at 12 months following surgery. A further 20 patients had repeat RFTs scheduled at 3 months, 6 months and 12 months post operatively.
Results: The RFTs of all 10 patients within the initial group had returned to their preoperative level at twelve months The RFTs of the further 20 patients showed a reduction in all parameters at the 3 month period post-operation but these had shown improvement at the 6 month period. The results are indicated for pre-op, 3months, 6 months and 12 months respectively. FVC 2.82, 2.51, 2.84 and 3.10 FVC% predicted 82.2%, 70.6%, 79.0% and 89.4%. FEV1 2.48, 2.23, 2.49 and 2.67 FEV% predicted 75.3%, 67.3%, 75.1% and 79.6
Discussion: The provisional results have shown that there is a reduction in the respiratory function in the immediate post-operative period following endoscopic scoliosis correction, but this does not lead to serious respiratory compromise. The respiratory function returns to the preoperative level at 12 months, showing there is no long-term deterioration of respiratory function following endoscopic correction and instrumentation.
The abstracts were prepared by I. B. McPhee. Correspondence should be addressed to the Spine Society of Australia Secretariat, The Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 5000, Australia.
References:
1 Vedantam R, Lenke LG, Bridwell KH, et al: A prospective evaluation of pulmonary function in patients with idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine2000; 25: 82–90. Google Scholar
2 Graham EJ, Lenke LG, Lowe TG, Betz RR, et al: Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusions in adolescent idiopathic scoliosis. Spine2000; 25: 2319–2325. Google Scholar
