Abstract
Introduction
Adolescent idiopathic scoliosis accounts for 80–85% of all lateral curvatures, and negatively affects pulmonary functions. The concave rib osteotomy technique is designed to provide additional mobility and flexibility of the spine, especially for rigid curves during correction. Only a few studies have investigated the effect of concave rib osteotomy on pulmonary functions.
Methods
We undertook a prospective study of 127 patients who underwent posterior spinal fusion for correction of adolescent idiopathic scoliosis. Patients were divided according to their Cobb angle into two groups: group 1 (n=78) with a Cobb angle greater than 70° who underwent an additional concave rib osteotomy (CRO); and group 2 (n=49) with a Cobb angle less than 70° who did not (NCRO). All patients received a programme of pulmonary rehabilitation immediately after the operation for 1 year. Vital capacity (VC) and peak expiratory flow rate (PEF) were measured preoperatively, at 3 months and 12 months postoperatively, and at 5 years postoperatively.
Results
In group 1 (CRO), the mean Cobb angle was 82·2° (□}22·78°) preoperatively and 10·9°(□}8·33°) at 1 year follow-up (87% correction). In group 2 (NCRO), the mean Cobb angle was 62·77° (□}18·43°) preoperatively and 6·9°(□}7·69°) at 1 year follow-up (89% correction). Preoperatively there was no significant difference in pulmonary functions between the two groups, with mean VC of 85·2% (□}33·7) in the CRO group and 90·1% (□}38·9) in the NCRO group (p=0·22) and mean PEF of 59·8% (□}27·4) and 52·2% (□}30·3), respectively (p=0·32). Postoperatively, mean VC was 40·4% (□}23·74) in the CRO group (52% reduction) and 48·05% (□}29·13) in the NCRO group (47% reduction) (p=0·05). Mean PEF was 27·38% (□}17·35) in the CRO group (54% reduction) and 34·1% (□}21·8) in the NRCO group (45% reduction) (p=0·02). 12 months postoperatively, mean VC was 102·4% (□}31·5; 150% improvement) and 103·5% (□}40; 115% improvement), respectively (p=0·43). Mean PEF was 76·2% (□}24·5; 170% improvement) and 73·5% (□}35·6; 117% improvement), respectively (p=0·32). 5 years postoperatively, mean VC was 111·84% (□}33·95; 0·09% improvement) and 114% (□}29·6; 0·10% improvement), respectively (p=0·086). Mean PEF was 82·56% (□}36·8; 0·08% improvement) and 82·3% (□}27·1; 0·11% improvement), respectively (p=0·26).
Conclusions
Concave rib osteotomy technique has a definite immediate effect on pulmonary functions postoperatively; however, this difference resolves with application of pulmonary rehabilitation programme in both groups and outcome is similar 1 year postoperatively. 5 years later we recorded no significant differences between groups.
