Background: The literature regarding pulmonary function in adult patients with spinal deformity is limited, and the effect of spinal deformity surgery on pulmonary function has not been clearly understood. We hypothesized that adult patients with spinal deformity who had preoperative pulmonary impairment (a percent-predicted value of <65% forced expiratory volume in one second [FEV1] as measured by pulmonary function test) or who were undergoing revision surgery may be at risk for exacerbated decline in pulmonary function.
Methods: Pulmonary function test results were prospectively collected for 164 adult patients with spinal deformity (mean age, 45.9 years) who underwent surgical treatment at a single institution and were followed for a minimum of two years (mean, 2.8 years). One hundred (61%) of the patients underwent primary surgery, and sixty-four (39%) of the patients had revision surgery. For the majority of patients (77%), a posterior-only surgical approach was used. Radiographs for 154 patients were analyzed for major thoracic and sagittal T5-T12 curve magnitude/correction.
Results: For all patients, we noted a significant change in major thoracic Cobb angle, from a mean of 47.4° to 24.9°(p < 0.001), and in sagittal Cobb angle, from a mean of 35.5° to 30.0°(p < 0.001), as well as a significant decline in absolute and percent-predicted pulmonary function values, with percent-predicted FEV1 and percent-predicted forced vital capacity (FVC) decreasing 5.3% (p < 0.001) and 5.7% (p < 0.001), respectively. A clinically significant decline (a decline of ≥10% in percent-predicted FEV1) was observed in 27% of the patients. The number of patients with pulmonary impairment increased nonsignificantly from seventeen (10%) preoperatively to twenty-three (14%) after surgery (p = 0.31). Patients with preoperative pulmonary impairment demonstrated a significant improvement in absolute and percent-predicted FEV1 after surgery compared with those without preoperative impairment (2.7% compared with −6.2%; p < 0.001). Patients who underwent revision surgery did not differ from primary surgery patients in terms of postoperative percent-predicted results. However, revision surgery more frequently resulted in a significant decline in pulmonary function (twenty-three patients [36%] compared with twenty-two [22%]; p = 0.05). There was no difference in pulmonary function when comparing surgical approaches (anterior/combined anterior-posterior or posterior-only) or when comparing results by upper-instrumented vertebra (UIV).
Conclusions: We found a significant decline in absolute and percent-predicted results of pulmonary function tests following surgical correction for spinal deformity in adults.
Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
1Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889. E-mail address for R.A. Lehman Jr.: firstname.lastname@example.org
2Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110