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Cardiopulmonary Exercise Testing in Patients with Idiopathic Scoliosis

Shen, Jianxiong MD; Lin, Youxi MD; Luo, Jinmei MD; Xiao, Yi MD

Journal of Bone & Joint Surgery - American Volume: 5 October 2016 - Volume 98 - Issue 19 - p 1614–1622
doi: 10.2106/JBJS.15.01403
Scientific Articles

Background: Scoliosis causes impairment of the respiratory and cardiovascular systems. Traditional pulmonary function tests only examine patients under static conditions. The aim of our study was to investigate the correlation between radiographic parameters and dynamic cardiopulmonary capacity in patients with idiopathic scoliosis.

Methods: Forty patients with idiopathic scoliosis were included in this prospective study from January 2014 to February 2016. The patients underwent full radiographic assessment of deformity, pulmonary function testing, and cardiopulmonary bicycle ergometer testing. The impact of the severity of thoracic curvature and kyphosis on pulmonary function and physical capacity was investigated.

Results: Thirty-three female patients with a mean age of 15.5 years (range, 11 to 35 years) and coronal thoracic curvature of 49.4° (range, 24° to 76°) and 7 male subjects with a mean age of 15.9 years (range, 13 to 18 years) and coronal thoracic curvature of 47.1°(range, 22° to 80°) were included. No correlation was found between coronal thoracic curvature and pulmonary function test results in the female patients. Female patients with a thoracic curve of ≥60° had lower blood oxygen saturation at maximal exercise in the cardiopulmonary exercise test (p = 0.032). Female patients with a thoracic curve of ≥50° had a higher respiratory rate (p = 0.041) and ventilation volume per minute (p = 0.046) and lower breathing reserve at maximal exercise (p = 0.038). Thoracic kyphosis in female patients was positively correlated with pulmonary function, as shown by the forced expiratory volume in 1 second (r = 0.456, p = 0.01), forced vital capacity (r = 0.366, p = 0.043), vital capacity (r = 0.525, p = 0.006), and total lung capacity (r = 0.388, p = 0.031), as well as with tidal volume (r = 0.401, p = 0.025) in cardiopulmonary exercise testing. Female patients who engaged in regular exercise had better peak oxygen intake normalized by body weight (p < 0.001), peak oxygen intake normalized by the predicted value (p = 0.003), maximum heart rate (p = 0.020), and heart rate reserve (p = 0.014).

Conclusions: Overall exercise tolerance was not correlated with the magnitude of the thoracic curve and kyphosis. Some parameters of ventilatory function and pulmonary gas exchange worsened as thoracic curvature increased or kyphosis decreased. Exercise capacity was better in patients who engaged in regular aerobic exercise, and physical activity is recommended for patients with idiopathic scoliosis.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Departments of Orthopedics (J.S. and Y.L.) and Respiratory Medicine (J.L. and Y.X.), Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People’s Republic of China

E-mail address for J. Shen: shenjianxiong@medmail.com.cn

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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