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Pulmonary Function Improvement After Vertebral Column Resection for Severe Spinal Deformity

Bumpass, David B. MD*; Lenke, Lawrence G. MD*; Bridwell, Keith H. MD*; Stallbaumer, Jeremy J. MD*; Kim, Yongjung J. MD; Wallendorf, Michael J. PhD; Min, Woo-Kie MD, PhD§; Sides, Brenda A. MA*

doi: 10.1097/BRS.0000000000000192
Deformity

Study Design. Retrospective review of prospectively accrued cohorts.

Objective. We hypothesized that posterior-only vertebral column resection (PVCR) would result in improved postoperative pulmonary function, avoiding pulmonary insults from combined anterior/posterior approaches.

Summary of Background Data. Pulmonary function after PVCR for severe spinal deformity has not been previously studied. Previous studies have demonstrated impaired pulmonary performance after combined anterior/posterior fusions.

Methods. Serial pulmonary function testing (PFTs) in 49 patients (27 pediatric, 22 adult) who underwent PVCR at a single institution was reviewed. Mean age at surgery was 28.7 years (range, 8–74 yr), and mean follow-up was 32 months (range, 23–64 mo). Thoracic PVCRs (T5–T11) were performed in 31 patients and thoracolumbar PVCRs (T12–L5) in 18 patients.

Results. Pediatric patients who underwent PVCR experienced both increased mean forced vital capacity (FVC) (2.10–2.43 L, P = 0.0005) and forced expiratory volume in 1 second (FEV1) (1.71–1.98 L, P = 0.001). There were no significant differences in percent-predicted values for FVC (69%–66%, P = 0.51) or FEV1 (64%–63%, P = 0.77). In adult patients, there were no significant changes in FVC (2.73–2.61 L, P = 0.35) or FEV1 (2.22–2.07 L, P = 0.51) after PVCR; also, changes in adult percent-predicted values for FVC (79%–76%, P = 0.47) and FEV1 (78%–74%, P = 0.40) were not significant. In pediatric patients who underwent PVCR, improved PFTs were correlated with younger age (P = 0.02), diagnosis of angular kyphosis (P ≤ 0.0001), no previous spine surgery (P = 0.04), and preoperative halo-gravity traction (P = 0.02). Comparison of PFT changes between patients who underwent PVCR and a control group who underwent combined anterior/posterior approaches revealed no significant differences.

Conclusion. In pediatric patients, PVCR resulted in small but significant improvements in postoperative FVC and FEV1. In adult patients, no significant increases in PFTs were found. Patients who have the greatest potential for lung and thoracic cage growth after spinal correction are most likely to have improved pulmonary function after PVCR.

Level of Evidence: 3

Posterior vertebral column resection (PVCR) for severe deformity resulted in small but significant increases in pulmonary function for pediatric patients. However, adult patients did not experience significant pulmonary improvements. Remaining lung growth at time of surgery seems to be important in predicting pulmonary improvement after PVCR.

*Department of Orthopaedic Surgery, Washington University, Saint Louis, MO

Department of Orthopaedic Surgery, Columbia University, New York, NY

Division of Biostatistics, Washington University, Saint Louis, MO; and

§Department of Orthopaedic Surgery, Kyungpook National University, Daegu, South Korea.

Address correspondence and reprint requests to Lawrence G. Lenke, MD, Washington University School of Medicine, Department of Orthopaedic Surgery, 660 S Euclid Ave, Campus Box 8233, Saint Louis, MO 63110; E-mail: lenkel@wudosis.wustl.edu

Acknowledgment date: September 30, 2013. First revision date: December 11, 2013. Acceptance date: December 16, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants/grants pending, consultancy, payment for lectures, royalties, travel/accommodations/meeting expenses and fellowship grant.

© 2014 by Lippincott Williams & Wilkins