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Pulmonary Function Recovery Demonstrated by Ventilation-Perfusion Scan After Posterior Vertebral Column Resection for Severe Adolescent Idiopathic Scoliosis: A Case Report

Fujii, Takeshi, MD*; Watanabe, Kota, MD, PhD; Toyama, Yoshiaki, MD, PhD*; Matsumoto, Morio, MD, PhD*

doi: 10.1097/BRS.0000000000000458
Case Report
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Study Design. Case report.

Objective. To describe a case in which a patient regained pulmonary function, assessed by ventilation-perfusion scans, after undergoing posterior vertebral column resection (VCR) to correct severe adolescent idiopathic scoliosis (AIS) with associated pulmonary dysfunction.

Summary of Background Data. Pulmonary improvement after corrective surgery for AIS has been reported. Ventilation-perfusion scans are useful for assessing pulmonary function. However, these scans have not been used to examine the recovery of pulmonary function after VCR for severe AIS with pulmonary dysfunction.

Methods. A patient was described in whom ventilation-perfusion scans were used to examine improvements in impaired air ventilation and blood perfusion after VCR surgery for severe AIS. The relevant literature was reviewed.

Results. An 18-year-old male came to Keio University Hospital with exertional dyspnea associated with severe AIS. Radiographs showed severe scoliosis of 91° at T6–T12, and hypokyphosis of 6° at T5–T12. Computed tomographic scans showed narrowing of the thoracic cage on the convex side of the main thoracic curve, with the vertebral bodies at the apex of the curve obstructing the right main bronchus. Pulmonary function tests revealed a percent vital capacity of 44% and percent forced expiratory volume in 1 second of 76%. A ventilation-perfusion scan showed decreased air ventilation and blood perfusion in the right lung. The patient underwent posterior correction surgery, which used segmental pedicle screws with a VCR at T9. The scoliosis was corrected to 28°, and the kyphosis to 14°. Postoperative computed tomographic scans showed expansion of the right main bronchus. A ventilation-perfusion scan conducted 1 year after surgery showed clear improvement in both ventilation and blood perfusion in the right lung. The patient's forced expiratory volume in 1 second had increased to 91%.

Conclusion. This is the first report in which ventilation-perfusion scans were used to examine improvements in impaired air ventilation and blood perfusion after VCR surgery in a patient with severe AIS.

Level of Evidence: N/A

An 18-year-old male with restrictive lung dysfunction associated with severe adolescent idiopathic scoliosis underwent posterior correction surgery with vertebral column resection at T9. Ventilation-perfusion scans showed right lung ventilation and perfusion improvements 1 year after surgery. Ventilation-perfusion scans are useful for assessing pulmonary function defects associated with severe late-onset spinal deformities.

Departments of *Orthopaedic Surgery and

Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan.

Address correspondence and reprint requests to Morio Matsumoto, MD, PhD, Department of Orthopaedic Surgery, Keio University, Shinanomachi 35, Shinjuku, Tokyo, Japan, 160-8582; E-mail: morio@a5.keio.jp

Acknowledgment date: March 20, 2014. Revision date: May 3, 2014. Acceptance date: May 28, 2014.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins