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Incidence of Pleural Fluid and Its Associated Risk Factors After Posterior Spinal Fusion in Patients With Adolescent Idiopathic Scoliosis

Hayashi, Kazunori MD; Terai, Hidetomi MD, PhD; Toyoda, Hiromitsu MD, PhD; Suzuki, Akinobu MD, PhD; Hoshino, Masatoshi MD, PhD; Tamai, Koji MD; Ohyama, Shoichiro MD; Nakamura, Hiroaki MD, PhD

doi: 10.1097/BRS.0000000000001861

Study Design. Retrospective review of prospectively-collected data.

Objective. To determine the incidence pleural fluid (PF) and its associated risk factors after posterior corrective spinal fusion (PCSF) in patients with adolescent idiopathic scoliosis (AIS).

Summary of Background Data. Subclinical PF is often observed after PCSF in AIS patients. However, a few reports have been published regarding the incidence, characteristics, and associated risk factors.

Methods. A total of 76 AIS patients who underwent PCSF and followed up for a minimum of 1 year were enrolled in this study. The volume of PF in each thorax was detected with thoracolumbar CT images taken preoperatively, at 1 week and 3 months follow up. Patient demographics, comorbidities, operation factors, serum albumin levels, scoliotic parameters, occurrence of malposition of pedicle screw insertion, and complications were collected and analyzed with univariate and multivariate analyses.

Results. There were 71 female and five male patients (mean age, 16.2 yrs). All cases had a right convex curve in thoracic spine. Other causes of PF were not observed. PF was detected in 54 cases (71%) at 1 week postsurgery. It accumulated bilaterally in 36 cases, only in the right thorax in 13 cases, and only in the left thorax in five cases. There was significant difference between the depth of PF in the right and left sides (P < 0.001). The independent risk factor for PF was increased number of fused levels (OR: 3.88, 95% CI: 1.31–11.47). The mean coronal curve correction rate and other scoliotic factors were not significantly correlated.

Conclusion. PF was observed in 71% of the patients who underwent PCSF for AIS. The right thorax was more commonly involved than the left. A higher number of fused levels (11 or more) was an independent risk factor of PF.

Level of Evidence: 3

Department of Orthopedic Surgery, Osaka City University Graduate school of Medicine, Osaka, Japan.

Address correspondence and reprint requests to Hidetomi Terai, MD, PhD, Department of Orthopedic Surgery, Osaka City Graduate school of Medicine, 1-4-3 Asahimachi Abeno-Ku, 545–8585, Osaka, Japan; E-mail:

Received 28 April, 2016

Revised 7 July, 2016

Accepted 22 July, 2016

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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