Summary: Pediatric patients undergoing a posterior vertebral column resection for severe deformity demonstrated improvement in postoperative pulmonary function testing, while adult VCR patients did not demonstrate any significant change in PFTs. Pediatric PFT improvement was correlated with both deformity diagnosis as well as previous spinal surgery.
Introduction: Posterior vertebral column resection (PVCR) enables surgical correction of severe spinal deformity via a posterior‐only approach, eliminating the need for a combined anterior/posterior (A/P) approach, which is known to have deleterious effects on pulmonary function. To our knowledge, no reports of pulmonary function test (PFT) changes after PVCR surgery are available.
Methods: PFTs in 20 pediatric/18 adult pts who underwent a PVCR at 1 institution were reviewed retrospectively with min 2yr followup (f/u). Mean age at surgery was 29.2yrs (range 8‐72), and mean f/u was 2+6yrs (range 2‐6). There were 24 females/14 males. Preop diagnoses were severe scoliosis (n=3), kyphoscoliosis (n=19), global kyphosis (n=9) and angular kyphosis (n=7). Thoracic PVCRs (T5‐11) were performed in 25pts and thoracoabdominal PVCRs (T12‐L5) in 13pts. Immediate preop and postop PFTs were obtained at regular f/u intervals. Comparison was made to PFTs from control groups of pediatric and adult pts who underwent combined A/P fusions for similar deformities.
Results: In pediatric pts, PVCR resulted in an increase of FVC from 2.12 to 2.42L (p=0.008) and FEV1 from 1.72 to 1.96L (p=0.01). However, there were no significant differences in % predicted values for FVC (71% to 69%, p=0.68) or FEV1 (66% to 64%, p=0.81). In adult pts, there were no significant changes in FVC (2.47 to 2.45L, p=0.87) or FEV1 (1.99 to 1.94L, p=0.61) after PVCR; also, changes in adult % predicted values for FVC (75% to 74%, p=0.96) and FEV1 (73% to 72%, p=0.86) were not significant. Comparison of changes in PFTs between the PVCR pts and control groups of pediatric and adult pts who underwent combined A/P approach did not reveal significant differences. In the pediatric PVCR pts, improved PFTs correlated with diagnosis (angular kyphosis showed most improvement, p=0.001 for FVC, p=0.0001 for FEV1), as well as with no history of previous surgery (p=0.002 for FEV1).
Conclusion: In pediatric pts, PVCR resulted in a small but significant increase in postop FVC and FEV1. In adult pts, no significant change in PFTs was found. No significant differences in PFTs were seen when comparing PVCR pts to combined A/P pts. Improvement in pediatric PFTs correlated with diagnosis as well as absence of prior spine surgery.