Abstract
BackgroundPrevious reports confirmed early spinal fusion may compromise pulmonary function and thoracic development in skeletal immature patients with scoliosis. However, the different effects in patients with various Risser signs remain unknown. This study aimed to compare the influence of early thoracic fusion on pulmonary function and thoracic growth in patients with idiopathic scoliosis (IS) with closed triangular cartilage (TRC) and different Risser signs.MethodsThirty-six patients with IS and a closed TRC were retrospectively selected and divided into the low Risser (LR, Risser sign ≤2, 22 patients) and high Risser (HR, 2<Risser sign≤4, 14 patients) groups. Patient age, Risser sign, main Cobb angle, thoracic kyphosis, and fusion levels were recorded. Perioperative and minimum of 2-year follow-up pulmonary function and thoracic diameters were compared between both groups.ResultsThere were no differences in patients’ general characteristics between two groups. The preoperative forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were 2.06±0.43 L and 2.50±0.49 L, respectively, in the LR group, and 2.31±0.49 L (p = 0.067) and 2.74±0.56 L (p = 0.122), respectively, in the HR group. While these values significantly increased postoperatively, to 2.62±0.46 L (p < 0.001) and 3.09±0.69 L (p < 0.001), in the LR group, they remained unchanged in the HR group [2.53±0.56 L (p = 0.093) and 2.70±0.98 L (p = 0.386), respectively]. The FEV1/FVC in both groups was >80% before and after surgery. The T1-T12 and anteroposterior thoracic diameter significantly increased after surgery in both groups, while the maximum inner chest diameter only increased in the LR group at the final follow-up. However, there were no significant differences in respiratory function and thoracic data between both groups.ConclusionFor patients with IS, early fusion did not deteriorate pulmonary function or thoracic development in TRC-closed patients whose Risser sign was ≤2 compared with those with a Risser sign >2.
Highlights
Previous reports confirmed early spinal fusion may compromise pulmonary function and thoracic development in skeletal immature patients with scoliosis
Previous studies found that early spinal fusion may halt progressive deformity in young children with scoliosis, but it does not facilitate lung growth and can result in thoracic insufficiency syndrome in certain children; these studies mainly focused on early onset scoliosis (EOS), congenital scoliosis (CS) [4,5,6,7,8], wherein pre-existing factors, including rib malformations, respiratory muscular disorders, or syndromerelated complications in CS and other forms of EOS may play a role in respiratory function
The Cobb angle and thoracic kyphosis decreased to 8.1±6.6° and 17.7± 9.7°, respectively, in the Low Risser (LR) group, and 9.5±6.6° and
Summary
Previous reports confirmed early spinal fusion may compromise pulmonary function and thoracic development in skeletal immature patients with scoliosis. This study aimed to compare the influence of early thoracic fusion on pulmonary function and thoracic growth in patients with idiopathic scoliosis (IS) with closed triangular cartilage (TRC) and different Risser signs. Scoliosis is defined as the lateral curvature of the spine ≥10° in the coronal plane It is a three-dimensional spinal deformity that usually presents as distortion of the body, thorax, and ribs, restricting pulmonary system development [1]. Previous studies found that early spinal fusion may halt progressive deformity in young children with scoliosis, but it does not facilitate lung growth and can result in thoracic insufficiency syndrome in certain children; these studies mainly focused on early onset scoliosis (EOS), congenital scoliosis (CS) [4,5,6,7,8], wherein pre-existing factors, including rib malformations, respiratory muscular disorders, or syndromerelated complications in CS and other forms of EOS may play a role in respiratory function. As remaining growth is a determining factor for the worsening of IS, evaluating the growth potential of young patients before therapeutic selection is vital as the higher is the risk of progression, the more severe will be the disease
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