Statistical changes of lung morphology in patients with adolescent idiopathic scoliosis after spinal fusion surgery-a prospective nonrandomized study based on low-dose biplanar X-ray imaging

Min Deng; Qianyun Chen; Qiao Deng; Lin Shi; Cherry Cheuk Nam Cheng; Kwong Hang Yeung; Rongli Zhang; Wai Ping Fiona Yu; Tsz Ping Lam; Jack Chun Yiu Cheng; Winnie Chiu Wing Chu

doi:10.21037/qims-21-1147

Statistical changes of lung morphology in patients with adolescent idiopathic scoliosis after spinal fusion surgery-a prospective nonrandomized study based on low-dose biplanar X-ray imaging

Quant Imaging Med Surg. 2022 Jun;12(6):3325-3339. doi: 10.21037/qims-21-1147.

Affiliations

¹ Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
² SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.

Abstract

Background: Adolescent idiopathic scoliosis (AIS) patients suffer from restrictive impairment of pulmonary function (PF) as a consequence of spinal and ribcage deformity. Statistic modelling of scoliotic geometry has been well-established based on low-dose biplanar X-ray device (EOS) imaging. However, the postoperative lung morphology change derived from EOS has not yet been studied adequately till now.

Methods: Twenty-five female AIS patients with severe right-sided major thoracic curve (aged 13-31 years; Cobb angle 45°-92°) underwent posterior spinal fusion (PSF) were prospectively recruited for standing EOS imaging at preoperative, postoperative, and 1-year follow-up (1Y-FU) stages. EOS-based lung morphology at frontal and lateral view was measured respectively to assess serial statistical changes in area and height.

Results: At frontal view, left lung area significantly increased postoperatively (104.7 vs. 125.1 cm²; P<0.001) but without continuous increase at 1Y-FU (125.1 vs. 124.5 cm²; P=0.084), whereas right lung area showed a slight but insignificant interval increase (median: 143.8, 146.5, 148.4 cm² at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05). At lateral view, the increase in left lung area was slight without statistically difference (median: 175.8, 178.4, 182.5 cm² at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05), while right lung area did not significantly change postoperatively (median: 209.9, 206.7, 212.4 cm² at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05). At both frontal and lateral view, left lung height significantly improved at both postoperative and 1Y-FU stage (all P<0.05), while preoperative right lung height was not significantly different from postoperative and 1Y-FU value (all P>0.05).

Conclusions: EOS imaging demonstrates that left lung area in severe AIS may improve after PSF surgery. EOS may provide useful information about lung morphology change after PSF in severe AIS.

Keywords: Biplanar radiography; idiopathic scoliosis; lung; radiation.