Severe restrictive lung disease and vertebral surgery in a pediatric population

Eur Spine J. 2009 Dec;18(12):1905-10. doi: 10.1007/s00586-009-1084-8. Epub 2009 Jul 10.

Abstract

The aim of this study is to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC) <40% and severe vertebral deformity. Few studies have examined surgical treatment in these patients, who are considered to be at a high risk because of their pulmonary disease, and in whom preoperative tracheostomy is sometimes recommended. Inclusion criteria include FVC <40%, age <19 years and diagnosis of scoliosis. The retrospective study of 24 patients with severe restrictive lung disease, who underwent spinal surgery. Variables studied were age and gender, pre- and postoperative spirometry (FVC, FEV1, FEV1/FVC), preoperative, postoperative and late use of non-invasive ventilation (BiPAP) or mechanical ventilation, associated multidisciplinary treatment, type and location of the curve, pre- and postoperative curve values, type of vertebral fusion, intra- and postoperative complications, duration of intensive care unit (ICU) stay and length of postoperative hospitalization. Mean age was 13 years (9-19) of which 13 were males and 11 females. Mean follow-up was 32 months (24-45). The etiology was neuromuscular in 17 patients and other etiologies in 7 patients. Mean preoperative FVC was 26% (13-39%). Eight patients had preoperative home BiPAP, 15 preoperative in-hospital BiPAP, and 2 preoperative mechanical ventilation. Nine patients had preoperative nutritional support. Preoperative curve value of the deformity was 88 degrees (40 degrees -129 degrees ). Nineteen patients with posterior fusion alone and 5 with anterior and posterior fusion were found. Mean duration of ICU stay was 5 days (1-21). Total postoperative hospital stay was 17 days (7-33). Ventilatory support in the immediate postoperative includes 16 patients requiring BiPAP and 2 volumetric ventilation. None of the patients required a tracheostomy. The intraoperative complications include one death due to acute heart failure; immediate postoperative, four respiratory failures (2 required ICU readmission) and one respiratory infection; and other minor complications occurred in six patients. Overall, 58% of patients had complications. Percentage of angle correction was 56%. After a follow-up of 30 months, FVC was 29% (13-50%). In conclusion, corrective scoliosis surgery in pediatric patients with severe restrictive lung disease is well tolerated, but the management of this population requires extensive experience with the vertebral surgery involved, and a multidisciplinary approach that includes pulmonologists, nutritionists and anesthesiologists. Currently, there is no indication for routine preoperative tracheostomy.

MeSH terms

  • Adolescent
  • Age Distribution
  • Age Factors
  • Child
  • Disability Evaluation
  • Female
  • Heart Failure / mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Lung Diseases / etiology
  • Lung Diseases / physiopathology*
  • Lung Diseases / surgery*
  • Male
  • Outcome Assessment, Health Care
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control
  • Preoperative Care
  • Radiography
  • Reconstructive Surgical Procedures / methods
  • Reconstructive Surgical Procedures / mortality
  • Reconstructive Surgical Procedures / statistics & numerical data*
  • Recovery of Function / physiology
  • Respiration, Artificial / statistics & numerical data
  • Respiratory Muscles / anatomy & histology
  • Respiratory Muscles / physiopathology
  • Retrospective Studies
  • Ribs / diagnostic imaging
  • Ribs / pathology
  • Ribs / surgery
  • Scoliosis / complications
  • Scoliosis / physiopathology*
  • Scoliosis / surgery*
  • Sex Distribution
  • Spinal Fusion / methods
  • Spinal Fusion / mortality
  • Spinal Fusion / statistics & numerical data*
  • Spirometry
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / pathology
  • Thoracic Vertebrae / surgery
  • Treatment Outcome
  • Young Adult