Charles E. Johnston, MD Anna McClung BSN, RN Scott Paradise

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Presentation transcript:

Charles E. Johnston, MD Anna McClung BSN, RN Scott Paradise Pulmonary Function Outcomes in Early-Onset Scoliosis (EOS) – Operative versus Non-operative Treatment Charles E. Johnston, MD Anna McClung BSN, RN Scott Paradise

Disclosures Anna McClung BSN, RN No Disclosures Charles E. Johnston, MD a,e Medtronic; e, Elsevier Scott Paradise No Disclosures Grants/Research Support Consultant Stock/Shareholder Speakers’ Bureau Other Financial Support

Background Recognized relationship between spine/chest deformity and pulmonary impairment in EOS However, little in the literature regarding correlation between radiographic measures and pulmonary outcomes We demonstrated correlation between thoracic height and width and CT lung volumes, however calculations based on x-ray parameters were too variable to replace the need for CT (IMAST, ICEOS-2010) Purpose of this study is to examine plane film parameters to PFT outcomes

Objective Compare pulmonary function tests (PFT) from EOS patients treated operatively those treated non-operatively, and correlate with anatomic indicators on x-ray Hypothesis: patients with less deformity and larger thorax have improved PFT values

Methods IRB prospective single institution study All EOS patients with at least 2 serial PFTs from 2004 to present Neuromuscular patients excluded Radiographic parameters documenting thoracic deformity correlated to FVC and FEV1 absolute volumes (AV) and percentage predicted (%)

Clinical Results Non-operative (observation, cast, brace) = 25 with 65 PFTs Operative (growing construct) = 19 with 78 PFTs 9 patients with both preoperative and postoperative PFTS Age at PFT (7.8±1.1yrs vs. 7.5±1.5yrs, p=0.34) Non-op Brace Pt Preop G.R. Pt

Radiographic Results Non-Operative Operative P-value Major Cobb° 41.1±20.2 54.9±15.9 .008 Kyphosis° 37.8±14.6 53.8±19.4 .003 Thoracic Height cm 18.7±2.2 17.3±3.2 .064 MC End Vertebra 10.9±3.5 10.8±2.0 .927 70° 102° 47° Non-op Brace Pt Preop G.R. Pt

PFT Absolute Volumes p=0.0004 p=0.001

PFT % Predicted % Predicted p=0.005 p=0.02

Non-Operative Correlations More distal end vertebra (p=.01, R=0.47) and gains in T6 width (p<.009, R=0.56) predicted better FEV1/FVC AV Gains in thoracic height (p<.0002, R=69) predicted better AV and % FEV1/FVC Increase in Cobb angle (p<.02, R>50) predicted no gain in AV and % FEV1/FVC No effect: Age, kyphosis and T6 depth

Operative Correlations Gain in thoracic height (p<.003, R=.68) predicted improved AV FEV1/FVC Gain in T6 width (p<.02, R=43) predicted improved AV and % FEV1/FVC No effect: Age, end vertebra, Cobb, kyphosis and T6 depth

Preoperative vs. Postoperative Correlations Increase in thoracic height and width at postop corresponded to improved AV FEV1/FVC (p<.01, R>.77) Loss of correction of major curve related to decrease in % predicted FEV1/FVC (p=0.009, R>.65)

Conclusions Major curve magnitude Thoracic height Thoracic width Patients with less severe EOS have better pulmonary function compared to their peers who require surgical intervention Significant relationships found between PFT outcomes in both groups and: Major curve magnitude Thoracic height Thoracic width The above verifies the value of these parameters and confirms the study hypothesis

Significance In patients with growing constructs increasing chest diameters leads to improved absolute values on PFTs This is the first study to document that anatomic improvement leads to enhanced physiologic function