Modi Hitesh N, Suh Seung-Woo, Hong Jae-Young, Park Young-Hwan, Yang Jae-Hyuk
Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Seoul, South Korea.
J Spinal Disord Tech. 2011 Jul;24(5):325-33. doi: 10.1097/BSD.0b013e3181f9f6fc.
A retrospective study.
To evaluate clinical and functional success by all pedicle screw construct in paralytic neuromuscular scoliosis (NMS) with poor pulmonary functions (PFT).
Duchene muscular dystrophy and spinal muscular atrophy are often associated with poor PFT and the development of scoliosis simultaneously. Poor PFT often make surgeons reluctant to operate.
Eighteen paralytic NMS patients who had preoperative forced vital capacity (FVC) < 30% were operated with all pedicle screw construct. Average preoperative, postoperative, and final follow-up Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis, PFT (FVC% and forced expiratory volume 1%), and preoperative and follow-up functional status were analyzed. Perioperative and postoperative complications were also noted.
The average follow-up was 31.6 ± 7.7 months. There was significant improvement in Cobb angle (61.7%) and pelvic obliquity (56.7%), postoperatively (P < 0.001). All corrections were maintained at final follow-up. FVC was decreased from 25.2 ± 4.7% preoperatively to 24.2 ± 5.0%, 6 weeks postoperatively (P = 0.067); and on follow-up it further decreased to 20.6 ± 3.9% (P < 0.0001) (1.8%/y). Forced Expiratory Volume 1 also decreased from 22.7 ± 4.5% preoperatively to 21.8 ± 4.2% postoperatively (P = 0.037) and was 19.8 ± 3.8% at final follow-up (P < 0.0001) (1.1%/y). However, none of the patients had any respiratory complications postoperatively. Functional status was improved in 6 patients and they were able to sit without support (P = 0.027). Eight (44.4%) perioperative complications (5 pulmonary, 1 intraoperative death, and 2 others) were noticed. Postoperatively, 4 patients (23.5%) had complications; coccygodynia, back sore because of screw prominence, impingement of iliac screw, and loosening of the rod from L5 screw. All the patients were satisfied with the treatment. There were no major pulmonary complications requiring admission postoperatively.
Although complications are associated with the treatment of paralytic NMS, a good clinical and function outcome suggests that poor PFT should not be considered as a contraindication of scoliosis surgery.
一项回顾性研究。
评估所有椎弓根螺钉固定术式治疗合并肺功能差（肺功能测试）的麻痹性神经肌肉型脊柱侧凸（NMS）的临床及功能疗效。
杜氏肌营养不良症和脊髓性肌萎缩症常与肺功能差及脊柱侧凸的发生同时存在。肺功能差常使外科医生不愿进行手术。
18例术前用力肺活量（FVC）<30%的麻痹性NMS患者接受了全椎弓根螺钉固定术。分析术前、术后及末次随访时的Cobb角、骨盆倾斜度、胸椎后凸角和腰椎前凸角、肺功能测试（FVC%和第1秒用力呼气量）以及术前和随访时的功能状态。同时记录围手术期和术后并发症。
平均随访时间为31.6±7.7个月。术后Cobb角（61.7%）和骨盆倾斜度（56.7%）有显著改善（P<0.001）。所有矫正效果在末次随访时均得以维持。FVC从术前的25.2±4.7%降至术后6周的24.2±5.0%（P=0.067）；随访时进一步降至20.6±3.9%（P<0.0001）（每年下降1.8%）。第1秒用力呼气量也从术前的22.7±4.5%降至术后的21.8±4.2%（P=0.037），末次随访时为19.8±3.8%（P<0.0001）（每年下降1.1%）。然而，所有患者术后均未出现任何呼吸并发症。6例患者的功能状态得到改善，能够独立坐立（P=0.027）。共发现8例（44.4%）围手术期并发症（5例肺部并发症、1例术中死亡和2例其他并发症）。术后，4例患者（23.5%）出现并发症；尾骨痛、螺钉突出致背部疼痛、髂骨螺钉撞击和L5螺钉处棒材松动。所有患者对治疗均满意。术后无需要住院治疗的严重肺部并发症。
尽管麻痹性NMS的治疗存在并发症，但良好的临床和功能结局表明，肺功能差不应被视为脊柱侧凸手术的禁忌证。
