Hamad Medical Corporation, Doha, Qatar.
Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Spine Deform. 2021 Jul;9(4):913-921. doi: 10.1007/s43390-021-00302-w. Epub 2021 Mar 8.
Scoliosis often occurs coincident with pulmonary function deterioration in spinal muscular atrophy but a causal relationship has not yet been reliably established. A systematic literature review was performed, with pulmonary function testing being the primary outcome pre- and post-scoliosis surgery. Levels of evidence were determined and GRADE recommendations made. Ninety studies were identified with only 14 meeting inclusion criteria. Four studies were level III and the rest were level IV evidence. The average age at surgical intervention was 11.8 years (follow-up 6.1 years). Post-operative pulmonary function progressively declined for the majority of studies. Otherwise, pulmonary function: improved (two studies), were unchanged (two studies), had a decreased rate of decline (three studies), declined initially then returned to baseline (two studies). Respiratory and spine-based complications were common. Given the available evidence, the following GRADE C recommendations were made: (1) surgery is most often associated with decreases in pulmonary function; (2) the impact of surgery on pulmonary function is variable, but does not improve over pre-operative baseline; (3) surgery may result in a decreased rate of decline in pulmonary function post-operatively. Given this lack of evidence-based support, the risk-benefit balance should be taken into consideration when contemplating scoliosis surgery.
脊柱侧凸常与脊髓性肌萎缩症的肺功能恶化同时发生，但尚未可靠地确定因果关系。进行了系统的文献回顾，以肺功能测试为脊柱侧凸手术后的主要结果。确定了证据水平并提出了 GRADE 建议。确定了 90 项研究，只有 14 项符合纳入标准。四项研究为 III 级，其余为 IV 级证据。手术干预的平均年龄为 11.8 岁（随访 6.1 年）。大多数研究的术后肺功能逐渐下降。否则，肺功能：改善（两项研究）、不变（两项研究）、下降速度减慢（三项研究）、最初下降然后恢复基线（两项研究）。呼吸和脊柱相关并发症很常见。鉴于现有证据，提出以下 GRADE C 建议：（1）手术通常与肺功能下降有关；（2）手术对肺功能的影响是可变的，但不会超过术前基线；（3）手术后肺功能下降的速度可能会减慢。鉴于缺乏基于证据的支持，在考虑脊柱侧凸手术时，应权衡风险效益比。
