Lee Sin Ying, Teng Zhi Sean, Wong Chee Kuan, Chiu Chee Kidd, Chan Chris Yin Wei, Kwan Mun Keong
Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
JB JS Open Access. 2025 Sep 23;10(3). doi: 10.2106/JBJS.OA.25.00169. eCollection 2025 Jul-Sep.
Curve severity is a recognized factor associated with impaired pulmonary function in patients with severe adolescent idiopathic scoliosis (AIS). Despite significant curve correction achieved after posterior spinal fusion, reports on the extent of potential pulmonary function improvement in these patients remain inconsistent. Therefore, we aimed to evaluate the changes in pulmonary function test (PFT) parameters in patients with severe AIS after posterior spinal fusion.
This study involved 18 severe AIS patients with major main thoracic curves (), who underwent posterior spinal fusion between 2019 and 2023, with a minimum 24-month follow-up. Primary PFT parameters measured preoperatively and at the most recent observation postoperatively were forced vital capacity (FVC), forced expiratory volume in one second (FEV), and total lung capacity (TLC). Moderate to severe pulmonary impairment () is defined as a predicted FVC/FEV of ≤65%. Patients were classified into having () and . Postoperatively, patients were further categorized into having or based on the transition of their pulmonary function classification.
The mean final follow-up duration was 37.9 ± 15.1 months. The major Cobb angle improved from 101.5° (93.0°-115.3°) to 45.0° (35.0°-58.0°) postoperatively ( < 0.001). There were increments of 14.7 ± 8.3% in predicted FVC and 15.2 ± 9.6% in predicted FEV postoperatively. The predicted FVC and FEV increased from 53.6 ± 11.9% and 50.1 ± 13.4% (preoperative) to 68.3 ± 7.9% and 65.3 ± 10.5% (postoperative), respectively ( < 0.001). Seven patients (50.0%) () and 6 patients (40.0%) ( ) with showed postoperative improvement in pulmonary function by transitioning to . The remaining patients exhibited stable pulmonary function, and none experienced deterioration.
Patients with severe AIS demonstrated significant improvements in pulmonary function parameters after posterior spinal fusion. None experienced postoperative deterioration, whereas approximately 40.0% to 50.0% of those with improved to the category.
Level III. See Instructions for Authors for a complete description of levels of evidence.
在重度青少年特发性脊柱侧凸（AIS）患者中，脊柱侧弯严重程度是与肺功能受损相关的一个公认因素。尽管后路脊柱融合术后脊柱侧弯得到了显著矫正，但关于这些患者肺功能潜在改善程度的报道仍不一致。因此，我们旨在评估重度AIS患者后路脊柱融合术后肺功能测试（PFT）参数的变化。
本研究纳入了18例主要为胸主弯的重度AIS患者，他们在2019年至2023年间接受了后路脊柱融合术，并进行了至少24个月的随访。术前和术后最近一次观察时测量的主要PFT参数为用力肺活量（FVC）、一秒用力呼气容积（FEV）和肺总量（TLC）。中度至重度肺功能损害（）定义为预测的FVC/FEV≤65%。患者被分为有（）和。术后，根据肺功能分类的转变，患者进一步分为有或。
平均最终随访时间为37.9±15.1个月。术后主要Cobb角从101.5°（93.0°-115.3°）改善至45.0°（35.0°-58.0°）（<0.001）。术后预测FVC增加了14.7±8.3%，预测FEV增加了15.2±9.6%。预测FVC和FEV分别从术前的53.6±11.9%和50.1±13.4%增加至术后的68.3±7.9%和65.3±10.5%（<0.001）。7例（50.0%）（）和6例（40.0%）（）的患者术后肺功能通过转变为而得到改善。其余患者肺功能保持稳定，无一例出现恶化。
重度AIS患者后路脊柱融合术后肺功能参数有显著改善。无一例患者术后出现恶化，而约40.0%至50.0%的患者改善至类别。
III级。有关证据水平的完整描述，请参阅作者指南。
