Severe Pulmonary Dysfunction Dysfunction in Scoliosis Surgery

Eight patients with scoliosis and severe pulmonary dysfunction, identified with vital capities less than 40% of predicted, had undergone reconstructive spine surgey. The mean magnitude of the thoracic scoliotic segments was 95.8∘preoperatively, and the mean correction rate of the thoracic curves was 38.8%. Preoperative parameters of pulmonary function tests were predicted value of forced vital capacity 31.4%, and that of forced expiratory volume in one second 29.1%. Five patients underwent initial video-assisted thoracoscopic releasing procedures, and four had second-staged posterior intrumented fusions. The remaining three patients had only posterior instrumented fusions. Six of the eight patients had concomitant thoracoplasty for rib hump correction. All patients survived the operative with uneventful results, even though three patients required endotracheal reintubation for ventilation owing to respiratory distress. Four major complications, including central venous catheter-induced tension pneumothorax, chylothorax, hypovolemic shock and bilateral pneumothorax, could be managed without any sequelae. The authors conclude that scoliosis reconstructive surgery is feasible for patients with severe pulmonary dysfunction, although perioperative complications are not uncommon and intensive lung care is mandatory. Video-assisted thoracoscopic surgery and thoracoplasty are also accessible for the treatment of patients with severe scoliosis and prominent rib hump deformity.