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P81 Long-term effect of combined anterior and posterior spinal fusion on pulmonary function and quality of life in young people with adolescent idiopathic scoliosis
  1. DS Urquhart,
  2. S Gallela,
  3. E Brady,
  4. S Blacklock,
  5. AT Tsirikos
  1. Royal Hospital for Sick Children, Edinburgh, UK

Abstract

Background The deleterious effects of progressive adolescent idiopathic scoliosis (AIS) on lung function and quality of life are cause for concern. Although surgical correction of AIS aims to halt progression of restrictive lung disease, evidence from current literature is conflicting with minor improvement, no change, or minor decline in lung function all reported in case series 2–5 years post-operatively. The longer term follow-up of lung function and quality of life of those who underwent surgery for AIS in adolescence are not well documented with only one study extending beyond 2 years.

Aim To evaluate the long-term change in pulmonary function and quality of life in children with adolescent idiopathic scoliosis (AIS) following anterior and posterior spinal fusion (APSF).

Methods Subjects who underwent APSF for AIS in the period 2005–2007 at RHSC Edinburgh were prospectively studied during 2011/2012. Data were collected for lung function by forced spirometry (Jaeger Masterscreen), and measurement of quality of life using the SRS-22 questionnaire. Paired t-test was used to compare data pre- and post-APSF.

Results Paired pre- and post-operative data were available for 12 patients who underwent scoliosis correction at mean 13.8(11.8–15) years. 9/12(75%) were female. Follow-up occurred 5.8(4.1–6.7) years after surgery.

Patients’ height increased from mean (sd) 169(9) cm pre-operatively to 175(5)cm at follow-up (p < 0.01). Scoliosis corrected from 100(15) to 29(11) degrees (p < 0.001). FEV1 was 60(19)%predicted pre-operatively versus 62(19) post-operatively (p = 0.32); FVC was 62(19)%predicted before and 64(13) after surgery (p = 0.67).

Overall SRS-22 scores improved from mean (sd) 3.6(0.3) before surgery to 4.6(0.4) at follow-up (p < 0.001). Improvements in individual SRS-22 domains for function [3.9(0.2) vs. 4.9(0.2), p < 0.001], pain [3.5(0.4) vs. 4.5(0.5), p < 0.001], self-image [3.3(0.3) vs. 4.4(0.5), p < 0.001] and mental health [3.7(0.5) vs. 4.4(0.6), p < 0.001] were also noted. High rates of patient satisfaction [4.8(0.3)] were recorded. No correlation was noted between changes in FEV1 (r = 0.08, p = 0.8) or FVC (r = 0.01, p = 0.97) with change in SRS-22 score.

Conclusion Long-term follow-up of a single surgeon’s cohort of AIS patients suggests no deficit in pulmonary function, whilst quality of life and patient satisfaction are high 6 years after combined A/PSF.

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