The effects of early spinal fusion on pulmonary function and thoracic development in patients with early-onset scoliosis / 中华骨科杂志

ABSTRACT

Early-onset scoliosis (EOS) is defined as the scoliosis occurs before 10 years old. Such patients with severe scoliosis often require early surgical intervention, but spinal fusion may also affect their thoracic development and lung function. Based on etiology, EOS can be classified as congenital, neuromuscular, syndrome-related and idiopathic scoliosis. The clinical goal is to control the progression of the curve while allowing the spine and chest to grow as much as possible to promote the development of alveolar. Clinical treatments include physiotherapy, plaster and brace correction as well as surgery. Patients of EOS were usually at the critical stage of thoracic and lung development due to their young age. In addition, the combination of severe thoracic deformity may also lead to life-threatening cardiopulmonary disorder and related complications considering the clinical inconsistency and complexity of EOS. Thoracic anatomical changes brought by scoliosis itself can limit chest wall movement and reduce lung compliance, resulting in changes in thorax diameter and compression of thoracic volume, leading to restrictive ventilation dysfunction. And spinal fusion can effectively correct curve and control progression, which still remains as the primary surgical option for severe EOS patients nowadays. However, early spinal fusion can also lead to deformation of lung tissue, collapse and malformation of alveolar while limiting the height and growth rate of thoracic cavity, hindering the circulatory system and leading to respiratory dysfunctionof children. Spinal growth restriction, crankshaft phenomenon and restricted alveolar proliferation may play a role in thisprocess. The present review retrospectively summarized the effects and possible mechanisms of early spinal fusion on lung function and thoracic development in patients with EOS, aiming to further provide guidance for clinical decisions.