ABSTRACT
AIMS: The aims of our study were to provide long-term information on the behaviour of the thoracolumbar/lumbar (TL/L) curve after thoracic anterior correction and fusion (ASF) and to determine the impact of ASF on pulmonary function. PATIENTS AND METHODS: A total of 41 patients (four males, 37 females) with main thoracic (MT) adolescent idiopathic scoliosis (AIS) treated with ASF were included. Mean age at surgery was 15.2 years (11 to 27). Mean follow-up period was 13.5 years (10 to 18). RESULTS: For the TL/L curve, the mean curve flexibility evaluated with supine pre-operative bending radiographs was 78.6% (standard deviation 16.5%), with no significant loss of correction observed. On comparing patients with an increase of the TL/L curve increase (> 4º, n = 9, 22%) to those without, significant differences were observed in the correction rate of the MT curve at the final follow-up (p = 0.011), correction loss of the MT curve (p = 0.003) and the proportion of patients who had semi-rigid instrumentation (p = 0.003). Pre-operative percentage predicted forced vital capacity (%FVC) was 80%, dropping to 72% at final follow-up (p < 0.001). The Scoliosis Research Society questionnaire score was not significantly different between patients with and without a TL/L curve increase (p = 0.606). Spontaneous lumbar curve correction (SLCC) was maintained up to 18 years following selective ASF in most patients and demonstrated significant correlation with maintenance of MT curve correction. CONCLUSION: Maintenance of MT curve correction using rigid instrumentation provided stable SLCC over time. An observed 8% decrease in %FVC indicates that ASF should be reserved for patients with no or only mild pulmonary impairment. Cite this article: Bone Joint J 2016;98-B:997-1002.
Subject(s)
Lumbar Vertebrae/diagnostic imaging , Scoliosis/surgery , Spinal Fusion , Thoracic Vertebrae/surgery , Adolescent , Adult , Child , Female , Follow-Up Studies , Humans , Male , Retrospective Studies , Scoliosis/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Vital Capacity , Young AdultABSTRACT
This article gives a comprehensive overview of diffuse interstitial lung diseases especially those associated with connective tissue diseases. Interstitial lung diseases (ILD) represent a heterogeneous group of diseases of very different and partially unknown etiologies. Therefore, an exact classification of the ILD is difficult. ILDs are rarely seen in clinical practice and often lead to diagnostic problems. Diagnostic procedures require the patient's history, physical examination, serological-immunological and routine laboratory tests, pulmonary function testing, chest X-ray and high-resolution CT scan, bronchioloalveolar lavage (BAL) and bioptic procedures. The diagnostic approach to ILD requires an intensive multidisciplinary cooperation to offer early and effective therapeutic regimens.
