Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association · 2026
Impact of postoperative residual deformity on bronchial narrowing and pulmonary function in adolescent idiopathic scoliosis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Kawai Masafumi, Yokogawa Noriaki, Ta Shih Jen, Kato Satoshi, Shimizu Takaki, Uto Takaaki, Ishino Yuji, Nanpo Kazuhiro, Demura Satoru
Аннотация
INTRODUCTION: Decreased pulmonary function in patients with adolescent idiopathic scoliosis (AIS) indicates restricted and obstructive ventilatory dysfunction. However, few studies have investigated obstructive ventilatory dysfunction, and the association between postoperative residual spinal and thoracic deformities and bronchial obstruction remains unclear. Therefore, this study aimed to quantify postoperative bronchial narrowing and investigate its association with residual spinal and thoracic deformities and pulmonary function in patients with AIS.
METHODS: We retrospectively reviewed 56 patients with major thoracic AIS who underwent posterior spinal instrumentation and fusion. Spinal and thoracic deformities were quantified using radiography and low-dose computed tomography (CT), and bronchial narrowing was quantified by measuring bronchial cross-sectional areas using 3-dimensional CT. Correlations between postoperative spinal and thoracic deformity parameters, bronchial narrowing, and pulmonary function at 2 years postoperatively were evaluated.
RESULTS: Thoracic kyphosis negatively correlated with vertebral protrusion into the thoracic cavity. Thoracic parameters such as the endothoracic hump ratio (EHr) and spinal penetration index showed negative correlations with the bronchial cross-sectional area, suggesting that greater vertebral protrusion corresponds to smaller bronchial areas. Additionally, a negative correlation was found between percent-predicted forced expiratory volume in 1 sec (%FEV1) at 2 years postoperatively and EHr. Multivariable analysis showed that EHr remained independently associated with postoperative total bronchial cross-sectional area after adjustment for proximal thoracic curve and thoracic kyphosis (TK) (standardized β = -0.27, p = 0.04). In contrast, EHr was not independently associated with %FEV1 at 2 years after adjustment for preoperative %FEV1 and postoperative TK (p = 0.90).
CONCLUSIONS: Residual vertebral protrusion into the thoracic cavity was independently associated with postoperative bronchial narrowing in patients with AIS. However, its association with %FEV1 at 2 years was not independent of baseline pulmonary function, indicating that postoperative airway morphology and long-term pulmonary function are associated with different factors.
METHODS: We retrospectively reviewed 56 patients with major thoracic AIS who underwent posterior spinal instrumentation and fusion. Spinal and thoracic deformities were quantified using radiography and low-dose computed tomography (CT), and bronchial narrowing was quantified by measuring bronchial cross-sectional areas using 3-dimensional CT. Correlations between postoperative spinal and thoracic deformity parameters, bronchial narrowing, and pulmonary function at 2 years postoperatively were evaluated.
RESULTS: Thoracic kyphosis negatively correlated with vertebral protrusion into the thoracic cavity. Thoracic parameters such as the endothoracic hump ratio (EHr) and spinal penetration index showed negative correlations with the bronchial cross-sectional area, suggesting that greater vertebral protrusion corresponds to smaller bronchial areas. Additionally, a negative correlation was found between percent-predicted forced expiratory volume in 1 sec (%FEV1) at 2 years postoperatively and EHr. Multivariable analysis showed that EHr remained independently associated with postoperative total bronchial cross-sectional area after adjustment for proximal thoracic curve and thoracic kyphosis (TK) (standardized β = -0.27, p = 0.04). In contrast, EHr was not independently associated with %FEV1 at 2 years after adjustment for preoperative %FEV1 and postoperative TK (p = 0.90).
CONCLUSIONS: Residual vertebral protrusion into the thoracic cavity was independently associated with postoperative bronchial narrowing in patients with AIS. However, its association with %FEV1 at 2 years was not independent of baseline pulmonary function, indicating that postoperative airway morphology and long-term pulmonary function are associated with different factors.