Pulmonary function after thoracoplasty in the surgical treatment of adolescent idiopathic scoliosis

Study design: Retrospective case series review. Objective: To compare two similar groups of adolescents surgically treated for their spinal deformity either by posterior segmental fusion alone (PSF) or by posterior spinal fusion and thoracoplasty (PSF+T); attention was focused on the long-term effects of thoracoplasty on pulmonary function in the surgical treatment of adolescent idiopathic scoliosis. Summary of Background data: Posterior spinal arthrodesis with thoracoplasty and an open anterior approach, with respect to a posterior only fusion have been found to have a deleterious effect on pulmonary function for as long as five years postoperatively after surgical treatment of adolescent idiopathic scoliosis. Methods: A group of 40 consecutive adolescent patients, surgically treated between 1998 and 2001 by posterior spinal fusion and thoracoplasty, was compared with a similar cohort of 40 adolescents treated in the same period by posterior segmental fusion alone. Pedicle screw instrumentation alone and a minimum five-year follow-up were requested as inclusion criteria. Both a radiographic analysis and a chart review was performed, evaluating the pulmonary function tests (PFTs), the SRS-30 score questionnaire and the Lenke classification system. A radiographic Rib Hump (RH) assessment was also performed. Results: The entire series was reviewed at an average clinical follow-up of 8.3 years. There were no statistically significant differences between the two groups in terms of gender, age (PSF+T: 16.3 y vs. PSF: 15.2 y), Lenke curve type classification and preoperative Cobb's main thoracic (MT) curve magnitude (PSF+T: 66° vs. PSF: 63°), whereas both final MT percent correction (PSF+T: 53.03% vs. PSF: 51.35%; P