Adaptation to reduced lung function in children and young people with spinal deformity

Fiona Jagger; Athanasios I Tsirikos; Sarah Blacklock; Don S Urquhart

doi:10.1016/j.jcot.2019.12.013

Adaptation to reduced lung function in children and young people with spinal deformity

J Clin Orthop Trauma. 2020 Mar-Apr;11(2):191-195. doi: 10.1016/j.jcot.2019.12.013. Epub 2020 Jan 3.

Authors

Fiona Jagger¹, Athanasios I Tsirikos², Sarah Blacklock¹, Don S Urquhart¹

Affiliations

¹ Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.
² Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh, UK.

Abstract

Background: Severe scoliosis can affect respiratory function in growing patients and produce cardiopulmonary complications, leading to significant morbidity. The development of spinal deformity may impact on young patients' level of function and reported quality of life (QOL). The aim of this study was to investigate the relationship between lung function, exercise capacity and quality of life in young patients with spinal deformity.

Methods: This is a retrospective analysis of 104 patients (31% male, 69% female with mean age 14.9yrs). 77% of patients had an adolescent idiopathic scoliosis, with the remainder having other scoliosis diagnoses or Scheuermann's kyphosis. Principal outcomes included Spirometry [FEV₁, FVC], Whole Body Plethysmography, Cardiopulmonary Exercise Testing [CPET] and patient outcome questionnaires (with SRS-22). CPET measures included maximal exercise capacity [VO_2peak] as well as VO₂ at ventilatory threshold [VT] expressed as %predicted VO_2max-a measure of physical conditioning, and minute ventilation [V_E] from which breathing reserve [BR] could be calculated.

Results: Mean (±SD) main thoracic scoliosis was 59.9⁰ (±15.2⁰), and mean kyphosis in those with Scheuermann's condition was 95.3⁰ (±11.5⁰). No correlation was elicited between FEV₁ or FVC (%predicted) and VO_2peak (%predicted) in this patient cohort. Greater thoracic curves were associated with lower FEV₁ (%predicted), r = -0.343, p = 0.001, FVC (%predicted), r = -0.307, p = 0.003 and BR (%) at the end of exercise (r = -0.-0.459, p < 0.001). The patient cohort had a mean (sd) VO₂peak of 98(17) %predicted, with greater VO₂peak levels recorded in female subjects, those of younger age and those with higher scoliosis angles. Those with better lung function [FEV₁ (%predicted)] had better BR (%) at the end of exercise (r = 0.483, p < 0.001). SRS-22 scores correlated significantly with VO_2peak (%predicted) (total SRS-22 versus VO_2peak (%predicted), r = 0.336, p = 0.002).

Conclusion: Larger thoracic scoliotic curves are associated with poorer lung function but better exercise capacity, likely related to higher levels of physical conditioning. Higher QOL scores were recorded in patients who had greater VO_2peak levels, suggesting that exercise capacity may be a protective factor for emotional well-being in patients with spinal deformity.

Keywords: Cardiorespiratory exercise testing; Exercise capacity; Outcomes; Respiratory function; SRS-22; Scheuermann’s kyphosis; Scoliosis.