The role of preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis

BACKGROUND The patients with extremely severe spinal deformity are commonly considered high-risk candidates for surgical treatment because of their underlying lung disease. Currently, little has been reported about the postoperative pulmonary complication events in this population. This retrospective study sought to evaluate preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis. METHODS Preoperative forced vital capacity (FVC), FVC ratio, forced expiratory volume at the end of the first second (FEV1), FEV1 ratio, peak expiratory flow (PEF), and PEF ratio were performed and evaluated on 60 patients with extremely severe scoliosis (coronary main Cobb angle ≥100°). RESULTS Among the 60 patients, 11 (18.3%), 13 (21.7%), and 22 (36.7%) had severe, moderate, and mild pulmonary dysfunction, respectively. Compared with the moderate and mild scoliosis groups, significant differences were observed in Cobb, FVC, FVC ratio, FEV1, FEV1 ratio, and PEF ratio in the extremely severe scoliosis group. Various postoperative pulmonary complications occurred in nine cases (15%). Patients with severe or moderate dysfunction as measured by the FVC ratio had a higher incidence of postoperative pulmonary complications. A transthoracic procedure was not related to postoperative pulmonary complications, but thoracoplasty significantly increased the incidence of postoperative pulmonary complications (P < 0.001, OR = 20, 95% CI = 3.45-115.97). DISCUSSION Pulmonary function was impaired in extremely severe scoliosis. Patients with severe restrictive pulmonary dysfunction had a higher incidence of postoperative pulmonary complications. Thoracoplasty was an important risk factor in the prediction of postoperative pulmonary complications.