• Nobuyuki Fujita, Mitsuru Yagi, Takehiro Michikawa, Yoshitake Yamada, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Eijiro Okada, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, and Kota Watanabe.
• Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
• Eur Spine J. 2019 Sep 1; 28 (9): 2034-2041.

PurposeAlthough lung volume (LV) can be measured directly by computed tomography (CT), the literature regarding CT-assessed LV in adolescent idiopathic scoliosis (AIS) patients is limited, and the influence of posterior spinal fusion with instrumentation (PSF) on LV has not been established. This study aimed to identify factors associated with decreased LV after PSF in AIS patients.MethodsWe retrospectively reviewed 111 consecutive AIS patients who were between 10 and 20 years of age and were treated by PSF at our facility. We assessed age at surgery, sex, height, body weight, Risser stage, Lenke classification, radiographic parameters, pulmonary function tests, and LV. Factors associated with a postoperative decrease in LV were identified by multivariable analysis.ResultsThe mean total LV had increased at the 2-year follow-up, although marginally significant (p = .06), and there was a significant increase in the left LV (p = .01) but not the right LV (p = .25). We observed a postoperative reduction in total LV, defined as a total LV postoperative/preoperative ratio < 0.9, in 20 of the 111 patients (18.0%). Univariable analysis showed a significant correlation between ≥ 11 fusion levels and postoperative LV reduction (OR 3.11, 95% CI 1.13-8.57). This factor remained significant in the multivariable analysis, which yielded an adjusted OR of 2.82 (95% CI 1.01-7.93) for postoperative LV reduction in patients with ≥ 11 fusion levels.ConclusionOur data suggest that a longer fusion area is associated with postoperative LV reduction. Therefore, avoidance of a longer fusion area of ≥ 11 will be preferable for preserving LV. These slides can be retrieved under Electronic Supplementary Material.

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