Pediatric scoliosis and the lung

OBJECTIVE: To determine the pattern of scoliosis in the pediatric age group and to determine the course of the disease and the result of surgical intervention.

METHODS: A retrospective review of all charts of patients referred to the Pulmonary Clinic of the King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia (KSA), for scoliosis and preoperative evaluation from the period November 1992 to October 2001. Demographic and clinical data, preoperative and postoperative pulmonary function test (PFT) and effect of surgery on the lung were presented.

RESULTS: A total of 66 patients with scoliosis were followed. The age at diagnosis was 8.5 +/- 4.4 years. Thirty-four (52%) males and 32 (48%) females. Fifty-seven (86%) were alive and 9 (14%) died. A period of follow up was 5.3 +/- 3.7 years. Idiopathic scoliosis was found in 20 patients (30%), congenital anomalies associated with scoliosis constituted 35 (53%) of the total scoliosis referral and secondary type due to trauma or malignancy formed 11 (17%). Mean Cobb s angle of 70 +/- 30 degrees. The most common curvatures were: thoracic 31 (47%), lumbar 12 (18%) and thoracolumbar 30 (45%). Thirteen patients (20%) had 2 or 3 types of curvatures simultaneously. Baseline PFT showed moderate restrictive lung disease in approximately two thirds of the patient population. Scoliosis surgery was carried out in 34 (52%) of the patients. Posterior approach was more commonly used in 30 (88%) of the patients. Pneumonia and atelectasis were the most common complication encountered in 15 (44%) of the patients. Recurrence of scoliosis after operation recurred in 12 (35%) of the population. Comparisons between both groups have shown that patients with congenital anomalies and scoliosis were diagnosed earlier, had significant postoperative complications and higher mortality compared to those with idiopathic scoliosis (p<0.05). Changes in PFT for patients who underwent surgery for scoliosis with Cobb s angle >40 degrees showed less deterioration compared to those with angle <40 degrees (p=0.004), due to progressive deterioration without surgery.

CONCLUSION: Scoliosis is a common problem in KSA. Patients need to be referred early for proper intervention before it becomes a severe magnitude and difficult to be fixed and to prevent permanent complications. Patients with congenital anomalies and scoliosis had poor prognosis compared to those with idiopathic scoliosis.