Spine J. 2021 Dec 25; doi: 10.1016/j.spinee.2021.12.011. Epub 2021 Dec 25.
Pulmonary function in children and adolescents with untreated idiopathic scoliosis: a systematic review with meta-regression analysis.
The spine journal : official journal of the North American Spine Society
Diederik H R Kempen, Johan L Heemskerk, Gozde Kaçmaz, Mark C Altena, Herre J Reesink, Joost W Vanhommerig, Nienke W Willigenburg
Affiliations
Affiliations
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands. Electronic address: [email protected].
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
- Department of Respiratory Medicine, OLVG, Amsterdam, The Netherlands.
- Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands.
PMID: 34963629
DOI: 10.1016/j.spinee.2021.12.011
Abstract
BACKGROUND CONTEXT: One of the controversies in untreated idiopathic scoliosis is the influence of curve size on respiratory function. Whereas scoliosis patients with curves over 90 to 100 degrees are agreed to be at risk for cardiorespiratory failure in later life, the impairment of curves below 90 degrees is generally considered mild. Although various studies showed that pulmonary function is affected in patients with scoliosis, quantification of the relation between curve size and pulmonary function is lacking.
PURPOSE: This systematic review with meta-regression analysis aims to characterize the relation between pulmonary function tests and scoliosis severity in children and adolescents with idiopathic scoliosis.
STUDY DESIGN: systematic review with meta-regression analysis METHODS: Pubmed, Embase, Cochrane, and CINAHL were systematically searched until November 3
RESULTS: A total of 126 studies, including 8,723 patients, were retrieved. Meta-regression analysis revealed a statistically significant inverse relation between thoracic Cobb angle and absolute and predicted forced vital capacity in 1 second, forced vital capacity, vital capacity, and total lung capacity. For these outcomes, the slope coefficients showed a decrease of 1% of the predicted pulmonary function per 2.6 to 4.5 degrees of scoliosis. A multivariable meta-regression analysis of potential confounders (age, year of publication, and kyphosis) hardly affected the majority of the outcomes.
CONCLUSION: This meta-regression analysis of summary data (means) from 126 studies showed an inverse relationship between the thoracic Cobb angle and pulmonary function. In contrast to previous conclusions, the decline in pulmonary function appears to be gradual over the full range of Cobb angles between <20 and >120 degrees. These findings strengthen the relevance of minimizing curve progression in children with idiopathic scoliosis.
Copyright © 2021. Published by Elsevier Inc.
Keywords: adolescents; idiopathic scoliosis; meta-regression; pulmonary function
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