Prevalence of pleural injury in an extrapleural approach to adolescent idiopathic scoliosis and association of pleural injury with postoperative respiratory function

Elsevier

Available online 30 November 2022

Journal of Orthopaedic ScienceAuthor links open overlay panelAbstractBackground

The prevalence of pleural injury during surgery for adolescent idiopathic scoliosis using an extrapleural approach and the association of pleural injury with postoperative pulmonary function remain unclear. We sought to determine the prevalence of pleural injury associated with an extrapleural approach to adolescent idiopathic scoliosis, and to determine any difference in respiratory function between patients with or without pleural injury.

Methods

Data from consecutive patients with scoliosis of the thoracolumbar/lumbar spine who underwent anterior spinal fusion using an extrapleural approach were assessed in this retrospective study. We had diagnosed and treated pleural injury according to our algorithm. Pre- and postoperative values of pulmonary function tests and postoperative change rates were compared between patients with and without pleural injury. FVC, %FVC, FEV1.0, and FEV1.0% were evaluated from pulmonary function tests.

Results

We included data from 51 patients with adolescent idiopathic scoliosis (45 female and 6 male) with a mean age of 17.2 ± 3.5 years in this retrospective study. The group with pleural injury comprised 31 patients and the group without 20. Therefore, the prevalence of pleural injury during an extrapleural approach was 61%. We found no significant differences in preoperative FVC, %FVC, FEV1.0, and FEV1.0% between the groups. We found no significant differences in FVC, %FVC, FEV1.0, and FEV1.0% between the groups at 3 months or 1 year postoperatively. Furthermore, we found no significant differences in the postoperative change ratio of FVC, %FVC, FEV1.0, and FEV1.0% between the groups.

Conclusion

The prevalence of pleural injury associated with an extrapleural approach to scoliosis was 61%. Pleural injury was not associated with a decrease in postoperative pulmonary function in patients with scoliosis treated using an extrapleural approach.

Introduction

Posterior spinal surgery using pedicle screws is a widely accepted surgical treatment for adolescent idiopathic scoliosis. By contrast, anterior spinal surgery can be an option for scoliosis of the thoracolumbar or lumbar spine. Anterior spinal fusion has a mechanical advantage and can make fusion levels shorter than posterior spinal fusion to correct the thoracolumbar or lumbar curve [[1], [2], [3]], whereas an extrapleural approach carries a risk of pleural injury despite careful precautions. Pleural injury is non-negligible damage, which can lead to pneumothorax, with a lower prevalence in posterior surgery for adolescent idiopathic scoliosis [[4], [5], [6], [7]]. The prevalence of pneumothorax in posterior spinal surgery for non-degenerative scoliosis has been reported to be 0.4% [8]. Therefore, caution should be used to avoid the occurrence of pleural injury, especially in anterior surgery. However, to our knowledge, no studies to date have determined the prevalence of pleural injury during surgery for adolescent idiopathic scoliosis using an extrapleural approach. In addition, whether pleural injury associated with an extrapleural approach reduces postoperative pulmonary function in patients surgically treated for adolescent idiopathic scoliosis remains unclear.

The purpose of the present study was to determine the prevalence of pleural injury associated with an extrapleural approach to anterior spinal surgery in patients with scoliosis of the thoracolumbar or lumbar spine. Further, we sought to determine any difference in respiratory function between patients with and without pleural injury associated with an extrapleural approach.

Section snippetsPatients

Our institutional review board approved the present study. This retrospective study included consecutive patients with scoliosis of the thoracolumbar or lumbar spine who underwent anterior spinal fusion using an extrapleural approach between 2004 and 2017. Inclusion criteria were as follows; (1) adolescent idiopathic scoliosis patients, (2) apical vertebra in the thoracolumbar or lumbar spine, (3) anterior spinal fusion surgery using an extrapleural approach. Exclusion criteria were as follows:

Demographics

In the present study we included 51 adolescent idiopathic scoliosis patients (45 female and 6 male) with a mean age of 17.2 ± 3.5 years. The mean preoperative and postoperative major Cobb angles were 47.3 ± 6.4° and 14.0 ± 7.2°, respectively. An extrapleural approach was used for 47 patients on the left side and 4 patients on the right side. The mean number of fused vertebrae was 4.3 ± 0.5.

Pleural injury

A pleural injury group comprised 31 patients and a group without pleural injury (non-pleural injury group)

Discussion

This study reports two important clinical observations. First, the prevalence of pleural injury associated with an extrapleural approach for adolescent idiopathic scoliosis patients with thoracolumbar or lumbar curve was 61%. Second, we found that pleural injury associated with an extrapleural approach was not associated with reduced postoperative pulmonary function in these patients with scoliosis. To our knowledge, this is the first study to analyze details of pleural injury associated with

Conclusions

The prevalence of pleural injury during surgery to treat scoliosis using an extrapleural approach was 62%. Pleural injury associated with the extrapleural approach was not associated with decreased pulmonary function postoperatively in patients surgically treated for scoliosis.

Authors’ contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Kosuke Sato, Toshiaki Kotani, Tsuyoshi Sakuma and Yasushi Iijima. Analysis was performed by Kosuke Sato and Toshiaki Kotani. The first draft of the manuscript was written by Kosuke Sato and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethical approval

This study has been approved by the institutional review board of our hospital.

Informed consent

Consent for participation in the trial was obtained from all patients.

Funding

Not applicable.

Availability of data and material

Data are presented in the present article as statistical summaries. Further details are available from the authors on reasonable request after deidentification from any patient included in the study. Material availability is not applicable.

Code availability

Proprietary statistical software was used and code availability is not applicable.

Declaration of competing interest

The authors declare that they have no conflict of interest.

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© 2022 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

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