Scoliosis Surgery:Complications

Posted by e-Medical PPT Friday, April 8, 2011
Scoliosis: lateral displacement or curvature of the spine, usually occurs with-
Kyphosis: spinal deformity with anteroposterior angulation (can occur in isolation , from destruction or injury to the vertebral bodies)
Severity of these two conditions is defined by measurement of the Cobb angle of curvature that is formed by the limbs of the convex primary curvature

Causes of Kyphoscoliosis
Idiopathic (80%)
Neuromuscular disease
 Muscular dystrophy
 Polio
 Cerebral palsy
Vertebral disease
 Osteoporosis/ osteomalacia
 Pott’s disease
 Neurofibromatosis
 Rickets
Disorders of connective tissue
 Marfan’s syndrome
 Ehlers-Danlos syndrome
 Morquio’s syndrome
Acquired abnormalities
 Thoracoplasty
 Fibrothorax

Pathophysiology
PFTs demonstrate a restrictive pattern usually, with decreased TLC, VC, FRC, and compliance (effects of breathing at low lung volumes)
ABG demonstrates hypoxemia without hypercapnia is seen in moderate to severe disease; V/Q mismatch has been reported with a scoliosis angle greater than 65 degrees
Pulmonary hypertension can develops as a result of persistent hypoxemia
Nocturnal hypoventilation and arterial oxygen desaturation are described during REM.
Exercise limitation is often present in patients with kyphoscoliosis. However, there is a normal breathing pattern response to exercise and a normal maximum tidal volume to vital capacity ratio. Hence, exercise intolerance may be a result of physical deconditioning

Treatment
Mild disease has a good prognosis and requires supportive care only
In adults, surgery is of questionable benefit and carries a significant complication rate
In adolescents, both surgery and brace treatment improve lung function.
Medical therapy can include pulmonary rehabilitation, supplemental oxygen as needed, and managing ventilatory failure (i.e. negative pressure ventilators, positive pressure ventilation administered via tracheostomy, and more recently, noninvasive positive pressure ventilation.

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