Cardiorespiratory Function Does Not Improve 2 Years After Posterior Surgical Correction of Adolescent Idiopathic Scoliosis.

STUDY DESIGN: A prospective evaluation of cardiorespiratory function following spinal fusion in adolescent idiopathic scoliosis (AIS). OBJECTIVE: To evaluate the cardiopulmonary function during exercise in patients with severe AIS, before and 2 years after undergoing a posterior spinal fusion. SUMMARY OF BACKGROUND DATA: After surgical correction of scoliosis, a greater cardiorespiratory adaptation to exercise would be expected from correction of the rib cage associated with the spine deformity. However, there is no clear evidence regarding whether tolerance to maximum exercise improves in the medium term after surgery in patients with severe curves. METHODS: We include patients with AIS proposed for posterior surgical correction aging between 12 and 17 years. Every patient had a Cobb angle >45° and a Lenke type 1A scoliosis. Cardiac and respiratory functional measures, such as heart rate and blood pressure, maximum oxygen consumption (VO2max), eliminated volume of carbon dioxide (VCO2), quotient between ventilation and volume of exhaled carbon dioxide (VE/CO2), respiratory exchange rate, ventilatory capacity at maximal exercise (VEmax), were recorded before and 2 years after surgery. RESULTS: Twenty patients were included in our study, 15 girls and 5 boys, with an average age of 13 years. The main scoliotic curve was corrected in the coronal plane in an average of 71.9%. The maximal aerobic power expressed by body weight normalized VO2max was found preoperatively to have an average of 30.9 ±â€Š6.2 mL/kg/minute, indicating a poor aerobic capacity, which did not improve at final follow-up, decreasing to a mean value of 29.3 ±â€Š5.7 but without statistical significance. However, the percentages of curve correction showed a statistically significant correlation with VO2max (r = 0.534; P < 0.05). CONCLUSION: Patients with severe adolescent idiopathic scoliosis Lenke type 1A showed limited cardiorespiratory tolerance to maximum exercise that did not improve 2 years after surgery. LEVEL OF EVIDENCE: 3.

Anthropometry and body composition profile of girls with nonsurgically treated adolescent idiopathic scoliosis.

STUDY DESIGN: Cross-sectional study with level III of evidence. OBJECTIVE: To describe different anthropometric and body composition parameters of adolescent girls with adolescent idiopathic scoliosis (AIS), comparing them with the standards of a healthy age-matched population. SUMMARY OF BACKGROUND DATA: Body growth and development of adolescent girls with AIS seems to differ from the healthy subjects, especially at perpubertal stages. Young scoliotic adults have been found to be taller, lighter, and thinner than age-matched healthy population. Body composition profile taken from measurements of skin-fold thickness, bony diameters at different levels, and arm and legs perimeters has not been previously reported in AIS patients. METHODS: A nonconsecutive series of 52 AIS girls (mean age: 13.9 years) with an average scoliotic curve of 27° Cobb (range: 20-58) underwent an anthropometric study. None of the AIS girls had been treated previously with spinal surgery. The control group consisted of 92 girls without spine deformity, matched in age (mean: 13.8 years). Weight, height, and skin-fold thickness in millimeters at six levels were measured. Body mass index (BMI), Ponderal index, percentage of body fat, percentage of muscular tissue, fat mass, lean body mass, muscular weight, bony weight, and residual weight were calculated using standard rules to estimate body composition. The somatotype components (endomorphy, mesomorphy, and ectomorphy) were calculated according to the Carter equations. RESULTS.: Compared with the control population, scoliotic girls had a significantly lower mean weight (51.4 ± 10.2 kg vs. 54.7 ± 8.1 kg; P < 0,05), a lower BMI (20.1 ± 3.4 vs. 21.4 ± 2.4; P < 0.001), and a higher Ponderal index (43.2 ± 2.4 vs. 42.2 ± 1.6; P < 0.01). Girls with AIS showed a progressive decrease of the BMI as the age increased. The percentage of body fat was also lower in scoliotic girls, without significant statistical differences (14.1 ± 3.8 vs. 15 ± 3.6). Out of the 52 AIS girls, 11 (21.2%) showed a BMI below 17.5, which has been considered the limit for anorexia. In the control group, only 3 of 92 girls (3.3%) had BMI below that level. The somatotype differed also between scoliotics and controls: higher in the ectomorphic component (3.29 ± 1.68 vs. 2.40 ± 1.11; P < 0.001), and lower in the mesomorphic component (2.86 ± 0.82 vs. 3.70 ± 1.11; P < 0.01) in AIS patients. CONCLUSION: The differences in some anthropometric parameters (weight, IMC, IP) and in the somatotype suggest that the idiopathic scoliosis not only disturbs normal spine growth but also seems to have implications on the whole corporal development. Whether these changes could be related to abnormal spinal growth or subsequent to nutritional changes in AIS still remains uncertain. Presumably, some endocrine factors affecting body composition and growth might be involved in the etiology of idiopathic scoliosis.