Outcome of Pediatric Patients with Severe Restrictive Lung Disease Following Reconstructive Spine Surgery

Purpose: To assess outcome and complications in pediatric patients with vital capacity (VC) less than or equal 45% of predicted who underwent reconstructive spine surgery for severe thoracic scoliosis.

Methods: A retrospective chart review was carried out on 20 pediatric patients (average age 11.5yrs, with range 2-21 yrs) with VC less than or equal to 45% who underwent reconstructive spine surgery during the period 1994-2001. All the patients underwent combined anterior and posterior spinal fusions including thoracotomy and multiple rib resections. All patients were seen by the pulmonary, cardiology, pediatric, and anesthesia services, as well as neurology and gastroenterology services if indicated, for pre-operative evaluation. Outcome variables examined were: 1) days on O2; 2) need for tracheostomy; 3) days on ventilator; 4) mortality rate; 5) pulmonary complications 6) blood loss; 7) other complications and 8) length of stay.

Results: Of the 20 patients studied, the average VC preoperatively was 31.4, with a standard deviation of 8.6. The median time on oxygen was 5 days, with a standard deviation of 26.8 days. Only one patient with VC of 15%, who was successfully extubated on POD #4, developed a deep wound infection which required I&D and prophylactic tracheostomy. Two patients required nocturnal non-invasive positive pressure ventilation following the surgery. There was one pneumonia and two pleural effusions. Seven patients developed post-operative atelectasis. There was one other reoperation for implant failure. There were no mortalities or adverse neurological outcomes. Major thoracic scoliosis measured an average of 80 degrees (40-140 degrees), which was corrected to an average of 36 degrees (6-75 degrees).

Conclusion: Reconstructive spine surgery in pediatric patients with severe restrictive lung disease and significant spinal deformities is well-tolerated. The importance of meticulous surgical technique and peri-operative multidisciplinary management, should be emphasized. Routine preoperative tracheostomy is not indicated.