Introduction: The objective of this study was to determine differences in pulmonary function in adult patients who are either younger (Y) or older (O) than age 60 following spinal deformity surgery. We hypothesize that older age may further exacerbate impairment of pulmonary function following spinal deformity surgery.
Methods: 128 consecutive adult deformity patients with idiopathic scoliosis undergoing surgical treatment were evaluated at a single institution with minimum 2 year follow-up. Prospectively collected PFTs, clinical records and radiographs were analyzed.
Results: There were 102 patients in Y group (avg age 39.3+14.1 yrs) and 26 in O group (avg age 63.7+2.7 yrs), with similar F/U (Y=2.9 v O=2.6 yrs, p=0.27). There were no differences in average preop main thoracic (MT) curve magnitude (Y=50.0deg, O=54.8deg, p=0.27), however O patients had significantly greater # of lumbar (5.9 v 4.2, p=0.00), thoracic (9.1 v 7.3, p=0.00), and total (15.0 v 11.5, p=0.00) levels fused. We also found O patients had significantly lower absolute pre-op FEV1 (2.1 v 2.6L,p=0.02) and FVC (2.7 v 3.3L, p=0.05), but no differences in %pred PFTs. This relationship remained at 2 yrs, with lower absolute FEV1 (1.9 v 2.5L, p=0.00) and FVC (2.5 v 3.1L, p=0.00). A clinically significant decline in PFTs (greater than 10% pred FEV1) occurred in 8 (31%) O patients and 26 (25%) Y patients, which was not statistically different. (p=0.63). We also observed pre-op PFT impairment (less than 65%pred FEV1) in 1 (4%) O patient, which significantly increased to 6 (23%; p=0.02) O patients postoperatively, compared to Y group experiencing no change in the number of patients (n=12, 12%) with PFT impairment postoperatively.
Conclusions: Despite age related reduction in PFTs, older patients (over age 60) had no significant difference in %pred PFTs compared to younger patients following spinal deformity surgery. We found older patients have no significant difference in %predicted PFTs compared to younger patients postoperatively, and no differences in the rate of clinically significant PFT decline (=10% pred FEV1). However, older patients more frequently (23% v 12%) experience PFT impairment (<65%pred FEV1) after spinal deformity surgery.
Patient Care: Spinal deformity surgery in older patients (> 60 years old) does not significantly compromise pulmonary function.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe pulmonary function test) Discuss, the difference in PFTs in young versus old patients following spinal deformity surgery