Pulmonary rehabilitation to decrease perioperative risks of spinal fusion for patients with neuromuscular scoliosis and low vital capacity

Background: In patients with neuromuscular disease and a forced vital capacity (FVC) of <30% of the predictive value, scoliosis correction operation was not recommended because of the possibility of subsequent complications. However, recent reports suggest that the operation can be performed safelyeven in these patients. Aim: This study aimed to determine the usefulness of pulmonary rehabilitation for scoliosis operation, in cases of patients with a low FVC. Design: A retrospective study of a clinical case series Setting: Inpatients of a university hospital Population : Neuromuscular patients with a low FVC who received mechanical correction of scoliosis (N.=24). Methods: End-tidal or transcutaneous carbon dioxide was monitored and noninvasive intermittent positive pressure ventilation was applied as needed to maintain normal carbon dioxide concentration. Air stacking, manually assisted coughing and mechanical insufflation-exsufflation were used to maintain normal oxygen saturation. Results : A total of 24 patients of neuromuscular disease (mean age: 15.2 years; average FVC: 19.2%) were included Noninvasive intermittent positive pressure ventilator (NIPPV) was applied in 22 of the 24 patients. The endotracheal tubes of all except two patients were removed within 3 days after the operation, and they were transferred to the general ward within 3 days of extubation. Eight patients had complications, such as pneumonia, wound infection, heart failure, and debility, which were controlled easily with medical management, there were neither lifethreatening complications nor a need for an invasiverespiratory intervention. Conclusion: Through pulmonary rehabilitation, scoliosis correction surgery could be performed safely even in patients with a neuromuscular disease and a low FVC. Clinical Rehabilitation Impact : The findings of this study can be used as a basis for practical guidelines for successful and safe mechanical correction of neuromuscular scoliosis.