Scoliosis and respiratory complications

Scoliosis is caused by the lateral displacement and rotation of the vertebral bodies. The prevalence of scoliosis in children and adolescents ranges from 0.19% to 11.03%. It can be congenital, secondary to a systemic or neuromuscular disorder, or most commonly idiopathic. The majority of scoliosis cases are categorized under idiopathic scoliosis with the mean age of presentation at 10 years old.

Scoliosis generally is known to cause restrictive lung disease. The decrease in lung volume is multifactorial, based on the severity of scoliosis (Cobb angle), the location of the scoliosis, and the loss of normal thoracic kyphosis. Other respiratory complications may be due lung hypoplasia, poor lung compliance following rib cage abnormality with evidence of hypoventilation, mechanical airway obstruction to the bronchus, airway hyper responsiveness as well as sleep disordered breathing.

Restrictive lung disease manifested by a reduction in the total lung capacity is characteristic of severe scoliosis. In children, usually a spirometry is performed, resulting in a decrease in FEV1 and FVC, resulting in a normal FEV1/FVC ratio. Pulmonary function testing is particularly used preoperatively to predict the incidence of post-operative pulmonary complications.  Management is in the form of observation, bracing, physiotherapy and surgery is offered to patients based on location of the scoliosis, the severity of it, if the patient has any symptoms and if the child or teen is still growing.

Overall scoliosis causes a debilitating deformity of the thoracic cage and potentially leads to severe and irreversible effects on lung function. Early recognition of the problem and regular evaluation is important to manage the patient.