Adult spinal deformity and respiratory failure: Surgical results in 35 patients

Study Design. Retrospective chart and complementary study review. Objectives. To describe the features of adult patients with spinal deformity and respiratory failure and to analyze the results of surgical treatment. Summary and Background Data. Many authors have studied the relation between spinal deformities and cardiorespiratory failure, but there exists little information about the benefits of reconstructive surgery in severely compromised patients. Methods. The charts and complementary studies of 35 adults patients surgically treated between January 1, 1978, and December 31, 1994, were reviewed. The patients were 18 years old or older (average age, 36 years). They had spinal deformity of any etiology with respiratory insufficiency as evidenced by vital capacity of less than 60% of predictive normal, PaO₂ less than 80 mm Hg, or PaCO₂ more than 45 mm Hg. All had reconstructive spinal surgery in an attempt to improve their respiratory problem. Results. Seven patients died within the first postoperative year, and one patient was lost to follow-up at 6 months. The other 27 patients had a mean follow-up time of 72 months. The 24 patients were divided into three groups: good, fair, and poor evolution. The patients in the good evolution group had a better preoperative general condition, had more correction of their deformities, had more improvement in their respiratory function, ad had fewer complications than those in the outer groups. The patients in the poor evolution group were older, had more cardiac problems, and had less correction at surgery. Conclusion. The results of surgery varied from extremely good to extremely bad. The seven patients who died within the first year had no benefit, but the 27 others did very well, usually gaining significant improvement of their respiratory function. Because the alternative to surgical correction is death, this study shows that, under the right circumstances, correction of spinal deformity and, therefore, correction of respiratory function can be life-saving.