The association between spinal curvature and respiratory function has long been established. Accordingly, the goals of spinal fusion have been to prevent the long-term compromise in respiratory function associated with progressive curvature. The introduction of the Harrington instrumentation system, while providing increased stabilization for spinal fusion, has been associated with many complications. The compression apparatus has been used effectively in the treatment of kyphotic deformities of the thoracic spine, and has been used in conjunction with distraction successfully in the treatment of idiopathic scoliosis. With the passage of time, in spite of Harrington's recommendation to use both the distraction and compression, it has been apparent that problems can arise from the routine use of compression. Winter et al have warned of the use of the compression apparatus in the hypokyphotic thoracic spine, as increased thoracic lordosis has clearly been associated with marked effect in decreased pulmonary function. While this effect has been considered a result of decreased anteroposterior diameter of the thoracic cavity and attendant decreased total lung volume, the direct effect on the bronchi of thoracic vertebral body rotation in progressive lordoscoliosis has been largely unrecognized. This case represents an extreme example of the effect of the use of a compression device in a hypokyphotic idiopathic curve. In this patient, pulmonary compromise developed secondary to diminished lung volumes, extrinsic compression of the right mainstem bronchus by the lordotic thoracic spine, and incidental weakness of the left hemidiaphragm.
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Clinical Neurology