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A Study of the Relationships Between Early Onset Scoliosis, Thoracic Deformity & Pulmonary Function

Wednesday, June 5, 2019

3:30 PM-5:30 PM

BIOMED Master's Thesis Defense

A Study of the Relationships Between Early Onset Scoliosis, Thoracic Deformity, and Pulmonary Function

Jennifer Sanville, Master's Candidate
School of Biomedical Engineering, Science and Health Systems
Drexel University

Sriram Balasubramanian, PhD
Associate Professor
School of Biomedical Engineering, Science and Health Systems
Drexel University

Early Onset Scoliosis (EOS) is an idiopathic disorder diagnosed in children under the age of ten years that is characterized by a three- dimensional deformity of the spine and rib cage. Thoracic insufficiency syndrome (TIS), commonly diagnosed in patients with EOS, describes how the physical deformity causes lung dysfunction and impaired lung growth. It has previously been hypothesized that surgical correction of spinal deformities can reverse pulmonary dysfunction, although measuring lung function via pulmonary function testing (PFT) in infants is quite difficult and not routinely done. In this study, we sought to further describe the relationships between EOS, thoracic deformity, and pulmonary function in three ways. First, we evaluated the pre- and postoperative differences in thoracic deformity of EOS patients. Second, we described the relationships between lung volumes calculated from CT scans (which are routinely collected for scoliosis patients) with pulmonary function measures collected clinically. Third, we developed multivariable models from thoracic deformity parameters that could be used to predict pulmonary function.

Overall, these goals were all met. Pre- and postoperative differences were seen in four thoracic deformity parameters (Haller, kyphosis-lordosis, pectus, and frontosagittal index), with the decrease in frontosagittal index being similar to the trend seen in normal patients over time. Additionally, computational lung volumes correlated strongly with five clinical measures of pulmonary function (residual volume, functional residual capacity, total lung capacity, forced vital capacity, and forced expiratory volume). Lastly, clinically relevant multivariable models were created for predicting five pulmonary function measures (forced expiratory volume, forced vital capacity, forced residual capacity, total lung capacity, and residual volume) from four predictor thoracic deformity parameters (Haller index, posterior hemithoracic symmetry ratio, rib hump index, and sternovertebral distance). These methods were limited by sample size and subjectivity of the calculations, so future work should look to increase the sample size and automate the calculation process. Overall, these results have the ability to guide surgical planning and provide clinicians with a comprehensive understanding of an EOS patient’s specific lung function.

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