Respiratory and Cardiovascular Consequences of Scoliosis

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Abstract
Observations were made on a series now comprising 500 patients with scoliosis studies at the Brompton Hospital by Dr. P. A. Zorabover a period of eight years. Most of the patients are under the age of 20 years. Detailed studies of lung function were performed on all patients, of these two-thirds had congenital or idiopathic scoliosis, and one-third had paralytic scoliosis. The results on the first 200 subjects are illustrated in the accompanying slides. The chest X-ray can be very informative if one shoulder is rotated slightly forward to move the curved spine posteriorally. The cardiac outline of lung markings are usually normal but the extra and intrapulmonary arteries may be small in severely handicapped patients. Lung function tests show a total lung capacity, vital capacity and maximum breathing capacity which is reduced in proportion to the degree of curvature. The loss was more marked in severe paralytic scoliosis compared with other types. Airways resistance is altered in proportion to lung volume. The difficulty of predicting the expected normal values in patients with curved spines will be discussed. Carbon dioxide retention, hypoxia and respiratory failure are very common under the age of 20, but may occur suddenly in older patients in their fourth or fifth decades. Cardiac disorders are found with some frequency in patients with scoliosis. They may occur in conditions such as Marfan’s Syndrome or Friedreich’s Ataxia in which scoliosis is also part. Diagnostic procedures, including the electrocardiograph, can be interpreted in the same fashion as in normal subjects. Right heart failure in the absence of congenital heart disease in the young scoliotic is rare. Autopsies have been performed on patients with scoliosis who have died from congenital heart disease, during surgery or from other causes. The lungs were distorted and of unequal size due to the curvature. The injection arteriogram is abnormal with failure of development of vessels of all sizes. The total number of alveoli is reduced and the sizes of the alveoli are very irregular though the mean size is normal for the age of the patient. These findings suggest failure of the normal post-natal alveolar development in severe scoliosis beginning in infancy. In the case of late onset scoliosis, evidence is found of atrophy of pulmonary parenchyma. The small blood vessels are reduced in number and have thicker walls but there is no relationship between muscular hypertrophy of the arteries and the right ventricle.

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