Relief of central airways obstruction following spinal release in a patient with idiopathic scoliosis

Patients with idiopathic scoliosis are reported to have a restrictive pattern on pulmonary function tests. A case is presented of a teenage girl with juvenile idiopathic scoliosis who had evidence of airways obstruction in addition to restriction on pulmonary function tests (PFT). Examination of flow-volume loops suggested central airways obstruction. At the time of induction of anesthesia for the initial spinal release surgery, a double-lumen endotracheal tube could not be passed, despite fiberoptic visualization, because of extreme deviation of the left main-stem bronchus. Postoperatively, PFT demonstrated improved flows at high lung volumes and normalization of the shape of the flow volume loop. We suggest that preoperative PFT may be used to predict which patients have central airways obstruction. This may lessen unanticipated problems with intubation at the time of surgery and may identify patients who may expect immediate improvement in lung function after scoliosis repair.