• William J M Kinnear, Milind Sovani, Arun Khanna, and Juliet Colt.
• Nottingham NHS Treatment Centre, Nottingham, UK.
• Spine. 2018 Jul 1; 43 (13): 900-904.

Study DesignObservational study of ribcage motion in scoliosis.ObjectiveTo see whether noninvasive ventilation corrected paradoxical inward motion of the ribs during inspiration.Summary Of Background DataParadoxical inward motion of the ribs is observed after rib fractures, low cervical cord injury, and in chronic obstructive pulmonary disease. It is not well recognized in scoliosis and the mechanism in this group has not been studied.MethodsLinearized magnetometers were used to measure the diameter of the ribcage. Changes in diameter during tidal breathing were recorded during spontaneous ventilation and noninvasive ventilation in 10 subjects with idiopathic or congenital thoracic scoliosis.ResultsDuring spontaneous breathing, the median change in ribcage diameter during inspiration was -1.5 (range -2.3 to -0.8) cm. The median change in ribcage diameter during noninvasive ventilation was +0.5 (range -1.1 to +1.2) cm. Noninvasive ventilation improved paradoxical motion in all subjects, completely correcting it in six.ConclusionParadoxical inward motion of the ribcage is seen in some subjects with severe scoliosis. This abnormal motion is improved or abolished by noninvasive ventilation. Since noninvasive ventilation takes over the work of breathing from the respiratory muscles, we suggest that inspiratory muscle contraction causes distortion of part of the ribcage in scoliosis, probably because of the abnormal orientation of diaphragmatic muscle fibers.Level Of Evidence2.

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