Comparison of pulmonary function after inspiratory muscle training in patients with cervical myelopathy

Patients with cervical spine pathology can have respiratorysystem dysfunction due to weakness of respiratory muscles including diaphragmor involvement of the respiratory center and lower cranial nerves secondary tomedullary compression.Pulmonary aspiration, atelectasis, poor respiratory function, and inadequatecough mechanism secondary to the diaphragm or respiratory muscle involvementcan lead to preoperative respiratory abnormalities in patients with cervicalspine pathology that might get exaggerated in the postoperative period becauseof various anesthetic and surgical causes.

Respiratory function is controlled by the phrenic(C3–C5) nerves, the intercostals (T2–10) nerves,  and autonomic nerve, especially thesympathetic (T1–L3) nerves. Therefore, smooth and effective breathing undernormal conditions would be impaired by disrupting descending neural pathways atany level in the cervical spine.People with respiratory muscle weakness have a higher risk of PPCs. This isthought to be due to inspiratory muscle fatigue leading to the collapse ofalveoli.Even if the impairment of neural function was subclinical, the effect mightlead to the deterioration of pulmonary function during the acute postoperativestage. PPCs are comprised of atelectasis, bronchospasm, respiratory failure,pneumonia, and ARDS.

There are several techniques for preoperativerespiratory optimization. However, the commonly used IS had been found to havelittle benefit.IMT can be defined as a technique that aims to improve the function of theinspiratory muscles through specific breathing exercises to increase strengthand endurance of the respiratory muscles and therefore improve respiration.   Several authors have reported thatpreoperative IMT resulted in significant improvement in mean inspiratory musclestrength and endurance after thoracic and abdominal surgery without causing adverse effects.Preoperative IMT has been shown to decrease the incidence of PPCs in patientsundergoing cardiac and major abdominal surgery.Thus, it is reasonable to assume that an increase in inspiratory musclestrength and endurance through preoperative IMT can lead to betterâ€qualitydeep breathing after surgery, which would in turn result in a decreasedincidence of PPCs in patients with cervical myelopathy who have a pre-existing muscledysfunction.

There are no studies on the role of preoperativemuscle training with IMT in patients with cervical myelopathy. In the presentstudy, we have compared pulmonary function after IMT in cervical myelopathypatients and have looked for the incidence of PPCs.