What Are the Effects of Posterior Corrective Surgery, With or Without Thoracoplasty, on Pulmonary Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis

Abstract

Study Design Systematic review and meta-analysis Objectives This study’s objective is to provide a critical review of the current literature regarding the changes in pulmonary function (PF) in Adolescent idiopathic scoliosis (AIS) patients who have undergone posterior spinal fusion and instrumentation (PSF), with and without thoracoplasty (TP). Methods A comprehensive search was performed using the following databases: EMBASE, PubMed, EBSCOhost (CINAHL and Medline) and OpenGrey. Our focus was on studies that compared pre-and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume in 1 second (%FEV1) in AIS patients who had undergone PSF, with and without TP, with a minimum 2-year follow-up. The risk of bias for included studies was assessed using the ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”) tool. Mean change scores were depicted using forest plots. Results Fifteen studies met our inclusion criteria. The results of our analysis suggest that PSF with TP caused a significant deterioration of %FVC in individuals with moderate AIS, with no significant effect on %FEV1. It also showed a minor improvement of FEV1% in individuals with moderate AIS after PSF only, but no significant change in %FVC. Conclusions PSF with TP caused a significant deterioration of % FVC while PSF alone caused a minor improvement of FEV1% in individuals with moderate AIS with a minimum 2-year follow-up.

In-office Maximal Voluntary Ventilation Testing Demonstrates Pulmonary Improvement Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

“…For example, measuring VO2 max would require additional equipment, time, and resources that are likely not available in most outpatient orthopaedic clinical settings. Some prior studies have shown no improvement in PFTs after surgical intervention in patients with AIS, including a 2023 systematic review and meta-analysis, which found that patients who underwent PSF alone had no significant change in %FVC with a minimum of 2-year follow-up after surgery, 15 which may suggest that MVV is a more sensitive test for measuring changes in pulmonary function in this patient population. In the group of patients who had no curve progression, pulmonary function also improved significantly by 12%, presumably due to growth and maturation.…”

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

“…A range of treatments for AIS are available and these range from exercises to bracing and finally surgery for those with severe disease and a large degree of deviation (i.e., Cobb angle) ( Day et al, 2019 ; Kaelin, 2020 ; Dufvenberg et al, 2021 ; Bowden et al, 2022 ; Park et al, 2022 ; Seleviciene et al, 2022 ; Turner et al, 2022 ; Zaina et al, 2022 ). For those patients with severe disease and needing surgery, the implantation of rods and screws can alleviate the curvature-associated complications but can also affect quality of life during post-skeletal maturity.…”