Growth-Friendly Surgery Improves Diaphragm Positioning, Thoracic Dimensions, and Patient-Reported Outcomes in...

Neuromuscular scoliosis (NMS) can displace the diaphragm into the thorax, reducing lung volume and impairing respiration. As an alternative to posterior spinal fusion, growth-friendly surgery (GFS) allows thoracic growth while correcting deformity. We evaluated associations of GFS with thoracic dimensions and diaphragm positioning, hypothesizing that GFS would alleviate respiratory constraints in pediatric NMS.

We reviewed data from 45 patients who underwent GFS for NMS at a mean age of 8 years, from 2003 to 2022. Radiographic measures were lung volume, space available for lung (SAL) ratio, diaphragm intrusion index (DII), diaphragm vertebral level (DVL), T1-T12 height, and T1-S1 height, assessed preoperatively, postoperatively, and at 2-year follow-up. We also analyzed Early-Onset Scoliosis 24-item Questionnaire (EOSQ-24) outcomes related to lung function. A "latest follow-up" time point was included for patients with extended data (mean: 7.2 years; range: 2.0-18.5). Paired t tests compared preoperative and follow-up values. Alpha = 0.05.

Mean lung volume increased from 1,992 cm³ preoperatively to 2,917 cm³ postoperatively and 3,210 cm³ at 2 years (p < 0.001), remaining stable (3,590 cm³) at latest follow-up. SAL ratio improved from 0.79 preoperatively to 0.91 postoperatively and 0.89 at 2 years, with no change at final follow-up. DII improved from 0.59 (right) and 0.56 (left) preoperatively to 0.69 (right) and 0.70 (left) at 2 years, with no decline thereafter (p < 0.001). DVL showed bilateral descent by approximately 1.3 vertebral levels through 2 years and remained stable. T1-T12 and T1-S1 heights increased to 21 and 34 cm, respectively, at 2 years (p < 0.001). EOSQ-24 scores improved postoperatively, with further gains by 2 years in energy (from 55 to 83), pulmonary function (from 69 to 94), and fatigue (from 48 to 19).

GFS was associated with improvements in thoracic dimensions, diaphragm position, lung volume, and respiratory-related quality of life in pediatric NMS, underscoring the potential of GFS to address deformity and long-term respiratory health in this population.

Level III. See Instructions for Authors for a complete description of levels of evidence.