Changes in Lung Volume and Pulmonary Ventilation in Adolescents with Idiopathic and Neuromuscular Scoliosis after Surgical Correction of Spinal Deformity: Retrospective Cohort Study

Background. Neuromuscular scoliosis (NMS) is the most challenging form of the disease to correct. Unlike idiopathic scoliosis (IS), in NMS, skeletal deformity is accompanied by primary weakness of the intercostal muscles and diaphragm, impaired cough clearance, and a tendency toward hypoventilation. The outcomes of surgical correction of IS and NMS in age- and deformity severity-matched patient groups have not been previously studied.

Objective. The aim of the study is to compare changes in volumetric and density characteristics of lung tissue in adolescents with IS and NMS after surgical correction.

Methods. This study included data from patients aged 13–17 years with IS and NMS who underwent posterior spinal instrumentation due to thoracic/thoracolumbar scoliosis >40° between 2021 and 2024. The primary endpoint was the change in total lung volume (mL). Secondary endpoint included changes in right and left lung volumes (mL), as well as the proportion of density-defined lung parenchymal zones (% of normoventilated, hypoventilated, and atelectatic zones). Lung volume and pulmonary ventilation were assessed via CT volumetry before (no earlier than 2 months prior) and after surgery (no earlier than 2 weeks and no later than 3 months after the procedure).

Results. The outcomes of surgical correction of spinal deformity were studied in 30 patients with IS and 32 patients with NMS matched in gender, age, and degree of spinal deformity (Cobb angle). Baseline total lung volume in the NMS group was lower than in the IS group, with median values of 1084 (639; 1547) and 2041 (1580; 2509) mL, respectively (p < 0.001). After surgery, patients with NMS showed an increase in total lung volume of 110 mL (95% confidence interval [CI] 28 to 192, p = 0.002), whereas the IS group showed a decrease of 266 mL (95% CI –490 to –42; p = 0.012). At the same time, the proportion of normoventilated lung zones increased (right lung by 16.5%, left lung by 15.6%; p < 0.001) in patients with NMS, while the proportion of hypoventilated zones decreased (right lung by 15.0%, left lung by 9.3%; p < 0.001), as did the proportion of atelectatic zones (right lung by 4.8%, left lung by 6.9%; p<0.001). In the IS group, no significant changes in the distribution of lung density zones were observed, except for a decrease in the proportion of left-sided atelectasis from 5.1% to 2.3% (p = 0.044).

Conclusion. Surgical correction of scoliosis leads to different dynamics of lung volumetric and density characteristics in adolescents with NMS and IS. There is an increase in total lung volume, an increase in the proportion normoventilated zones, and a decrease in hypoventilated and atelectatic zones in NMS group, while in IS group there is a decrease in total lung volume and atelectatic zones without changes in other pulmonary ventilation parameters. The main limitations of the study are its retrospective design and the analysis of lung volumetric and density characteristics dynamics in early postoperative period.

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