Predicting postoperative pulmonary function improvement in pediatric scoliosis using 3-dimensional computed tomography analysis.

BACKGROUND

Thoracic scoliosis is associated with pulmonary function impairment, yet the predictive value of thoracic deformity parameters remains unclear. This study aimed to evaluate whether 3-dimensional computed tomography (3D-CT) analysis predicts postoperative pulmonary function improvement in pediatric patients with thoracic scoliosis.

METHODS

This retrospective cohort study included 67 pediatric patients with thoracic scoliosis who underwent posterior spinal fusion. All patients completed preoperative and 2-year postoperative pulmonary function tests (PFTs), radiographs, and low-dose chest CT scans. 3D-CT was used to assess lung volume (LV), airway dimensions, and rib cage parameters. Patients were grouped into adolescent idiopathic scoliosis (AIS, n = 56) and non-AIS (n = 11) cohorts. Correlations were determined between anatomical deformities and changes in pulmonary function using Spearman's rank correlation coefficient.

RESULTS

Surgical correction significantly improved thoracic Cobb angle and PFT values. Preoperative LV and bronchial cross-sectional area (CSA) correlated positively with postoperative FVC%. Rib cage deformity metrics-including apical rotation angle, vertebra-sternum angle, and spinal penetration index-were associated with greater FVC% improvement. Correction of thoracic hypokyphosis toward a more physiological kyphosis was also significantly linked to postoperative pulmonary function gains. Subgroup analysis indicated that non-AIS patients, although presenting with more severe deformities and poorer baseline function, achieved greater improvements postoperatively, yet still had inferior outcomes compared with AIS patients.

CONCLUSIONS

This study showed that 3D low-dose CT imaging provides critical insights into the relationship between thoracic deformity and pulmonary function in pediatric scoliosis. Preoperative lung volume strongly predicted postoperative outcomes, and patients with more severe deformities had lower baseline function but greater improvement after surgery. Correction of thoracic hypokyphosis toward an acceptable kyphosis enhanced thoracic cavity configuration and pulmonary capacity. These results highlight the importance of detailed preoperative assessment and precise surgical planning. Incorporating 3D imaging may help tailor corrective strategies, particularly in non-idiopathic scoliosis with complex deformities and potential for greater functional recovery.

TRIAL REGISTRATION: Not applicable.