Cardiopulmonary Consequences of Scoliosis and the Clinical Implications of VO2max: A Systematic Review.

INTRODUCTION: Multiple parameters, including VO2max, ventilatory efficiency, lung volumes, and exercise tolerance, have been examined, yet their progression with pediatric scoliosis remains unclear. Although pulmonary function tests are widely used, they may underestimate functional impairment, as spirometric measures can remain relatively preserved despite clinically meaningful reductions in exercise capacity. This review aims to define the extent of functional impairment, its association with curve severity, and the potential of VO2max as a marker of surgical recovery.

MATERIALS AND METHODS: We systematically searched PubMed, Embase, and Cochrane for eligible studies reporting cardiopulmonary outcomes in pediatric scoliosis. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools and the ROBINS-I risk-of-bias tool. Results were synthesized narratively following the Synthesis Without Meta-analysis guideline.

CONCLUSIONS: From 455 records, 6 studies met the inclusion criteria. Adolescents with idiopathic scoliosis consistently demonstrated reduced aerobic capacity, with mean VO2max values ranging from 27.9 to 33.6 mL kg-1·min-1, approximately 20-25% below reference norms, indicating mild-to-moderate cardiopulmonary impairment. Functional tests such as the 6-min walk and E-fit correlated strongly with VO2max, validating their use as practical surrogates of aerobic performance. Greater curve severity and thoracic deformity were associated with progressive reductions in forced expiratory volume in one second, forced vital capacity, and VO2max, reflecting restrictive ventilatory physiology. Postoperative studies showed stable but not improved VO2 or pulmonary function, suggesting that surgery preserves rather than enhances respiratory capacity. Exercise-based rehabilitation improved posture and endurance, though effects on VO2max remain inconclusive.A spectrum of cardiopulmonary parameters deteriorates with scoliosis progression. VO2 max may provide the most integrative marker of physiological burden, and prospective longitudinal data are required to establish its role in recovery after surgery.

KEY CONCEPT: (1)Adolescents with scoliosis exhibit clinically meaningful reductions in cardiopulmonary reserve, which may not be apparent on resting spirometry but become evident during exercise and directly influence perioperative physiological resilience.(2)Radiographic measures of deformity correction do not reliably reflect functional recovery, underscoring the limitations of relying on Cobb angle and pulmonary function tests alone when assessing surgical readiness and postoperative outcomes.(3)Cardiopulmonary exercise testing (CPET) provides an objective, integrative assessment of surgical fitness, allowing differentiation between ventilatory, cardiovascular, and peripheral contributors to exercise limitation, with VO2max serving as a robust summary metric.(4)Corrective scoliosis surgery appears to preserve rather than restore cardiopulmonary function, suggesting that preoperative physiological status may be a key determinant of postoperative recovery trajectory and length of convalescence.(5)Incorporation of VO2max into preoperative assessment and Enhanced Recovery After Surgery pathways may enhance risk stratification, inform prehabilitation strategies, and guide postoperative rehabilitation, enabling more individualized perioperative care for children and adolescents undergoing scoliosis surgery.