Surgical Outcome of Correction of Adolescent Idiopathic Scoliosis

Abstract

Introduction

Professionals employ a variety of scoliosis classifications to aid in patient care and outcome prediction. The Lenke classification is being utilized for surgical planning. Discussing the surgical results of treating adolescent idiopathic scoliosis (AIS) and assessing their viability, effectiveness, and safety were the objectives of this study.

Methods

This prospective study was conducted on 30 patients with idiopathic scoliosis and cobb angle >40 °. All patients were subjected to imaging (plain X-ray radiography, computed tomography (CT) scan, magnetic resonance imaging (MRI) and 3D printed model spine).

Results

There was a positive correlation between height gain and degree of correction (r = 0.396, p = 0.030). There was a positive correlation between the number of fused levels and (postoperative height gain and postoperative shoulder balance) (P value < 0.05). There was a positive correlation between thoracoplasty and (postoperative height, postoperative cobb, 1year postoperative forced vital capacity (FVC) and postoperative pelvic incidence) (P value <0.05).

Conclusions

Surgical correction of AIS significantly improved spinal alignment, height, and deformity correction, with height gain influenced by factors such as the number of fused levels and preoperative cobb angle. While complications were minimal, thoracoplasty was linked to greater height gain but lower postoperative FVC, indicating potential effects on pulmonary function.

Resumo

Introdução

Os profissionais utilizam uma variedade de classificações de escoliose para auxiliar no tratamento do paciente e na previsão de resultados. A classificação de Lenke está a ser utilizada para o planeamento cirúrgico. Discutir os resultados cirúrgicos do tratamento da escoliose idiopática do adolescente (EIA) e avaliar a sua viabilidade, eficácia e segurança foram os objetivos deste estudo.

Métodos

Este estudo prospectivo foi realizado em 30 pacientes com escoliose idiopática e ângulo de Cobb > 40°. Todos os pacientes foram submetidos a exames de imagem (radiografia simples, tomografia computadorizada (TC), ressonância magnética (RM) e modelo de coluna vertebral impresso em 3D).

Resultados

Houve correlação positiva entre o ganho de altura e o grau de correção (r = 0,396, p = 0,030). Houve correlação positiva entre o número de níveis fundidos e (ganho de altura pós-operatório e equilíbrio do ombro pós-operatório) (valor de p < 0,05). Houve correlação positiva entre toracoplastia e (altura pós-operatória, Cobb pós-operatório, capacidade vital forçada (CVF) pós-operatória de 1 ano e incidência pélvica pós-operatória) (valor de p < 0,05).

Conclusões

A correção cirúrgica da AIS melhorou significativamente o alinhamento da coluna, a altura e a correção da deformidade, com o ganho de altura influenciado por fatores como o número de níveis fundidos e o ângulo de Cobb pré-operatório. Embora as complicações tenham sido mínimas, a toracoplastia foi associada a maior ganho de altura, mas menor CVF pós-operatória, indicando potenciais efeitos na função pulmonar.

Keywords

adolescent idiopathic scoliosis - cobb angel - lenke classification - clavicular angle

Palavras-chave

escoliose idiopática do adolescente - cobb angel - classificação de lenke - ângulo clavicular

Introduction

The word “scoliosis” is derived from the Greek word “skoliosis,” which means crooked. It is a complicated three-dimensional spinal deformity that is typically linked to a decrease in the spine's normal kyphotic curvature and is defined by a lateral deviation of at least 10 degrees with a rotation of the vertebra.[1]

To determine the degree of scoliosis, we must first determine which vertebrae are the terminal vertebrae, or the vertebrae whose endplates are most slanted toward one another. This is known as the Cobb angle. After that, lines are drawn along the endplates, and the angle formed by the intersection of the two lines is measured. Two further lines can be plotted, each at a right angle to the preceding lines, if the curvature is not indicated because the lines will not overlap on the film or monitor.[1]

According to recent research, the total prevalence of adolescent idiopathic scoliosis (AIS) ranges between 0.47 to 5.2%. Girls with a female to male ratio of 1.5:1 to 3:1 are frequently affected by AIS. 90% of presentations will display a right-sided thoracic curve, and this percentage rises significantly with age.[2]

Due to early physiological puberty and the progression of the spine's curvature during puberty, adolescent girls are more susceptible to idiopathic scoliosis. It is thought that the fact that girls typically grow more than boys between the ages of 11 and 13 explains why scoliosis is more common in females than in boys.[3]

AIS most likely stems from a confluence of environmental and genetic factors. According to studies, the aberrant spine curvature could be caused by hormonal issues, aberrant muscle or bone formation, anomalies in the neurological system, or other unidentified reasons.[4]

Professionals employ a variety of scoliosis classifications to aid in patient care and outcome prediction. The Lenke classification is being utilized for surgical planning.[5]

Three elements make up the Lenke classification developed by Lenke et al.[6] kinds of curves (1–6): according to the structural and affected areas of the spine.[5] Modifiers for the lumbar spine (A, B, C): based on how the lumbar curve and the central sacral vertical line (CSVL) relate to one another.

Modifier CSVL Position. CSVL passes between pedicles of the apical lumbar vertebra, CSVL touches the apical vertebra and CSVL is completely lateral to the apical vertebra.[5] Sagittal thoracic modifier (-, N, +): Based on thoracic kyphosis (T5–T12).[6]

To assist surgeons in assessing the degree of spinal instrumentation, this categorization was created. The majority of patients first show up because of malformation.[6]

In X-ray imaging, the Cobb method is used to quantify the curve's degree while standing anteriorly and posteriorly. To measure any sagittal abnormalities, a standardized lateral radiograph is used. The pelvis should be included in these entire spine X-rays to evaluate the ossification of the iliac crest and determine the Risser's sign (growth status). To evaluate the curve's flexibility, get bending films.[5]

The three Os observation, orthosis (bracing), and operative treatment can be used to sum up the primary scoliosis treatment options. Observing patients with curves less than 25 degrees, bracing patients between 25 and 40 degrees, and doing surgery on patients with curves larger than 40 degrees are frequent treatment-guiding protocols.[7]

A few studies on the assessment and possible classification of AIS using three-dimensional language and approaches have been published in recent years. The spine should be evaluated using magnetic resonance imaging (MRI) and computed tomography (CT) scans.[8]

The aim of this study was to examine the surgical results of AIS repair and assess their viability, effectiveness, and safety.

Methods

This prospective study involved 30 individuals of both sexes, aged 10 to 18, who had idiopathic scoliosis with a Cobb angle greater than 40 degrees.

Cobb angle <40 °, congenital abnormalities, anesthetic contraindication, coagulopathy, osteoporosis, and patients younger than 10 or older than 18 years were the exclusion criteria.

Laboratory tests (complete blood count (CBC), pulmonary function test, forced vital capacity (FVC), liver, kidney function tests, blood glucose, and international normalized ratio (INR)) and imaging (plain X-ray radiography, CT scan, and MRI, and 3D printed spine) were performed on all patients; their histories were thoroughly taken.

The primary radiologic method for assessing AIS cases is plain X-ray radiography. From the occiput to the mid-femur, the first posteroanterior and lateral 36- x 14-inch standing long cassette images are acquired. Updated standing anteroposterior view (AP), lateral scoliosis, and lateral bending radiographs were acquired after a patient was deemed an operative candidate. These radiographs were used to evaluate the curve's progression and flexibility, distinguishing between structural and non-structural curves for classification and operative planning. By measuring the cobb angle of the aberrant curves and computing the clavicular angle (CA), AP is used to determine the kind and apex of the curve. Radiographs of the hand and iliac bones are also used to assess age-related skeletal maturity. Spino-pelvic characteristics and thoracic kyphosis are measured using the lateral view.

CT scan: to measure the length of the vertebral body in axial view and the size of the pedicles to determine the degree of vertebral rotation and choose the right screw. In every instance, it was done.

MRI: recommended when individuals with idiopathic scoliosis have neurologic symptoms as well as let-sided, sharp, angular, or irregular curvature patterns.

3D printed model spine: by using CT scan of spine for creation of patient specific models for preoperative planning purposes and to identify pedicles entry, vertebral rotation and improving surgical accuracy.

To improve the fluoroscopic image, all patients were told to fast the night before the procedure and have an enema to clear their colons. The specifics of the procedure and any potential risks were explained to each patient. Consent in writing regarding the process and development of this research was acquired.

Third-generation cephalosporin antibiotics are used as prophylactic antibiotics throughout the procedure, which is performed under general anesthesia.

To minimize pressure neuropathy, patients were positioned prone on a Jackson table, making sure that all pressure points were cushioned.

Saturation, blood pressure, and heart rate are continuously monitored after the process begins. Somatosensory evoked potential, motor evoked potentials, electromyographic monitoring, and c-arm guided fluoroscopy were used in all procedures.

Patients were prepared and draped in a sterile fashion. All surgeries were performed using a posterior midline incision with sub periosteal dissection.

In cases of thoracic rib hump prominence and sever vertebral rotation thoracoplasty was done to facilitate later correction and derotation after that patient underwent posterior laminectomies, facetectomies, posterior pedicle screw fixation (@Medtronic).

Using upright AP and lateral radiographs, intraoperative fluoroscopy, or triggered electromyograms, the surgical location of pedicle screws was verified. Rod implantation and deformity correction come next.

For additional proof of intact motor power, a neuromonitoring check was conducted on all patients right after curve rectification. a last stage of allograft placement and bone decortication for bony fusion. Following that, skin closure and anatomic reconstruction are performed.

Post Procedure Care

Following surgery, all patients were admitted to the pediatric or neurologic intensive care unit. All patients were urged to walk as much as they could on the first day following the operation. After surgery, drains were removed for two to five days.

Prior to discharge, each patient's immediate postoperative height was measured using standing anteroposterior and lateral standing scoliosis radiographs. To evaluate alignment, curve correction preservation, and hardware placement, repeat standing radiographs were taken six weeks, three months, six months, and a year following surgery.

Follow Up

It was performed at regular intervals for 6 weeks, 3 months, 6 months and 1 year after. In each time the patient was evaluated as follows: neurological examination, Plain X-ray: were performed for all cases with each follow up visit to assess preservation of curve correction, cobb angle, shoulder level by measuring CA and spino-pelvic parameters. Pulmonary function test was observed especially FVC at 1.5 months, 6 months and 1year.

Statistical Analysis

Statistical analysis was performed using SPSS version 26 (IBM Inc., Chicago, IL, USA). Normality of data distribution was assessed using histograms and the Shapiro-Wilks test. The paired t-test was applied for comparing parametric quantitative data (presented as mean ± SD), while the Wilcoxon test was used for non-parametric data (presented as median and IQR). Categorical variables were compared using the Chi-square test and expressed as frequency and percentage. A two-tailed P value < 0.05 was considered statistically significant. Correlation analyses utilized Spearman's rank for non-normal or non-linear data and Pearson's correlation for normally distributed linear data. Univariate regression assessed relationships between single independent and dependent variables, while multivariate regression evaluated associations involving multiple independent variables.

Results

The age with a mean ± SD of 13.2 ± 2.71 years. There were 3 (10%) male and 27 (90%) female. The weight with a mean ± SD of 57.9 ± 12.64 kg. [Table 1]

Table 1 Demographic data of the studied patient

		(n = 30)
Age (years)		13.2 ± 2.71
Sex	Male	3 (10%)
	Female	27 (90%)
Weight (kg)		57.9 ± 12.64

Data are presented as Mean ± SD, Frequency (%).

Baseline features, Risser, sander and lenke classification of the studied patient were enumerated in [Table 2]

Table 2 Baseline features, Risser, sander and lenke classification of the studied patient

		(n = 30)
Number of fused levels		11 ± 2.53
Thoracoplasty		13 (43.33%)
Levels of thoracoplasty	4	5 (16.67%)
	5	5 (16.67%)
	6	2 (6.67%)
	7	1 (3.33%)
LIV		2.9 ± 0.91
Risser	0	2 (6.67%)
	1	2 (6.67%)
	2	2 (6.67%)
	3	3 (10%)
	4	(33.33%) 10
	5	(36.67%)11
Sanders	2	(6.67%)2
	3	(10%)3
	4	(6.67%)2
	5	(6.67%)2
	6	(13.33%)4
	7	(33.33%)10
	8	(23.33%)7
Lenke classification (Curve type)	1	19 (63.33%)
	2	3 (10%)
	3	2 (6.67%)
	5	2 (6.67%)
	6	4 (13.33%)
Lumber modifier	A	16 (53.33%)
	B	2 (6.67%)
	C	12 (40%)
Sagittal modifier	Normal	23 (76.67%)
	Negative	7 (23.33%)

Data are presented as Mean ± SD, Frequency (%), LIV: Lower instrumented vertebra.

Height was significantly higher postoperative than preoperative (P value <0.001). Sh.CA was significantly lower postoperative than preoperative (P value <0.001) improved shoulder balance. FVC was significantly lower at 1.5 months postoperative than preoperative then improved gradually over 6 months and 1 year postoperative. LL and pelvic incidence (PI) were significantly lower postoperative than preoperative (P value <0.001). Pelvic tilt (PT) was insignificantly different between preoperative and postoperative. Cobb angle was significantly lower at (immediate postoperative and after 1 year postoperative) than preoperative (P value <0.001) and was insignificantly different between immediate postoperative and after 1 year postoperative. [Table 3]

Table 3 Height, Sh.CA, FVC, spinopelvic parameters and Cobb angle of the studied patient

		Preoperative	Postoperative		P value
Height (m)		1.5 ± 0.08	1.6 ± 0.07		<0.001[*]
Sh.CA (∘)		7.3 ± 1.86	4.2 ± 1.5		<0.001[*]
FVC
FVC (L)	Preoperative (n = 30)	3.7 ± 0.67			—
	1.5 months postoperative (n = 30)	3.3 ± 0.55			<0.001[*]
	6 months postoperative (n = 30)	3.5 ± 0.56			0.005[*]
	1 year postoperative (n = 30)	3.58 ± 0.68			<0.001[*]
Spinopelvic parameters
		Preoperative	Postoperative		P value
LL (∘)		57.7 ± 6.57	46.7 ± 5.07		<0.001[*]
PI (∘)		57.3 ± 8.55	51.7 ± 7.09		<0.001[*]
PT (∘)		15.6 ± 7.3	14.5 ± 6.08		0.487
Cobb angle
	Preoperative	Postoperative		P value	Post hoc
Cobb angle (∘)		Immediate	After 1 year
		52.6 ± 10.65	9.4 ± 5.89	7.5 ± 5.86	<0.001[*]	P1 < 0.001[*] P2 < 0.001[*] P3 = 0.625

Data are presented as Mean ± SD.

^* Significant as P value ≤ 0.05, Sh.CA: Shoulder balance clavicular angle, FVC: Forced vital capacity, LL: Lumbar lordosis, PI: Pelvic incidence, PT: Pelvic tilt.

FVC was significantly lower in patients with thoracoplasty than in patients without thoracoplasty (P value 0.002). Immediate postoperative cobb and cobb after 1 year postoperative were insignificantly different between patients with thoracoplasty and patients without thoracoplasty. Preoperative cobb's angel was insignificantly different between patients who lost <500 cc blood and patients who lost 500–1000 cc blood and was significantly higher in patients who lost >1000 cc blood than (patients who lost <500 cc blood and patients who lost 500–1000 cc blood) (P value < 0.001). There was a positive correlation between height gain and degree of correction (r = 0.396, p = 0.030). Lenke classification type (I, II and VI) was significantly higher postoperative height than preoperative height (P value≤0.05). Lenke classification type III and V were insignificantly different between preoperative and postoperative height. [Table 4]

Table 4 Blood loss, intraoperative complications, relation between thoracoplasty and (FVC change and cobb change), relation between blood loss and preoperative cobb angel, relation and correlation between degree of correction and height gain and relation between lenke classification and (preoperative and postoperative height) of the studied patient

Blood loss and intraoperative complications (n = 30)				(n = 30)
Blood loss			<500 cc	8 (26.67%)
			500-1000 cc	16 (53.33%)
			>1000 cc	6 (20%)
Pneumothorax				1 (3.33%)
Dural tear				2 (6.67%)
Relation between thoracoplasty and (FVC change and cobb change) (n = 13)					P value
FVC (L)				3.04 ± 0.4	0.002*
Immediate postoperative cobb (∘)				9.31 ± 6.17	0.963
Cobb after 1 year postoperative (∘)				7.15 ± 5.19	0.783
Relation between blood loss and preoperative cobb angel
		<500 cc (n = 7)	500-1000 cc (n = 17)	>1000 cc (n = 6)	P value
Cobb's angel (∘)		44 ± 2.38	51.1 ± 8.44	66.8 ± 8.33	<0.001*	P1 = 0.106 P2 < 0.001* P3 < 0.001*
Relation and correlation between degree of correction and height gain
	25-34° (n = 4)	35-44° (n = 14)	45-54° (n = 5)	55-64° (n = 4)	65-72° (n = 3)	P value
Height gain (%)	5.4 ± 1.13	5.5 ± 0.87	5.9 ± 0.77	6 ± 0.8	6.4 ± 0.67	0.391
Correlation between degree of correction and height gain				r = 0.396		P = 0.030*
Relation between lenke classification and (preoperative and postoperative height)
	I (n = 19)	II (n = 3)	III (n = 2)	V (n = 2)	VI (n = 4)	P value
Preoperative height (m)	1.52 ± 0.08	1.59 ± 0.04	1.64 ± 0.06	1.55 ± 0.05	1.5 ± 0.08	0.169
Postoperative height (m)	1.61 ± 0.07	1.66 ± 0.03	1.65 ± 0.18	1.63 ± 0.07	1.62 ± 0.08	0.674
P'	<0.001*	0.007*	0.889	0.111	0.003*

Data is presented as Mean ± SD, Frequency (%), *significant as P value ≤ 0.05, r: correlation coefficient, FVC: forced vital capacity, P': P value between preoperative and postoperative height.

There was no correlation between the number of fused levels and (age, weight, postoperative cobb, 1.5 months postoperative FVC, postoperative CA, postoperative LL and postoperative PI). There was a positive correlation between the number of fused levels and (postoperative height gain and postoperative PT) (P value < 0.05). There was no correlation between thoracoplasty and (age, weight, postoperative CA, postoperative LL and postoperative PT). There was a positive correlation between thoracoplasty and (postoperative height, postoperative cobb, 1year postoperative FVC and postoperative PI) (P value < 0.05). [Table 5]

Table 5 Correlation of studied parameters with number of fused levels and thoracoplasty

Number of Fused levels	Number of fused levels
	r	P value
Age	0.059	0.753
Weight	0.217	0.249
Postoperative height	0.435	0.016*
Postoperative cobb	−0.249	0.179
1.5 months postoperative FVC	−0.252	0.179
Postoperative CA	−0.078	0.683
Postoperative LL	−0.121	0.528
Postoperative PI	0.121	0.523
Postoperative PT	0.480	0.007*
Thoracoplasty
Age	−0.051	0.789
Weight	−0.152	0.424
Postoperative height	0.394	0.031*
Postoperative cobb	0.453	0.012*
1year postoperative FVC	0.457	0.011*
Postoperative CA	−0.173	0.362
Postoperative LL	−0.312	0.093
Postoperative PI	0.466	0.009*
Postoperative PT	−0.285	0.127

Data are presented as numbers.

*Significant as P value ≤ 0.05, r: correlation coefficient, FVC: forced vital capacity, CA: Clavicular angle, LL: Lumbar lordosis, PI: Pelvic incidence, PT: Pelvic tilt.

Age, weight, number of fused levels, preoperative cobb angle, preoperative CA, preoperative LL, preoperative PI, and preoperative PT were utilized in regression analysis to predict the factors influencing height gain. Only in univariable analysis was CA seen as a predictor of considerable height increase; in univariate and multivariable analysis, the number of fused levels and preoperative Cobb angle were regarded as predictors of significant height gain. [Table 6]

Table 6 Regression analysis for prediction of height gain

	Univariate			Multivariate
	Odds ratio	95% CI	P	Odds ratio	95% CI	P
Age	0.872	0.659-1.153	0.336	—	—	—
Weight	0.958	0.90-1.02	0.181	—	—	—
Number of fused levels	0.668	0.467-0.955	0.027*	1.552	0.999–2.335	0.049*
Preoperative cobb angle	0.869	0.776-0.972	0.014*	0.852	0.734–0.990	0.037*
Preoperative CA	2.015	1.149-3.532	0.015*	1.827	0.917–3.639	0.192
Preoperative LL	0.975	0.872-1.091	0.663	—	—	—
Preoperative PI	0.953	0.872-1.042	0.290	—	—	—
Preoperative PT	0.991	0.896-1.097	0.863	—	—	—

Data are presented as numbers.

*Significant as P value ≤ 0.05, CI: Confidence interval, CA: Clavicular angle, LL: Lumbar lordosis, PI: Pelvic incidence, PT: Pelvic tilt.

Age:12years, gender: female, height: 142cm, weight: 37kg, Lenke type: 1A, Risser grade: 5, preoperative cobbs angle: 60 degrees, clavicular angle: 6 degrees with elevated RT shoulder, C/O: back pain, back disfigurement, and shoulder imbalance. Fusion was done from D4 to L3. Postoperative cobbs angle becomes 15-degree, clavicular angle become 2 degree and height 145cm. [Fig. 1]

Fig. 1 (A) Preoperative and (B) Postoperative Xray AP view.

Discussion

AIS is an abnormal curvature of the spine that appears in late childhood or adolescence. Instead of growing straight, the spine develops a side-to-side curvature, usually in an elongated “S” or “C” shape; the bones of the spine are also slightly twisted or rotated.[9]

The current study indicated that FVC was significantly lower in patients with thoracoplasty than in patients without thoracoplasty in immediate postoperative period.

Thoracoplasty is a surgical procedure often performed during scoliosis surgery to reduce rib hump deformity by removing portions of the posterior ribs. While this improves cosmetic appearance, it has implications for pulmonary function, especially FVC.[10]

A previous study by Kumar et al.[11] indicated that thoracoplasty lead to a significant decrease in percent-predicted FVC postoperatively in patients with AIS.

Conversely, Akazawa et al.[12] found no significant differences in FVC changes between patients who underwent thoracoplasty and those who did not .These discrepancies suggest that the effect of thoracoplasty on FVC may vary depending on individual patient factors and surgical techniques.

In the present study, preoperative cobb's angel was insignificantly different between patients who lost <500 cc blood and patients who lost 500–1000 cc blood and was significantly higher in patients who lost >1000 cc blood than (patients who lost <500 cc blood and patients who lost 500–1000 cc blood). There is a direct correlation between preoperative Cobb angle and intraoperative blood loss in scoliosis surgery. Larger Cobb angles typically result in greater blood loss.

In the same manner, Rajanigandha et al.[13] observed that Cobb's angle was positively correlated with mean intraoperative blood loss.

Also, Shirasawa et al.[14] illustrated that the preoperative Cobb angle was significantly associated with intraoperative total blood loss.

In the present study, there was a positive correlation between height gain and degree of correction. Lenke classification type (I, II and VI) was significantly higher postoperative height than preoperative height.

There is a notable relationship between the Lenke classification of scoliosis, and the amount of height gain observed after corrective surgery. This is primarily due to differences in: curve location and severity, number of structural curves, extent of correction possible and levels fused.

The majority of scoliosis patients with Lenke types 1 and 2 acquire up to 3 cm following surgery, but the majority of patients with Lenke types 3, 4, and 6 gain more than 3 cm, according to a prior study by Smorgick et al.[15] Additionally, they discovered that the average height gain following surgery was roughly 3.85 cm, and that there were noteworthy correlations between height gain and variables including the number of fused levels, the preoperative thoracic curve, the thoracolumbar curve, the thoracic kyphosis, and the flexibility of the main curves.

The current study indicated that there was a positive correlation between number of fused levels and (postoperative height and postoperative PT).

This agreed with Smorgick et al.[15] who found a statistically significant correlation between height gain and number of fused levels

Also, Harada et al.[16] revealed that immediately postoperatively, patients with 3 or more level fusions had significantly greater PT.

According to our findings, there was a positive correlation between thoracoplasty and (postoperative height gain, cobbs angle, 1-year postoperative FVC and postoperative pelvic tilt).

Supporting our findings, Ahmed et al.[17] revealed that patients with AIS who underwent thoracoplasty showed greater improvements in Cobb angles after surgical intervention

In the same line, Yuan et al.[10] reported that modified thoracoplasty provides enhanced correction of thoracic curve and rib hump deformity in scoliosis patients.

In the current study, in univariate regression, number of fused levels, preoperative cobb angle and preoperative CA were independent predictors of height gain. In multivariate regression, the number of fused levels and preoperative cobb angle were independent predictors of height gain while preoperative CA was not. Preoperative cobb angle and number of fused levels were the most important predictors of height gain after surgery.

In the same line, Langlais et al.[18] revealed that the best predictors of height gain due to surgical correction are the number of fused vertebrae and the degrees of the corrected cobb angle.

In agreement with our findings, Ali et al.[19] observed that the higher number of fused levels and cobb angle degree were considered as predictors of significant height gain in uni- and multivariable analyses.

Limitations of the study included that the sample size was relatively small. The study was in a single center that may result in different findings than elsewhere. Patient-reported outcomes, including pain levels and physical function were not analyzed.

Conclusions

The surgical correction of AIS demonstrated significant improvements in spinal alignment, height gain, and overall deformity correction. Postoperatively, height increased significantly, and cobb's angle was effectively reduced, maintaining stability over time. The number of fused levels, preoperative cobb angle, and preoperative CA were significant predictors of height gain, reinforcing the importance of careful preoperative assessment. Despite improvements in posture and alignment, FVC was lower postoperatively, suggesting a potential impact on pulmonary function. The presence of thoracoplasty was associated with lower postoperative FVC and better height gain, highlighting its role in surgical planning. Blood loss varied among patients, with a majority experiencing moderate intraoperative bleeding. Complications were minimal, with pneumothorax and dural tears occurring in a small percentage of cases. Additionally, there is a positive correlation between the number of fused levels and postoperative height gain and PT.

Conflict of Interests

The authors have no conflict of interests to declare.

Ethical Aspects

According to the Ethical Committee of Tanta University in Tanta, Egypt, the study was conducted between March 2023 and March 2025. Written informed consent was acquired from the patient or their family members.

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Publication History

Received: 23 June 2025

Accepted: 10 November 2025

Article published online:
29 December 2025