Pulmonary function does not improve after 10 years of posterior spinal fusion in adolescent idiopathic scoliosis: a systematic review and meta-analysis.

PURPOSE

This systematic review and meta-analysis aimed to comprehensively assess the medium- and long-term effects of PSF on respiratory function in patients with adolescent idiopathic scoliosis (AIS) through a systematic review and meta-analysis.

METHODS

Four major databases were searched. Mean differences and differences with 95% confidence intervals (CIs) were calculated. The meta-analysis was performed using Review Manager version 5.4. The risk of bias was assessed using MINORS criteria. Random-effects meta-analyses were conducted across the follow-up periods. Subgroup and sensitivity analyses considered the magnitude of the curve correction.

RESULTS

Nineteen studies comprising 1413 patients treated with PSF were included. Meta-analyses found no significant differences in %FVC between pre- and post-PSF follow-up to 2 years (MD 0.40, 95%CI -1.65 to 2.45), around 5 years (MD 1.02, 95%CI -1.59 to 3.62), and 10 or more years (MD -2.90, 95%CI -5.98 to 0.18). No significant differences were found in %FEV1. Similarly, %TLC showed no significant difference at 2 years (MD -2.75, 95%CI -7.20 to 1.71). Short-term follow-up up to 1 year demonstrated some degree of pulmonary function loss for both %FVC (MD 12.37, 95%CI 6.72 to 18.03) and %FEV1 (MD 12.42, 95%CI 2.48 to 22.35).

CONCLUSIONS

This rigorous meta-analysis demonstrates that PSF does not enhance respiratory function in AIS patients in either the short- or long-term, as assessed using current static pulmonary metrics. Future studies should explore non-fusion alternatives and their effects on lung health.