Literature review: Early-onset Scoliosis and the Space Available for Lung (SAL) post-surgery

Background: Early-onset scoliosis (EOS) poses significant risks to thoracic development and pulmonary function in children due to the deformities’ impact on the space available for lung (SAL). Various surgical techniques, including growth-sparing methods like growing rods, vertical expandable prosthetic titanium ribs (VEPTR), and the Shilla system, aim to correct spinal deformities while allowing for thoracic growth. This literature review explores the efficacy of these interventions in improving SAL and lung function, as measured by forced vital capacity (FVC) and other pulmonary outcomes. Studies indicate that growth-friendly techniques are associated with substantial improvements in SAL, with growing rods showing an average 30% increase in thoracic volume and a corresponding improvement in pulmonary function. VEPTR has been similarly effective in increasing thoracic volume by 25% in patients with thoracic insufficiency syndrome. The Shilla system offers advantages in maintaining spinal correction while promoting growth but has been noted for potential complications like metal debris. Conclusion: Despite these advances, complications such as hardware failure and the need for revision surgeries remain concerns. This review underscores the importance of early surgical intervention to maximize thoracic volume and prevent long-term pulmonary impairment. However, further research is needed to assess the long-term outcomes of these surgical techniques, particularly in adulthood.