Waiting for Change: Pulmonary Function Improves in a Delayed Fashion Following Dual Growing-Rod Surgery for Early-Onset Scoliosis: Commentary on an article by Yunsheng Wang, MD, et al.: "Long-Term Radiographic and Pulmonary Function Outcomes After Dual Growing-Rod Treatment for Severe Early-Onset Scoliosis".

Abstract

Commentary Jess Lair, PhD, said, “Children are not things to be molded, but people to be unfolded.” He clearly understood the fine line that we walk when we treat children with early-onset scoliosis. We need to intervene in a way that helps the child to grow and maximizes lung capacity without doing so too early, too late, too aggressively, or not aggressively enough, with a limited fusion, but also just enough fusion to avoid progression. All the while, we wonder if these interventions really help children to live longer or better. Pulmonary function is a very objective way to evaluate our outcomes, but these data are difficult to obtain. Redding and Mayer have shown us that lung structure and function change with early-onset scoliosis and with early-onset scoliosis treatment1,2. We tend to rely on radiographs and patient-reported outcomes as our measures of success, with some good evidence that there is correlation3. This study by Wang et al. not only identifies successful improvement in children with severe early-onset scoliosis, but also goes a step further in describing the timeline of radiographic and respiratory changes. Notably, the pulmonary function at 1 year following original dual growing-rod surgery improved but was not significantly different from before the operation, although this was the time frame in which the radiographic parameters improved the most. The improvement in pulmonary function was delayed to the time between 1 year postoperatively and the final follow-up. The lungs may have taken a bit of time to grow or may have still been recovering from the surgical procedure, but improvement was ultimately seen: dual growing-rod surgery indeed resulted in improvements in lung function demonstrated by pulmonary function testing. One concern with regard to this study is the ability of children to participate in pulmonary function testing, and another concern is the flexibility of curves that improved from 104° to 38° following the index surgical procedure. Also, the cohort was heterogeneous, and these results cannot be universally applied to all children with early-onset scoliosis, as some diagnoses will not show the same response. Although we as pediatric orthopaedic surgeons do our best to let children “unfold” over their natural course, sometimes we do have to “mold” them a bit, and it is reassuring to know that we ultimately help create healthier adults with better lung function than they would have had without intervention.