For Idiopathic Scoliosis Patients, Have You Considered Pre-Op Lung Training?

Key Takeaways

• Pre‑op pulmonary rehab reduced complications from 9% to 2%.
• Non‑rehab patients faced a 4.2‑fold higher complication risk.
• Complication rates were independent of curve severity or instrumentation level.
• Study was retrospective; causation cannot be definitively proven.
• Thoracic surgeons' prehab model may inform spine surgery protocols.

Pulse Analysis

Anterior vertebral body tethering (AVBT) has emerged as a compelling alternative to spinal fusion for adolescents with idiopathic scoliosis, preserving motion while harnessing growth modulation. Yet, because the procedure accesses the thoracic cavity, patients are vulnerable to pulmonary sequelae such as pleural effusions, atelectasis, and occasional chylothorax. These complications, though relatively infrequent, can extend hospital stays, increase readmission rates, and drive up overall treatment costs, underscoring the need for strategies that mitigate respiratory risk.

A recent retrospective analysis of 185 AVBT cases examined the impact of a three‑week preoperative pulmonary rehabilitation (PPR) regimen. The cohort that completed PPR (144 patients) experienced a markedly lower pulmonary complication rate—approximately 2% versus 9% in the non‑rehab group—translating to a risk ratio of 4.21 (p = 0.016). Importantly, the study found no correlation between complication incidence and curve magnitude, tethering technique, or instrumentation level, isolating the lung conditioning variable as the primary differentiator. While the design was time‑based rather than randomized, the magnitude of the effect suggests a genuine protective benefit.

The findings prompt spine surgeons to reconsider pre‑operative preparation, borrowing proven protocols from thoracic surgery where pulmonary rehab is standard practice. Prospective, randomized trials are needed to confirm causality and define optimal program duration, but the current evidence advocates for integrating respiratory training into AVBT pathways. Doing so could enhance patient outcomes, reduce postoperative morbidity, and align spine surgery with broader peri‑operative safety standards.