{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T19:04:06Z","timestamp":1783969446953,"version":"3.55.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Neuromuscular scoliosis (NMS) can displace the diaphragm into the thorax, reducing lung volume and impairing respiration. As an alternative to posterior spinal fusion, growth-friendly surgery (GFS) allows thoracic growth while correcting deformity. We evaluated associations of GFS with thoracic dimensions and diaphragm positioning, hypothesizing that GFS would alleviate respiratory constraints in pediatric NMS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We reviewed data from 45 patients who underwent GFS for NMS at a mean age of 8 years, from 2003 to 2022. Radiographic measures were lung volume, space available for lung (SAL) ratio, diaphragm intrusion index (DII), diaphragm vertebral level (DVL), T1-T12 height, and T1-S1 height, assessed preoperatively, postoperatively, and at 2-year follow-up. We also analyzed Early-Onset Scoliosis 24-item Questionnaire (EOSQ-24) outcomes related to lung function. A \u201clatest follow-up\u201d time point was included for patients with extended data (mean: 7.2 years; range: 2.0-18.5). Paired\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      tests compared preoperative and follow-up values. Alpha = 0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean lung volume increased from 1,992 cm\n                      <jats:sup>3<\/jats:sup>\n                      preoperatively to 2,917 cm\n                      <jats:sup>3<\/jats:sup>\n                      postoperatively and 3,210 cm\n                      <jats:sup>3<\/jats:sup>\n                      at 2 years (p &lt; 0.001), remaining stable (3,590 cm\n                      <jats:sup>3<\/jats:sup>\n                      ) at latest follow-up. SAL ratio improved from 0.79 preoperatively to 0.91 postoperatively and 0.89 at 2 years, with no change at final follow-up. DII improved from 0.59 (right) and 0.56 (left) preoperatively to 0.69 (right) and 0.70 (left) at 2 years, with no decline thereafter (p &lt; 0.001). DVL showed bilateral descent by approximately 1.3 vertebral levels through 2 years and remained stable. T1-T12 and T1-S1 heights increased to 21 and 34 cm, respectively, at 2 years (p &lt; 0.001). EOSQ-24 scores improved postoperatively, with further gains by 2 years in energy (from 55 to 83), pulmonary function (from 69 to 94), and fatigue (from 48 to 19).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>GFS was associated with improvements in thoracic dimensions, diaphragm position, lung volume, and respiratory-related quality of life in pediatric NMS, underscoring the potential of GFS to address deformity and long-term respiratory health in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.26.00097","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T18:04:07Z","timestamp":1783965847000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Growth-Friendly Surgery Improves Diaphragm Positioning, Thoracic Dimensions, and Patient-Reported Outcomes in Neuromuscular Scoliosis"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5501-9282","authenticated-orcid":false,"given":"Zaid","family":"Elsabbagh","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0529-1989","authenticated-orcid":false,"given":"William","family":"ElNemer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Gabos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Alfred I. DuPont Institute, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2094-3690","authenticated-orcid":false,"given":"Gregory J.","family":"Redding","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Seattle Children\u2019s Hospital, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2934-6374","authenticated-orcid":false,"given":"Paul D.","family":"Sponseller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"issue":"1","key":"R1-20260713","doi-asserted-by":"crossref","first-page":"S124","DOI":"10.1016\/j.otsr.2012.11.002","article-title":"Neuromuscular 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