{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:10:00Z","timestamp":1769724600702,"version":"3.49.0"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"8","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,8,25]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Severe kyphoscoliosis in spina bifida patients can result in thoracic insufficiency syndrome, which significantly compromises pulmonary function. While traditional clinical measures for spina bifida focus primarily on bladder function and motor strength, this case highlights pulmonary function as an essential additional indicator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors report on the case of a 16-year-old male with spina bifida and severe thoracic kyphoscoliosis presenting with progressive respiratory difficulty limiting ambulation. Imaging revealed a thoracic curve of approximately 107\u00b0 and markedly reduced thoracic spine height (13.4 cm). During definitive posterior spinal fusion and deformity correction surgery, intraoperative tidal volumes were continuously monitored. As spinal correction progressed, tidal volumes increased substantially, achieving approximately 20% improvement. Postoperatively, radiographic assessment showed correction of the thoracic scoliosis to approximately 40\u00b0, with thoracic height improving to 23.4 cm. Clinically, the patient reported subjective improvement in breathing and demonstrated increased ambulation endurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case illustrates real-time intraoperative tidal volume monitoring as a potential physiological marker correlating directly with deformity correction efficacy and thoracic volume restoration. These findings suggest that pulmonary function may serve as an intraoperative adjunct to guide the surgical management of severe spinal deformities alongside conventional functional indicators. Further studies may establish a standardized formula that reliably predicts pulmonary function following deformity correction.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25379\">https:\/\/thejns.org\/doi\/10.3171\/CASE25379<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25379","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T23:49:19Z","timestamp":1756770559000},"source":"Crossref","is-referenced-by-count":0,"title":["Improved intraoperative tidal volume during deformity correction in a 16-year-old with spina bifida, severe kyphoscoliosis, and thoracic insufficiency syndrome: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9091-5818","authenticated-orcid":true,"given":"Christopher H.","family":"Sollenberger","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Vaz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan F.","family":"Judy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali K.","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Gooldy","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Heuer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Division of Neurosurgery, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7129-1007","authenticated-orcid":true,"given":"Patrick J.","family":"Cahill","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"The Wyss\/Campbell Center for Thoracic Insufficiency Syndrome, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam J.","family":"Kundishora","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Division of Neurosurgery, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"J Bone Joint Surg Am","first-page":"399","article-title":"The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis","volume":"85","author":"Campbell","year":"2003","unstructured":"Campbell RMJrSmith MDMayes TCThe characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2003;85(3):399-408."},{"issue":"3","key":"bib2","series-title":"Curr Probl Pediatr Adolesc Health Care","first-page":"72","article-title":"Thoracic insufficiency syndrome","volume":"46","author":"Mayer","year":"2016","unstructured":"Mayer OCampbell RCahill PRedding G.Thoracic insufficiency syndrome. Curr Probl Pediatr Adolesc Health Care. 2016;46(3):72-97."},{"issue":"4","key":"bib3","series-title":"Spine Deform","first-page":"771","article-title":"Bigger is better: larger thoracic height is associated with increased health related quality of life at skeletal maturity","volume":"8","author":"Roye","year":"2020","unstructured":"Roye BDSimhon MEMatsumoto HBigger is better: larger thoracic height is associated with increased health related quality of life at skeletal maturity. Spine Deform. 2020;8(4):771-779."},{"issue":"6","key":"bib4","series-title":"PLoS One","first-page":"e0235123","article-title":"Long-term pulmonary function after posterior spinal fusion in main thoracic adolescent idiopathic scoliosis","volume":"15","author":"Byun","year":"2020","unstructured":"Byun YMIida TYamada KLong-term pulmonary function after posterior spinal fusion in main thoracic adolescent idiopathic scoliosis. PLoS One. 2020;15(6):e0235123."},{"key":"bib5","series-title":"Front Med (Lausanne)","first-page":"915904","article-title":"Pulmonary recovery following corrective surgery in adult patients with severe scoliosis: a minimum of five-year follow-up","volume":"9","author":"Zhou","year":"2022","unstructured":"Zhou XZhang ZYang YPulmonary recovery following corrective surgery in adult patients with severe scoliosis: a minimum of five-year follow-up. Front Med (Lausanne). 2022;9:915904."},{"issue":"1","key":"bib6","series-title":"BMC Musculoskelet Disord","first-page":"697","article-title":"Sequential correction of severe and rigid kyphoscoliosis: a new technical note and preliminary results","volume":"24","author":"Hua","year":"2023","unstructured":"Hua WLi SFeng XSequential correction of severe and rigid kyphoscoliosis: a new technical note and preliminary results. BMC Musculoskelet Disord. 2023;24(1):697."},{"issue":"18","key":"bib7","series-title":"Spine (Phila Pa 1976)","first-page":"1447","article-title":"Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery","volume":"41","author":"Wang","year":"2016","unstructured":"Wang XB, Lenke LG, Thuet E, Blanke K, Koester LA, Roth M. Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine (Phila Pa 1976). 2016;41(18):1447-1455."},{"issue":"11","key":"bib8","series-title":"J Bone Joint Surg Am","first-page":"2440","article-title":"Neurophysiological detection of impending spinal cord injury during scoliosis surgery","volume":"89","author":"Schwartz","year":"2007","unstructured":"Schwartz DMAuerbach JDDormans JPNeurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am. 2007;89(11):2440-2449."},{"issue":"5","key":"bib9","series-title":"Spine Deform","first-page":"1259","article-title":"Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment","volume":"9","author":"Yen","year":"2021","unstructured":"Yen WGartenberg ACho W.Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment. 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PLoS One. 2020;15(6):e0235123."},{"key":"bib5","series-title":"Front Med (Lausanne)","first-page":"915904","article-title":"Pulmonary recovery following corrective surgery in adult patients with severe scoliosis: a minimum of five-year follow-up","volume":"9","author":"Zhou","year":"2022","unstructured":"Zhou XZhang ZYang YPulmonary recovery following corrective surgery in adult patients with severe scoliosis: a minimum of five-year follow-up. Front Med (Lausanne). 2022;9:915904."},{"issue":"1","key":"bib6","series-title":"BMC Musculoskelet Disord","first-page":"697","article-title":"Sequential correction of severe and rigid kyphoscoliosis: a new technical note and preliminary results","volume":"24","author":"Hua","year":"2023","unstructured":"Hua WLi SFeng XSequential correction of severe and rigid kyphoscoliosis: a new technical note and preliminary results. BMC Musculoskelet Disord. 2023;24(1):697."},{"issue":"18","key":"bib7","series-title":"Spine (Phila Pa 1976)","first-page":"1447","article-title":"Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery","volume":"41","author":"Wang","year":"2016","unstructured":"Wang XB, Lenke LG, Thuet E, Blanke K, Koester LA, Roth M. Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine (Phila Pa 1976). 2016;41(18):1447-1455."},{"issue":"11","key":"bib8","series-title":"J Bone Joint Surg Am","first-page":"2440","article-title":"Neurophysiological detection of impending spinal cord injury during scoliosis surgery","volume":"89","author":"Schwartz","year":"2007","unstructured":"Schwartz DMAuerbach JDDormans JPNeurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am. 2007;89(11):2440-2449."},{"issue":"5","key":"bib9","series-title":"Spine Deform","first-page":"1259","article-title":"Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment","volume":"9","author":"Yen","year":"2021","unstructured":"Yen WGartenberg ACho W.Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment. Spine Deform. 2021;9(5):1259-1265."},{"issue":"7","key":"bib10","series-title":"Curr Probl Pediatr Adolesc Health Care","first-page":"173","article-title":"Spina bifida management","volume":"47","author":"Phillips","year":"2017","unstructured":"Phillips LABurton JMEvans SH.Spina bifida management. Curr Probl Pediatr Adolesc Health Care. 2017;47(7):173-177."},{"issue":"7","key":"bib11","series-title":"Childs Nerv Syst","first-page":"1149","article-title":"Prenatal surgery for myelomeningocele: review of the literature and future directions","volume":"33","author":"Heuer","year":"2017","unstructured":"Heuer GGMoldenhauer JSScott Adzick N.Prenatal surgery for myelomeningocele: review of the literature and future directions. 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