{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:30:31Z","timestamp":1791502231214,"version":"4.3.4"},"reference-count":99,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Early Onset Scoliosis (EOS), defined as presenting before 10 years of age, often has a significant adverse impact on pulmonary function, due to a complex interrelationship between the spine, chest, pulmonary structures and their development. Left untreated, EOS leads to premature death, with early fusion surgery to arrest curve progression making little impact on this. To date, the natural history has not been clearly established as compounded by the heterogeneity of pathologies, causing EOS and challenges in objective measurements of pulmonary function in this young age group. A desire to address this poor natural history has motivated interest in pursuing \u2018growth friendly\u2019 surgical strategies. The implants used have evolved with time, often to address compromises and poor results, with multiple options now available based on treatment principles (distraction, compression, or guided growth systems). The aims of such strategies are to control the structural spinal deformity, whilst allowing spinal and thoracic growth, with the seemingly reasonable expectation that this will result in improved pulmonary function and avoidance of premature death. Most studies have focused on radiological outcome measures such as Cobb angle and thoracic height to gauge the success of surgery, with these measures acting as surrogate markers of improved pulmonary outcome. This assumption, however, is not supported by more recent clinical data which has attempted to assess directly the pulmonary outcomes associated with growth-friendly surgical strategies. This literature review therefore sets out to characterise the effect of EOS on pulmonary function and to critically analyse the impact surgical treatment options will have while addressing this.<\/jats:p>","DOI":"10.3390\/jcm15020754","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T14:46:33Z","timestamp":1768574793000},"page":"754","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Current Knowledge of Respiratory Function in Early Onset Scoliosis and the Effect of Its Contemporary Surgical Treatment"],"prefix":"10.3390","volume":"15","author":[{"given":"Sai Gautham","family":"Balasubramanian","sequence":"first","affiliation":[{"name":"Great North Children\u2019s Hospital and Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fender","sequence":"additional","affiliation":[{"name":"Great North Children\u2019s Hospital and Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Rushton","sequence":"additional","affiliation":[{"name":"Great North Children\u2019s Hospital and Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1097\/00007632-199209000-00014","article-title":"Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms","volume":"17","author":"Pehrsson","year":"1992","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/0007-0971(86)90089-6","article-title":"Cardiorespiratory consequences of unfused idiopathic scoliosis","volume":"80","author":"Branthwaite","year":"1986","journal-title":"Br. J. Dis. Chest."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jspd.2015.07.007","article-title":"Pulmonary Function in Middle-Aged Patients with Idiopathic Scoliosis with Onset Before the Age of 10 Years","volume":"3","author":"Danielsson","year":"2015","journal-title":"Spine Deform."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1302\/0301-620X.37B3.400","article-title":"The natural history and prognosis of infantile idiopathic scoliosis","volume":"37","author":"Scott","year":"1955","journal-title":"J. Bone Jt. Surgery. Br. Vol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/00007632-198207000-00004","article-title":"Scoliosis and cor pulmonale","volume":"7","author":"Swank","year":"1982","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1136\/thx.46.7.474","article-title":"Lung function in adult idiopathic scoliosis: A 20 year follow up","volume":"46","author":"Pehrsson","year":"1991","journal-title":"Thorax"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s43390-020-00224-z","article-title":"Continued deterioration in pulmonary function at average 23-year follow-up from early thoracic fusion in non-neuromuscular scoliosis","volume":"9","author":"Bouton","year":"2021","journal-title":"Spine Deform."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1378\/chest.83.5.717","article-title":"A descriptive analysis of the growth and decline of the FVC and FEV1","volume":"83","author":"Burrows","year":"1983","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/BF00442448","article-title":"Lung function in congenital and idiopathic scoliosis","volume":"142","author":"Harrison","year":"1984","journal-title":"Eur J Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1007\/s11999-010-1621-0","article-title":"Structure-respiration function relationships before and after surgical treatment of early-onset scoliosis","volume":"469","author":"Redding","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1302\/0301-620X.67B5.4055863","article-title":"The assessment of lung function in children with scoliosis","volume":"67","author":"Muirhead","year":"1985","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1097\/00007632-199405000-00004","article-title":"Pulmonary functions in congenital scoliosis","volume":"19","author":"Day","year":"1994","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.spinee.2007.04.020","article-title":"Lung function asymmetry in children with congenital and infantile scoliosis","volume":"8","author":"Redding","year":"2008","journal-title":"Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e818","DOI":"10.1097\/BPO.0000000000001641","article-title":"Preoperative 6-Minute Walk Performance in Children with Congenital Scoliosis","volume":"40","author":"Nakashima","year":"2020","journal-title":"J. Pediatr. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/01.brs.0000197203.76653.d0","article-title":"Effects on lung function of multiple expansion thoracoplasty in children with thoracic insufficiency syndrome: A longitudinal study","volume":"31","author":"Motoyama","year":"2006","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1002\/ppul.21197","article-title":"Sleep-disordered breathing in children with thoracic insufficiency syndrome","volume":"45","author":"Striegl","year":"2010","journal-title":"Pediatr. Pulmonol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2530","DOI":"10.1097\/BRS.0b013e3181bd09f5","article-title":"Weight gain following vertical expandable prosthetic titanium ribs surgery in children with thoracic insufficiency syndrome","volume":"34","author":"Skaggs","year":"2009","journal-title":"Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"399","DOI":"10.2106\/00004623-200303000-00001","article-title":"The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis","volume":"85","author":"Campbell","year":"2003","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/BPO.0b013e31816521bb","article-title":"Health-related quality of life in children with thoracic insufficiency syndrome","volume":"28","author":"Vitale","year":"2008","journal-title":"J. Pediatr. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1136\/thx.17.4.329","article-title":"Postnatal Growth of the Lung","volume":"17","author":"Dunnill","year":"1962","journal-title":"Thorax"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/0034-5687(87)90058-2","article-title":"The postnatal development and growth of the human lung. II. Morphology","volume":"67","author":"Zeltner","year":"1987","journal-title":"Respir. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1164\/rccm.201107-1348OC","article-title":"Alveolarization continues during childhood and adolescence: New evidence from helium-3 magnetic resonance","volume":"185","author":"Narayanan","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Olson, J.C., Takahashi, A., Glotzbecker, M.P., and Snyder, B.D. (2015). Extent of Spine Deformity Predicts Lung Growth and Function in Rabbit Model of Early Onset Scoliosis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0136941"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1136\/thx.39.9.681","article-title":"Lung developmental abnormalities in severe scoliosis","volume":"39","author":"Boffa","year":"1984","journal-title":"Thorax"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1136\/adc.46.249.623","article-title":"Effect of scoliosis on growth of alveoli and pulmonary arteries and on right ventricle","volume":"46","author":"Davies","year":"1971","journal-title":"Arch. Dis. Child."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s00276-018-2164-4","article-title":"Thoracic cage volume and dimension assessment by optoelectronic molding in normal children and adolescents during growth","volume":"41","author":"Canavese","year":"2019","journal-title":"Surg. Radiol. Anat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1097\/01.brs.0000140779.22741.33","article-title":"The volume of lung parenchyma as a function of age: A review of 1050 normal CT scans of the chest with three-dimensional volumetric reconstruction of the pulmonary system","volume":"29","author":"Gollogly","year":"2004","journal-title":"Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1136\/thx.48.8.803","article-title":"Lung function in white children aged 4 to 19 years: II--Single breath analysis and plethysmography","volume":"48","author":"Rosenthal","year":"1993","journal-title":"Thorax"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s00586-011-1983-3","article-title":"The growing spine: How spinal deformities influence normal spine and thoracic cage growth","volume":"21","author":"Dimeglio","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1097\/01.brs.0000244613.66055.b6","article-title":"The reciprocal relationship between thoracic and spinal deformity and its effect on pulmonary function in a rabbit model: A pilot study","volume":"31","author":"Mehta","year":"2006","journal-title":"Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.2106\/JBJS.G.00184","article-title":"Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis","volume":"90","author":"Karol","year":"2008","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e21.00093","DOI":"10.2106\/JBJS.OA.21.00093","article-title":"The 18-cm Thoracic-Height Threshold and Pulmonary Function in Non-Neuromuscular Early-Onset Scoliosis: A Reassessment","volume":"6","author":"Johnston","year":"2021","journal-title":"JBJS Open Access"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1097\/01.BRS.0000085367.24266.CA","article-title":"Respiratory function and cosmesis at maturity in infantile-onset scoliosis","volume":"28","author":"Goldberg","year":"2003","journal-title":"Spine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1097\/BRS.0b013e31816fc3a5","article-title":"Prospective pulmonary function comparison of anterior spinal fusion in adolescent idiopathic scoliosis: Thoracotomy versus thoracoabdominal approach","volume":"33","author":"Kim","year":"2008","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1097\/BRS.0000000000000449","article-title":"Is there a relationship between thoracic dimensions and pulmonary function in early-onset scoliosis?","volume":"39","author":"Glotzbecker","year":"2014","journal-title":"Spine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s007760300007","article-title":"Spinal penetration index: New three-dimensional quantified reference for lordoscoliosis and other spinal deformities","volume":"8","author":"Dubousset","year":"2003","journal-title":"J. Orthop. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1136\/thx.36.6.456","article-title":"Mechanical inefficiency of the thoracic cage in scoliosis","volume":"36","author":"Jones","year":"1981","journal-title":"Thorax"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1097\/BRS.0000000000002351","article-title":"Maximal Respiratory Muscle Strength and Vital Capacity in Children with Early Onset Scoliosis","volume":"42","author":"Redding","year":"2017","journal-title":"Spine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s43390-022-00487-8","article-title":"Spinal mobility and muscle function in middle-aged patients treated for early onset idiopathic scoliosis: Compared with untreated and treated adolescent onset patients","volume":"10","author":"Romberg","year":"2022","journal-title":"Spine Deform."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1097\/00007632-199907010-00007","article-title":"Kinematics of the chest cage and spine during breathing in healthy individuals and in patients with adolescent idiopathic scoliosis","volume":"24","author":"Leong","year":"1999","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/01.BRS.0000106490.82936.89","article-title":"An analysis of chest wall and diaphragm motions in patients with idiopathic scoliosis using dynamic breathing MRI","volume":"29","author":"Kotani","year":"2004","journal-title":"Spine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.prrv.2008.10.004","article-title":"Thoracic malformation with early-onset scoliosis: Effect of serial VEPTR expansion thoracoplasty on lung growth and function in children","volume":"10","author":"Motoyama","year":"2009","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/BPO.0b013e3181929c8b","article-title":"Early changes in pulmonary function after vertical expandable prosthetic titanium rib insertion in children with thoracic insufficiency syndrome","volume":"29","author":"Mayer","year":"2009","journal-title":"J. Pediatr. Orthop."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1097\/01.brs.0000232822.74349.32","article-title":"Dynamic magnetic resonance imaging in assessing lung volumes, chest wall, and diaphragm motions in adolescent idiopathic scoliosis versus normal controls","volume":"31","author":"Chu","year":"2006","journal-title":"Spine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/BPO.0000000000001262","article-title":"Persistence and Progression of Airway Obstruction in Children with Early Onset Scoliosis","volume":"40","author":"Redding","year":"2020","journal-title":"J. Pediatr. Orthop."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1097\/BPO.0000000000000078","article-title":"Obstructive lung disease is common in children with syndromic and congenital scoliosis: A preliminary study","volume":"33","author":"McPhail","year":"2013","journal-title":"J. Pediatr. Orthop."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"E59","DOI":"10.1097\/BRS.0b013e318191f389","article-title":"Lordoscoliosis and large intrathoracic airway obstruction","volume":"34","author":"Bartlett","year":"2009","journal-title":"Spine"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1097\/BRS.0b013e31825d2ea3","article-title":"Scoliosis associated with airflow obstruction due to endothoracic vertebral hump","volume":"37","author":"Ito","year":"2012","journal-title":"Spine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/BPO.0000000000000073","article-title":"Chest Wall and Spine Deformity Study Group; Growing Spine Study Group; Pediatric Orthopaedic Society of North America; Scoliosis Research Society Growing Spine Study Committee. A classification of growth friendly spine implants","volume":"34","author":"Skaggs","year":"2014","journal-title":"J. Pediatr. Orthop."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S46","DOI":"10.1097\/01.brs.0000175190.08134.73","article-title":"Dual growing rod technique for the treatment of progressive early-onset scoliosis: A multicenter study","volume":"30","author":"Akbarnia","year":"2005","journal-title":"Spine"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/BPO.0b013e3180333eea","article-title":"Growing rod techniques in early-onset scoliosis","volume":"27","author":"Thompson","year":"2007","journal-title":"J. Pediatr. Orthop."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1097\/BRS.0b013e31816c8b4e","article-title":"Growing Spine Study Group. Dual growing rod technique followed for three to eleven years until final fusion: The effect of frequency of lengthening","volume":"33","author":"Akbarnia","year":"2008","journal-title":"Spine"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1097\/01.brs.0000179082.92712.89","article-title":"Comparison of single and dual growing rod techniques followed through definitive surgery: A preliminary study","volume":"30","author":"Thompson","year":"2005","journal-title":"Spine"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/BRS.0b013e318214d78f","article-title":"Lengthening of dual growing rods and the law of diminishing returns","volume":"36","author":"Sankar","year":"2011","journal-title":"Spine"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.2106\/JBJS.16.00796","article-title":"Functional and Radiographic Outcomes Following Growth-Sparing Management of Early-Onset Scoliosis","volume":"99","author":"Johnston","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1302\/1863-2548.15.210021","article-title":"Pulmonary function and health-related quality of life in patients with early onset scoliosis after repeated traditional growing rod procedures","volume":"15","author":"Chang","year":"2021","journal-title":"J. Child. Orthop."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e734","DOI":"10.1097\/BPO.0000000000001567","article-title":"Growing-rod graduates with idiopathic early-onset scoliosis have comparable exercise tolerance to patients with surgically treated adolescent idiopathic scoliosis","volume":"40","author":"Celebioglu","year":"2020","journal-title":"J. Pediatr. Orthop."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.2106\/JBJS.L.01386","article-title":"Growing Spine Study Group. Growing-rod graduates: Lessons learned from ninety-nine patients who completed lengthening","volume":"95","author":"Flynn","year":"2013","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e25.00120","DOI":"10.2106\/JBJS.OA.25.00120","article-title":"Longitudinal Pulmonary Function After Surgical Treatment of Early-Onset Scoliosis","volume":"10","author":"Yang","year":"2025","journal-title":"JBJS Open Access"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Johnston, C.E., Thompson, T., Robinson, A., and Koehler, R. (2025). Traditional versus magnetic-controlled growth rods for early onset scoliosis treatment: Radiographic, pulmonary, and quality-of-life outcomes at graduation. Spine Deform.","DOI":"10.1007\/s43390-025-01192-y"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1097\/BRS.0b013e3182773560","article-title":"Next Generation of Growth-Sparing Techniques","volume":"38","author":"Akbarnia","year":"2013","journal-title":"Spine"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1016\/S0140-6736(12)60112-3","article-title":"Magnetically controlled growing rods for severe spinal curvature in young children: A prospective case series","volume":"379","author":"Cheung","year":"2012","journal-title":"Lancet"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1186\/s13018-022-03200-7","article-title":"Magnetically controlled growing rods in the management of early onset scoliosis: A systematic review","volume":"17","author":"Migliorini","year":"2022","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"12","DOI":"10.18103\/mra.v12i12.6121","article-title":"Does growth sparing techniques improve lung function tests in idiopathic Early Onset Scoliosis\u2013A Retrospective Single Centre Analysis","volume":"12","author":"Balasubramanian","year":"2024","journal-title":"Med. Res. Arch."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1007\/s43390-021-00302-w","article-title":"The impact of scoliosis surgery on pulmonary function in spinal muscular atrophy: A systematic review","volume":"9","author":"Alhammoud","year":"2021","journal-title":"Spine Deform."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1097\/BRS.0000000000000383","article-title":"Improvement of pulmonary function in children with early-onset scoliosis using magnetic growth rods","volume":"39","author":"Yoon","year":"2014","journal-title":"Spine"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1002\/ppul.24664","article-title":"Impact of scoliosis surgery on pulmonary function in patients with muscular dystrophies and spinal muscular atrophy","volume":"55","author":"Farber","year":"2020","journal-title":"Pediatr. Pulmonol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.2106\/00004623-200408000-00009","article-title":"The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis","volume":"86","author":"Campbell","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2106\/00004623-200403001-00008","article-title":"Expansion thoracoplasty: The surgical technique of opening-wedge thoracostomy [surgical technique]","volume":"86","author":"Campbell","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1097\/01.brs.0000175194.31986.2f","article-title":"The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: Growth of thoracic spine and improvement of lung volumes","volume":"30","author":"Emans","year":"2005","journal-title":"Spine"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e599","DOI":"10.1097\/BPO.0000000000000943","article-title":"Children\u2019s Spine Study Group. VEPTR Implantation to Treat Children with Early-Onset Scoliosis Without Rib Abnormalities: Early Results From a Prospective Multicenter Study","volume":"37","author":"Kadhim","year":"2017","journal-title":"J. Pediatr. Orthop."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/BPB.0b013e32832bf5e0","article-title":"The Vertical Expandable Prosthetic Titanium Rib in the treatment of spinal deformity due to progressive early onset scoliosis","volume":"18","author":"Ramirez","year":"2009","journal-title":"J. Pediatr. Orthop. B."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1007\/s00586-009-1253-9","article-title":"Efficacy and safety of VEPTR instrumentation for progressive spine deformities in young children without rib fusions","volume":"19","author":"Hasler","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/BPO.0b013e31829d55a2","article-title":"VEPTR to treat nonsyndromic congenital scoliosis: A multicenter, mid-term follow-up study","volume":"33","author":"Flynn","year":"2013","journal-title":"J. Pediatr. Orthop."},{"key":"ref_75","first-page":"841","article-title":"Rib-based distraction surgery maintains total spine growth","volume":"36","author":"Samdani","year":"2015","journal-title":"J. Pediatr. Orthop."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jpedsurg.2010.09.070","article-title":"Vertical expandable prosthetic titanium rib device insertion: Does it improve pulmonary function?","volume":"46","author":"Gadepalli","year":"2011","journal-title":"J. Pediatr. Surg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.2106\/JBJS.M.01218","article-title":"Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis","volume":"96","author":"Dede","year":"2014","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1007\/s00586-021-07029-2","article-title":"Analysis of the pulmonary function in patients undergoing vertebral body tethering for adolescent idiopathic scoliosis","volume":"31","author":"Baroncini","year":"2022","journal-title":"Eur. Spine J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2750","DOI":"10.1007\/s00586-025-08654-x","article-title":"Two to five years pulmonary functions after thoracic, thoracolumbar and bilateral vertebral body tethering surgery","volume":"34","author":"Yucekul","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"S86","DOI":"10.1016\/j.spinee.2021.05.201","article-title":"Two to five years follow up results after thoracoscopic VBT: A single surgeon\u2019s experience","volume":"21","author":"Alanay","year":"2021","journal-title":"Spine J."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Trobisch, P., Migliorini, F., Vanspauwen, T., and Baroncini, A. (2022). Pulmonary Complications after Vertebral Body Tethering: Incidence, Treatment, Outcomes and Risk Factor Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133778"},{"key":"ref_82","first-page":"37","article-title":"Treatment of scoliosis without arthrodesis or external support, preliminary report","volume":"1","author":"Cardoso","year":"1977","journal-title":"Orthop. Trans."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1007\/s11999-011-1783-4","article-title":"Surgical technique: Modern Luqu\u00e9 trolley, a self-growing rod technique","volume":"469","author":"Ouellet","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1007\/s43390-025-01102-2","article-title":"Management of early-onset scoliosis: Modern Luque trolley technique led to fewer reoperations within 3 years than other growth-friendly techniques, a prospective cohort study with matched historical controls","volume":"13","author":"Dayer","year":"2025","journal-title":"Spine Deform."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/BPO.0b013e31829f92dc","article-title":"The Shilla growth guidance technique for early-onset spinal deformities at 2-year follow-up: A preliminary report","volume":"34","author":"McCarthy","year":"2014","journal-title":"J. Pediatr. Orthop."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jspd.2017.01.011","article-title":"Growing Spine Study Group. Radiographic Outcomes of Shilla Growth Guidance System and Traditional Growing Rods Through Definitive Treatment","volume":"5","author":"Luhmann","year":"2017","journal-title":"Spine Deform."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"e567","DOI":"10.1097\/BPO.0000000000000751","article-title":"A Comparison of Shilla Growth Guidance System and Growing Rods in the Treatment of Spinal Deformity in Children Less Than 10 Years of Age","volume":"37","author":"Luhmann","year":"2017","journal-title":"J. Pediatr. Orthop."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.jspd.2014.11.005","article-title":"Growing Spine Study Group. Growing Rods Versus Shilla Growth Guidance: Better Cobb Angle Correction and T1-S1 Length Increase But More Surgeries","volume":"3","author":"Andras","year":"2015","journal-title":"Spine Deform."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s43390-020-00076-7","article-title":"Growing Spine Study Group. Growth guidance constructs with apical fusion and sliding pedicle screws (SHILLA) results in approximately 1\/3rd of normal T1-S1 growth","volume":"8","author":"Nazareth","year":"2020","journal-title":"Spine Deform."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/j.jcot.2020.07.013","article-title":"Active Apex Correction: An overview of the modified SHILLA technique and its clinical efficacy","volume":"11","author":"Ahmad","year":"2020","journal-title":"J. Clin. Orthop. Trauma."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1177\/2192568219859836","article-title":"Active Apex Correction with Guided Growth Technique for Controlling Spinal Deformity in Growing Children: A Modified SHILLA Technique","volume":"10","author":"Agarwal","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"31","DOI":"10.22603\/ssrr.2019-0045","article-title":"Active Apex Correction (Modified SHILLA Technique) Versus Distraction-Based Growth Rod Fixation: What Do the Correction Parameters Say?","volume":"4","author":"Agarwal","year":"2019","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1177\/21925682241289902","article-title":"Controlling the Apex in Early Onset Scoliosis Through Active Apex Correction (APC) Non Fusion Growth Modulating Technique, Is It a Myth?","volume":"15","author":"Ahmad","year":"2024","journal-title":"Glob. Spine J."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1177\/21925682241229677","article-title":"A Prospective Multicenter \u2265 2 Years Clinical Study of the Active Apex Correction (APC) Technique in Early Onset Scoliosis (EOS) Patients","volume":"15","author":"Hammad","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Akbarnia, B.A., Yazici, M., and Thompson, G.H. (2016). Apical control in the management of severe early-onset scoliosis. The Growing Spine: Management of Spinal Disorders in Young Children, Springer.","DOI":"10.1007\/978-3-662-48284-1"},{"key":"ref_96","unstructured":"Akbarnia, B.A., Thompson, G.H., and Yazici, M. (2022). Apical control techniques in the management of severe early onset scoliosis. The Growing Spine: Management of Spinal Disorders in Young Children, Springer International Publishing."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.14245\/ns.2346406.203","article-title":"Traditional Dual Growing Rods with 2 Different Apical Control Techniques in the Treatment of Early-Onset Scoliosis","volume":"20","author":"Wang","year":"2023","journal-title":"Neurospine"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"199","DOI":"10.3171\/2022.8.SPINE22618","article-title":"Hybrid technique versus traditional dual growing rod technique to treat congenital early-onset scoliosis: A comparative study with more than 3 years of follow-up","volume":"38","author":"Wang","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1007\/s00264-020-04604-y","article-title":"New growth rod concept provides three dimensional correction, spinal growth, and preserved pulmonary function in early-onset scoliosis","volume":"44","author":"Skov","year":"2020","journal-title":"Int. Orthop."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/754\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T05:15:39Z","timestamp":1768886139000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/754"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":99,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020754"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020754","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]}}}