• Mandy M P Kan, Stefano Negrini, Francesca Di Felice, CheungJason P YJPY0000-0002-7052-0875Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China., Sabrina Donzelli, Fabio Zaina, Dino Samartzis, Esther T C Cheung, and WongArnold Y LAYL0000-0002-5911-5756Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China. arnold.wong@polyu.edu.hk..
• Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
• Eur Spine J. 2023 Jan 1; 32 (1): 118139118-139.

PurposeSome teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients remains unclear, which affects clinical management. This systematic review and meta-analysis aimed to summarize the associations between various lung function parameters and radiographic features in teenagers with AIS.MethodsA search of PubMed, Embase, PEDro, SPORTDiscus, CINAHL, Cochrane Library, and PsycINFO (from inception to March 14, 2022) without language restriction. Original studies reporting the associations between lung function and spinal deformity in patients with AIS were selected. Independent reviewers extracted data and evaluated the methodological quality of the included studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pearson correlation and 95% confidence intervals were calculated using random-effects meta-analysis.ResultsTwenty-seven studies involving 3162 participants were included. Limited-quality evidence supported that several spinal parameters were significantly related to lung function parameters (e.g., absolute value and percent of the predicted forced vital capacity (FVC; %FVC), forced expiratory volume in one second (FEV1; %FEV1), and total lung capacity (TLC; %TLC)) in AIS patients. Specifically, meta-analyses showed that main thoracic Cobb angles in the coronal plane were significantly and negatively related to FVC (r =  - 0.245), %FVC (r =  - 0.302), FEV1 (r =  - 0.232), %FEV1 (r =  - 0.348), FEV1/FVC ratio (r =  - 0.166), TLC (r =  - 0.302), %TLC (r =  - 0.183), and percent predicted vital capacity (r =  - 0.272) (p < 0.001). Similarly, thoracic apical vertebral rotation was negatively associated with %FVC (r =  - 0.215) and %TLC (r =  - 0.126) (p < 0.05). Conversely, thoracic kyphosis angles were positively related to %FVC (r = 0.180) and %FEV1 (r = 0.193) (p < 0.05).ConclusionLarger thoracic Cobb angles, greater apical vertebral rotation angle, or hypokyphosis were significantly associated with greater pulmonary impairments in patients with AIS, although the evidence was limited. From a clinical perspective, the results highlight the importance of minimizing the three-dimensional spinal deformity in preserving lung function in these patients. More research is warranted to confirm these results.© 2022. The Author(s).

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