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The risk factors for type ii respiratory failure in patients with severe scoliosis (less than 40-year old)

Journal of Orthopaedic Surgery and Research volume 20, Article number: 213 (2025) Cite this article

Abstract

Objective

To investigate the risk factors for Type II respiratory failure associated with severe scoliosis in patients under 40 years of age.

Methods

Patients with severe scoliosis and pulmonary impairment treated in our hospital from January 2020 to December 2022 were recorded. We evaluated the spinal parameters in standing full spine X-rays, including the main thoracic curve, thoracic kyphosis, apical vertebrae, and distance between T1-T12. We also assessed the patient’s pulmonary function test (PFT), including forced vital capacity (FVC) and the percentage of measured FVC values to predicted values (FVC%).

Results

The study included 64 patients with severe and rigid scoliosis accompanied by severe pulmonary impairment. They were divided into two groups: Group 1 comprised 22 patients with Type II respiratory failure, and Group 2 comprised the remaining 42 patients without respiratory failure. The average age of onset for the two groups was 2.3 ± 2.9 years and 4.0 ± 4.5 years, respectively. The range of the apical vertebrae in Group 1 was from T6 to T11, and the range in Group 2 was the same. There was no significant difference in the main curve and kyphosis angle between the two groups. The average T1-T12 distances for the two groups were 130.3 ± 32.7 mm and 148.2 ± 37.6 mm, respectively. The PFT results indicated that all patients had severe pulmonary function impairment. Multivariate logistic regression analysis revealed that a T1-T12 distance of less than 100 mm was an independent risk factor for Type II respiratory failure.

Conclusions

If not treated properly, early onset scoliosis would have a severe impact on pulmonary function. The T1-T12 distance was a risk factor for Type II respiratory failure associated with severe scoliosis in patients under 40 years old.

Scoliosis, especially thoracic scoliosis, is often associated with rib cage deformity, which can directly affect pulmonary function. The greater the major thoracic curve, the more severe the pulmonary function impairment [1]. The pathophysiology of pulmonary dysfunction in patients with thoracic scoliosis is thought to be influenced by chest wall deformities, reduced chest wall compliance, and respiratory muscle weakness [2]. Reduced total lung capacity may reflect different pathophysiological mechanisms, depending on the age at onset of scoliosis and the degree of chronicity of the condition. Scoliosis in infants (and possibly adolescents) is more likely to be associated with true lung hypoplasia, as the thoracic deformity typically occurs during the rapid growth and development of the lungs [3, 4]. Pehrsson et al. [5] reported that the mortality rate of untreated children and adolescents with scoliosis is significantly increased, with the risk being particularly pronounced between the ages of 40 and 50. Some patients with severe scoliosis may develop respiratory failure (PaO2<60mmHg) or even Type II respiratory failure (PaO2<60mmHg and PaCO2>50mmHg) if associated with severe pulmonary dysfunction. Guilleminault et al. [6] reported that respiratory failure was more likely to occur at night, which may be related to reduced sensitivity to low oxygen and high carbon dioxide during sleep, uncoordinated pulmonary ventilation and blood flow ratios, and upper airway obstruction.

Although many studies have investigated the relationship between scoliosis and lung function, there are still few reports on the risk factors for Type II respiratory failure in patients with severe scoliosis. The aim of this study is to analyse the risk factors for Type II respiratory failure in patients with scoliosis under the age of 40, in order to prevent potentially serious consequences through early intervention.

Material and methods

Patient data

This retrospective study was approved by the Institutional Review Board (IRB) of the Third People’s Hospital of Chengdu, and all patients signed an informed consent form. We reviewed the medical records of patients with severe and rigid scoliosis combined with pulmonary dysfunction who came to our hospital for treatment from January 2020 to December 2022. The inclusion criteria were as follows: (1) severe and rigid thoracic scoliosis (with an apical vertebra ranging from T5 to T10) and a Cobb’s angle greater than 110 degrees; (2) complete data, including demographic information, arterial blood gas analysis, radiographic film, and PFT results. Exclusion criteria were: (1) patients over 40 years of age, as the incidence rate of respiratory failure has been shown to be significantly increased in this age group [5]; (2) coexistence of respiratory system diseases, such as asthma or pulmonary infections, or other respiratory disorders; (3) coexistence of congenital heart disease, which could have affected the results of arterial blood gas analysis; (4) patients who had undergone surgery on the thoracic spine or chest.

Radiographic parameter and pulmonary function test

The main thoracic Cobb’s angle, thoracic kyphosis, and T1-T12 distance were assessed using standing whole spine anteroposterior (AP) films. All patients underwent arterial blood gas analysis and PFT. PFT parameters included FVC and FVC%. According to the American Thoracic Society guidelines, the severity of pulmonary impairments was graded on the basis of FVC was as follows: FVC% > 80% indicated no impairment; FVC% between 65% and 80% indicated mild impairment; FVC% between 50% and 65% indicated moderate impairment; FVC% < 50% indicated severe impairment. Type II respiratory failure was defined as a PCO2 greater than 50 mmHg and a PO2 less than 60 mmHg in arterial blood gas analysis results.

Statistical analysis

Data analysis was performed using SPSS software (version 27.0; IBM). Each variable was presented as the mean and standard deviation. Radiological parameters were compared between two groups using independent samples t-tests and chi-square tests. Multivariate logistic regression analysis was used to determine the risk factors for Type II respiratory failure. The significance level was set at P < 0.05.

Results

Patient characteristics

This study involved 64 patients with severe and rigid scoliosis combined with severe pulmonary impairment. They were divided into two groups: Group 1 consisted of 22 patients with Type II respiratory failure, and Group 2 consisted of the remaining 42 patients without respiratory failure. The etiological diagnosis included idiopathic scoliosis, congenital scoliosis, and neurofibromatosis. The mean age at admission for Group 1 was 28.9 ± 6.8 years (range: 16 to 39 years), compared to 24.4 ± 7.1 years (range: 12 to 35 years) for Group 2. The mean age at onset was 2.3 ± 2.9 years (range: 0 to 12 years) for Group 1 and 4.0 ± 4.5 years (range: 0 to 15 years) for Group 2.

Radiographic parameters and PFT results

The range of the apical vertebrae was T6 to T11 for both groups. The mean main curve was 140.9 ± 25.9 degrees (range: 105 to 190 degrees) in Group 1 and 138.6 ± 21.3 degrees (range: 110 to 177 degrees) in Group 2. The mean kyphosis angle was 119.8 ± 52.7 degrees (range: 0 to 180 degrees) for Group 1 and 124.1 ± 45.0 degrees (range: -12 to 180 degrees) for Group 2. The mean T1-T12 distance was 130.3 ± 32.7 mm (range: 83 to 197 mm) for Group 1 and 148.2 ± 37.6 mm (range: 88 to 209 mm) for Group 2. PFT results showed severe impairment in all patients. Demographic data, radiographic parameters, and PFT results for both groups are detailed in Table 1.

Table 1 The demographic data, radiographic parameters, and PFT results for both groups
Full size table

To identify the risk factors for Type II respiratory failure complicated by scoliosis, we performed multivariate logistic regression analysis on the data described above. As all variables (including age of onset, apical vertebrae, main curve, kyphosis, T1-T12 distance) were continuous, it was complex to perform multivariate regression analysis. Therefore, we categorized the data as shown in Table 2. FVC and FVC% were PFT results and not causative factors of Type II respiratory failure. The results of the Chi-square test are shown in Table 3. Multivariate logistic regression analysis demonstrated that T1-T12 distance of less than 100 mm (95% CI = 0.001–0.479, P = 0.014) was independent risk factors associated with Type II respiratory failure.

Table 2 Variables categorized as different grades
Full size table
Table 3 Comparison of grade date between the two groups
Full size table

Typical cases are shown in Figs. 1 and 2. These two patients are a 23-year-old female with Type II respiratory failure and a 22-year-old male without respiratory failure. However, the patient with respiratory failure has a lesser degree of scoliosis than the patient without respiratory failure.

Fig. 1
figure 1

A 23-year-old female patient was diagnosed with severe scoliosis accompanied by Type II respiratory failure, characterized by: (A) Cobb angle of approximately 110° with a measured length of T1-T12 at about 92 mm. (B) kyphosis angle of approximately 96° C & D. 3D CT reconstructions of the spine.

Full size image
Fig. 2
figure 2

A 22-year-old male patient was diagnosed with severe scoliosis, featuring: (A) Cobb angle of approximately 172° with a measured length of T1-T12 at about 152 mm. (B) kyphosis angle of 159°. (C) 3D CT reconstruction of the spine

Full size image

Discussion

In our study, all patients had severe impairment of pulmonary function according to the American Thoracic Society guidelines. It demonstrated that the severe thoracic scoliosis could have a direct impact on pulmonary function. The relationship between spinal deformity and pulmonary function is a topic of considerable interest. The prevalence of moderate to severe pulmonary impairment in patients with adolescent idiopathic scoliosis (AIS) varies from 14 to 28% [7, 8]. Numerous studies have investigated the association between scoliosis and abnormalities in PFT, dyspnoea, thoracic morphology, bronchial narrowing, muscle dysfunction, exercise limitation, and the impact of pulmonary impairment on morbidity and mortality [2, 9,10,11,12]. Studies have indicated that risk factors reduced pulmonary function include thoracic scoliosis, hypokyphosis, the number of affected vertebrae, and the proximal extension [13]. Weinstein et al. [14] reported a direct correlation between pulmonary impairment and the severity of thoracic scoliosis curves, suggesting that clinically relevant decreases in pulmonary function only occur when the degree of thoracic scoliosis curve exceeds 100 degrees. Newton et al. [15] conducted a PFT survey of 631 AIS patients and found that the prevalence of moderate to severe pulmonary impairment increased to 74% when thoracic scoliosis curves exceeded 80 degrees. They also observed that the risk of moderate to severe pulmonary dysfunction was increased in cases with structural cephalad thoracic curves, major thoracic curves spanning eight or more vertebral levels, or thoracic hypokyphosis. However, their findings suggested that the severity of scoliosis associated with clinically relevant reductions in pulmonary function was significantly lower than previously described. In addition, many of the observed changes in pulmonary function could not be fully attributed to the radiographic characteristics of the deformity. In our study, there was no significant difference of main curve angle and kyphosis between the two groups, and the main curve angle and kyphosis were not independent risk factors for Type II respiratory failure in scoliosis cases.

In our study, the average age of onset for the two groups of scoliosis patients was 2.3 ± 2.9 years and 4.0 ± 4.5 years, respectively. There was no statistical difference in the age of onset between the two groups. This indicated that most of these patients had untreated early-onset scoliosis (EOS), which was defined as any spinal deformity occurring before the age of 10 years, regardless of etiology [16]. The progression curve of EOS demonstrated that earlier onset was associated with more severe final curvature and a poorer prognosis, potentially leading to significant deformity, cardiopulmonary deterioration, and reduced life expectancy [5]. The thoracic spine contributed to the vertical component of thoracic volume, while the thorax contributed to width and depth [17]. The growth of the spine was synchronized with the growth of the thorax, which affected the shape, volume, and circumference of the thorax, ultimately affecting the lung development [18]. Limitations in the anatomical boundaries of the deformed thoracic cage in EOS reduced the volume in early life, thereby reducing pulmonary function, as alveolar growth was most rapid in the first 8 years of life [19, 20]. Consequently, untreated EOS patients were at high risk of severe pulmonary impairment. However, there was no statistical difference in the age of onset between the two groups. Multivariate logistic regression analysis also demonstrated that age at scoliosis onset was not an independent risk factor for Type II respiratory failure.

Many articles have reported cases of severe scoliosis combined with respiratory failure [5, 6, 21,22,23,24,25]. For example, Ma et al. [21] reported the treatment of a 14-year-old girl with severe congenital scoliosis and Type II respiratory failure using halo gravity traction and orthopedic surgery, which resulted in significant improvements, including correction of scoliosis and improvement in pulmonary function. Kanagaraju et al. [22] also reported a successful treatment of a patient with severe rigid congenital scoliosis and Type II respiratory failure using stepwise controlled axial traction. Gill et al. performed deformity correction surgery in 8 patients with neuromuscular scoliosis and pre-existing respiratory failure, achieving favorable results without major pulmonary complications [23]. Buyse et al. [24] recommended a combination of nocturnal intermittent nasal positive pressure ventilation and long-term oxygen therapy for chronic respiratory failure in patients with kyphosis. However, research into the risk factors for Type II respiratory failure in patients with severe scoliosis remains relatively limited.

The present study aimed to analyse the differences between the Type II respiratory failure group and the control group in terms of age of onset, apical vertebra, main curve, kyphosis, and T1-T12 distance, in order to determine the risk factors for Type II respiratory failure. The study population comprised 64 patients with severe scoliosis, of whom 22 were diagnosed with Type II respiratory failure. The results of the PFT showed significant differences between the two groups, with the Group 1 showing a more severe condition. The mean age at admission in Group 1 was higher than in Group 2 (P < 0.05). It is recognised that patients have a greater degree of pulmonary function impairment with increasing age. Consequently, the potential of age at admission as an independent risk factor for Type II respiratory failure was not investigated. Although apical vertebra level was higher in Group 1 than in the Group 2 (P<0.01), regression analysis indicated that this was not a risk factor. The average T1-T12 distance in Group 1 was shorter than that of Group 2, but the difference was not significant. Multivariate logistic regression analysis demonstrated that T1-T12 distance less than 100 mm (95% CI = 0.001–0.479, P = 0.014) was an independent risk factor associated with Type II respiratory failure.

Spinal deformities would directly affect the height of the spine. The T1-S1 segment grows approximately 10 cm before the age of 5, about 5 cm between the ages of 5 and 10, and roughly 10 cm during puberty. Thus, the most rapid and significant growth period of the TI-S1 segment occurs before the age of 10 years [26]. The height of the thoracic spine is 12 cm at birth, 18 cm at 5 years of age, and 27 cm at skeletal maturity [18, 26]. Karol et al. [27] reported a direct relationship between thoracic spine height and pulmonary function, with a shorter thoracic spine leading to a smaller FVC. They also determined that to avoid severe restrictive lung disease (FVC < 50%), the height of the thoracic spine at skeletal maturity should exceed 22 cm. Their conclusion was consistent with our research findings. In our study, regression analysis indicated that a shorter distance between T1-T12 was associated with a stronger correlation with Type II respiratory failure.

Limitations

This study has several limitations. First, the sample size was small, which may have introduced some significant bias. Continuous variables such as age of onset, apical vertebra, main curve, kyphosis, and T1-T12 distance could not be analyzed directly because of the small sample size. We have to categorize continuous variables for regression analysis, which may lead to loss of information and potential misinterpretation of the data, and oversimplify complex relationships and reduce the statistical power of the analysis. Second, this is a retrospective study. Retrospective studies are prone to selection bias and cannot establish causality. The lack of randomisation may result in unrecognised confounding variables influencing the results. Thirdly, we could not identify the time of onset of Type II respiratory failure. Patients usually had a period of dyspnoea before they came to our hospital. Therefore, the time at which they came to our hospital may have been later than the time at which Type II respiratory failure was diagnosed. Although there was a significant difference between the age on admission of the two groups, it was still difficult to determine whether age was a risk factor for Type II respiratory failure. How to safely and effectively treat these severe scoliosis cases combined with Type II respiratory failure would be more challenging. Further studies are needed.

Conclusions

This study has highlighted the significant impact of severe thoracic scoliosis on pulmonary function and the risk factors of Type II respiratory failure. It emphasizes the critical period of spinal growth before the age of 10 and establishes a direct correlation between shorter thoracic spine height at skeletal maturity and an increased likelihood of respiratory complications. If not treated properly, early onset scoliosis would have a severe impact on pulmonary function. The T1-T12 distance was a risk factor for Type II respiratory failure associated with severe scoliosis in patients under 40 years old.

Data availability

Data and materials contributing to this article may be provided by sending an e-mail to the corresponding author.

References

  1. de Torres García I, de Cabo Moreno P, Ramírez AM. Extrinsic bronchial obstruction caused by scoliosis.spine. (Phila Pa 1976). 2013;38(13):E840–843.

    Article  Google Scholar 

  2. Yaszay B, Bastrom TP, Bartley CE, Parent S, Newton PO. The effects of the three-dimensional deformity of adolescent idiopathic scoliosis on pulmonary function. Eur Spine J. 2017;26(6):1658–64.

    Article  PubMed  Google Scholar 

  3. Day GA, Upadhyay SS, Ho EK, Leong JC, Ip M. Pulmonary functions in congenital scoliosis.spine. (Phila Pa 1976). 1994;19(9):1027–31.

    Article  CAS  Google Scholar 

  4. Davies G, Reid L. Effect of scoliosis on growth of alveoli and pulmonary arteries and on right ventricle. Arch Dis Child. 1971;46(249):623–32.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms.spine. (Phila Pa 1976). 1992;17(9):1091–6.

    Article  CAS  Google Scholar 

  6. Guilleminault C, Kurland G, Winkle R, Miles LE. Severe kyphoscoliosis, breathing, and sleep: the quasimodo. Syndrome Dur Sleep Chest. 1981;79(6):626–30.

    CAS  Google Scholar 

  7. Farrell J, Garrido E. Predicting preoperative pulmonary function in patients with thoracic adolescent idiopathic scoliosis from spinal and thoracic radiographic parameters. Eur Spine J. 2021;30(3):634–44.

    Article  PubMed  Google Scholar 

  8. Johnston CE, Richards BS, Sucato DJ, Bridwell KH, Lenke LG, Erickson M. Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis.spine. (Phila Pa 1976). 2011;36(14):1096–102.

    Article  Google Scholar 

  9. Vedantam R, Lenke LG, Bridwell KH, Haas J, Linville DA. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis.spine. (Phila Pa 1976). 2000;25(1):82–90.

    Article  CAS  Google Scholar 

  10. Farrell J, Garrido E, Vavruch L, Schlösser T. Thoracic morphology and bronchial narrowing are related to pulmonary function in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2021;103(21):2014–23.

    Article  PubMed  Google Scholar 

  11. Farrell J, Garrido E. Effect of idiopathic thoracic scoliosis on the tracheobronchial tree.bmj. Open Respir Res. 2018;5(1):e000264.

    Article  Google Scholar 

  12. Martínez-Llorens J, Ramírez M, Colomina MJ, Bagó J, et al. Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis. Eur Respir J. 2010;36(2):393–400.

    Article  PubMed  Google Scholar 

  13. Sponseller PD, Yazici M, Demetracopoulos C, Emans JB. Evidence basis for management of spine and chest wall deformities in children.spine. (Phila Pa 1976). 2007;32(19 Suppl):S81–90.

    Article  Google Scholar 

  14. Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg Am. 1981;63(5):702–12.

    Article  PubMed  CAS  Google Scholar 

  15. Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients. J Bone Joint Surg Am. 2005;87(9):1937–46.

    Article  PubMed  Google Scholar 

  16. Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, et al. Development and initial validation of the classification of Early-Onset scoliosis (C-EOS). J Bone Joint Surg Am. 2014;96(16):1359–67.

    Article  PubMed  Google Scholar 

  17. Campbell RM Jr, Smith MD. Thoracic insufficiency syndrome and exotic scoliosis. J Bone Joint Surg Am. 2007;89:108–22.

    PubMed  Google Scholar 

  18. Canavese F, Dimeglio A. Normal and abnormal spine and thoracic cage development. World J Orthop. 2013;4(4):167–74.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Campbell RM Jr, Smith MD, Mayes TC, Mangos JA, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2003;85(3):399–408.

    Article  PubMed  Google Scholar 

  20. Thurlbeck WM. (1975) Lung growth and alveolar multiplication.Pathobiol Annu 5(1–34.

  21. Ma Y, Wang Y, Dou X, Yang F, Zhang L, Kang X. Treatment of severe congenital scoliosis with type ІI respiratory failure. J Coll Physicians Surg Pak. 2022;32(12):SS174–7.

    Article  PubMed  Google Scholar 

  22. Kanagaraju V, Chhabra HS, Srivastava A, Mahajan R, et al. A case of severe and rigid congenital thoracolumbar lordoscoliosis with diastematomyelia presenting with type 2 respiratory failure: managed by staged correction with controlled axial traction. Eur Spine J. 2016;25(10):3034–41.

    Article  PubMed  Google Scholar 

  23. Gill I, Eagle M, Mehta JS, Gibson MJ, Bushby K, Bullock R. Correction of neuromuscular scoliosis in patients with preexisting respiratory failure.spine. (Phila Pa 1976). 2006;31(21):2478–83.

    Article  Google Scholar 

  24. Buyse B, Meersseman W, Demedts M. Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation. Eur Respir J. 2003;22(3):525–8.

    Article  PubMed  CAS  Google Scholar 

  25. Libby DM, Briscoe WA, Boyce B, Smith JP. Acute respiratory failure in scoliosis or kyphosis: prolonged survival and treatment. Am J Med. 1982;73(4):532–8.

    Article  PubMed  CAS  Google Scholar 

  26. Dimeglio A, Canavese F. The growing spine: how spinal deformities influence normal spine and thoracic cage growth. Eur Spine J. 2012;21(1):64–70.

    Article  PubMed  Google Scholar 

  27. Karol LA, Johnston C, Mladenov K, Schochet P, Walters P, Browne RH. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am. 2008;90(6):1272–81.

    Article  PubMed  Google Scholar 

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Author notes

  1. Zhengjun Hu and Yuanxian Leng contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopaedics, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, China

    Zhengjun Hu, Yuanxian Leng, Deng Zhao, Rui Zhong, Zhong Zhang, Dengxu Jiang, Fei Wang & Yijian Liang

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  1. Zhengjun Hu
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Contributions

Zhengjun Hu and Yuanxian Leng: Conceptualization, Writing - original draft, prepared Figs. 1 and 2. Rui Zhong: Investigation, Methodology. Fei Wang: Conceptualization, Methodology. Zhong Zhang: Investigation, Conceptualization, Resources. Dengxu Jiang: Conceptualization, Formal analysis. Yijian Liang: Investigation, Conceptualization, Resources. Deng Zhao: Conceptualization, Writing - review & editing. All authors approved the final manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Deng Zhao.

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Ethics approval and consent to participate

This retrospective study was approved by the Institutional Review Board (IRB) of The Third People’s Hospital of Chengdu. All patients involved in the study consent to participate in the study. And the written consent has been obtained from all the patients.

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All individual person’s data consent to publish.

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The authors declare no competing interests.

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Hu, Z., Leng, Y., Zhao, D. et al. The risk factors for type ii respiratory failure in patients with severe scoliosis (less than 40-year old). J Orthop Surg Res 20, 213 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13018-025-05630-5

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Journal of Orthopaedic Surgery and Research

ISSN: 1749-799X