Improved intraoperative tidal volume during deformity correction in a 16-year-old with spina bifida, severe kyphoscoliosis, and thoracic insufficiency syndrome: illustrative case.

backgroundSevere 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. OBSERVATIONS: 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° 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°, with thoracic height improving to 23.4 cm. Clinically, the patient reported subjective improvement in breathing and demonstrated increased ambulation endurance. LESSONS: 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. https://thejns.org/doi/10.3171/CASE25379.