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The Indonesian Journal of General Medicine
Published by International Medical Journal Corp. Ltd.
ISSN : -     EISSN : 3048104X     DOI : -
Core Subject : Health,
Dentistry Health Professions Medicine & Pharmacology Public Health Veterinary
ims: The Indonesian Journal of General Medicine aims to advance the field of medicine by disseminating high-quality research findings that are accessible to a broad audience of healthcare professionals, researchers, and policymakers. The journal is committed to supporting the development of medical knowledge and practice in Indonesia and globally, fostering innovative research and evidence-based clinical practices. Scope: The journal covers a wide range of topics within the general medical field, including but not limited to: Clinical studies in various medical disciplines Epidemiological research and public health issues Innovations in diagnostic techniques and treatments Reviews on current practices and emerging trends in medicine Case studies and clinical trials Health policy and medical education The Indonesian Journal of General Medicine welcomes submissions from all areas of medicine, particularly those that have significant implications for patient care, public health, and policy-making. The journal encourages submissions that offer new insights, propose novel approaches, or address challenges pertinent to the Indonesian and international medical communities.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 240 Documents
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A Comprehensive Systematic Review of The Association between the DASH Diet and Systolic Blood Pressure in Hypertensive Patients Mohamad Fadli; Hendandy Driya Pamungkas
The Indonesian Journal of General Medicine Vol. 34 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ph9qy691

Abstract

Introduction: Hypertension is a major modifiable risk factor for cardiovascular disease worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet has been recommended as an effective lifestyle intervention, but the magnitude of its effect on systolic blood pressure (SBP) in hypertensive patients varies across studies. This systematic review aims to comprehensively evaluate the association between the DASH diet and SBP reduction in hypertensive adults, identify effect modifiers, and provide context-specific clinical recommendations. Methods: A systematic review was conducted including randomized controlled trials, etc that examined the DASH diet in adults with hypertension (SBP ≥140 mmHg or on antihypertensive medication). Studies were screened based on predefined criteria including intervention duration ≥2 weeks and isolation of the DASH diet from major co-interventions. Data were extracted on study characteristics, DASH implementation, SBP outcomes, and effect modifiers. Results: Eighty studies were included, encompassing over 45,000 participants. The DASH diet consistently reduced SBP, with effects ranging from 3-16 mmHg depending on context. Controlled feeding trials demonstrated larger reductions (8-16 mmHg) compared to free-living implementations (3-6 mmHg). Baseline BP severity modified effects: patients with SBP ≥150 mmHg achieved up to -20.8 mmHg reduction with combined low-sodium DASH. The DASH diet enhanced the BP-lowering effects of RAS inhibitors, with reductions up to -9.5 mmHg in medicated patients. Sodium restriction produced additive effects, with the DASH-sodium combination achieving 84% BP control. Mechanistic studies revealed early natriuretic effects and later improvements in nitric oxide bioavailability. Discussion: The heterogeneity in SBP reduction reflects differences in study design, adherence levels, and patient characteristics rather than inconsistency in the diet's efficacy. Controlled feeding studies establish physiological maximum effects, while real-world implementations reflect practical effectiveness. The diet demonstrates particular efficacy in isolated systolic hypertension, older adults, and patients on RAS inhibitors. Conclusion: The DASH diet is a highly effective intervention for reducing SBP in hypertensive patients, with effects comparable to single-drug therapy in some populations. Implementation strategies should prioritize adherence support and cultural adaptation to maximize real-world effectiveness.
A Comprehensive Systematic Review of The Association between Low-Carbohydrate Diet and Weight Loss in Morbidly Obese Patients Mohamad Fadli; Hendandy Driya Pamungkas
The Indonesian Journal of General Medicine Vol. 35 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/d10wvf66

Abstract

Introduction: Morbid obesity (BMI ≥40 kg/m² or ≥35 kg/m² with comorbidities) presents a significant global health challenge with limited effective non-surgical interventions. Low-carbohydrate diets (LCD) have emerged as potential therapeutic approaches, but their efficacy and safety in morbidly obese populations remain incompletely characterized. This systematic review synthesizes evidence from randomized controlled trials and cohort studies examining LCD effects on weight loss and metabolic outcomes in morbidly obese patients. Methods: We systematically screened studies based on predefined criteria: morbidly obese participants (BMI ≥40 kg/m² or ≥35 kg/m² with comorbidities), LCD intervention (≤130g carbohydrates daily or ≤26% total energy), reported weight loss outcomes, study duration ≥4 weeks, and non-surgical dietary focus. Data extraction encompassed study characteristics, intervention details, comparator groups, weight loss outcomes, metabolic parameters, effectiveness moderators, and safety parameters. Results: Eighty studies comprising diverse populations (mean BMI 27-43 kg/m²) were included. LCD demonstrated superior short-term weight loss at 3-6 months compared to control diets, with mean differences ranging from -2.0 kg (95% CI: -3.1 to -0.9) in meta-analyses to -5.8 kg versus -1.9 kg (p=0.002) in individual trials. Very low-carbohydrate ketogenic diets (VLCKD) achieved the most dramatic initial results (13.6±3.9 kg loss at 2 months). At 12 months, advantages diminished but remained detectable (mean difference -0.93 kg; 95% CI: -1.81 to -0.04). Long-term follow-up (≥18 months) revealed weight regain patterns with convergence between dietary approaches. In diabetic populations, LCD produced superior glycemic control (HbA1c reductions of -0.61% to -1.5%) and medication reduction (95.2% of participants reduced/eliminated diabetes medications). Metabolic improvements included triglyceride reductions (-29.71 mg/dL; 95% CI: -31.99 to -27.44), HDL increases (+1.73 mg/dL; 95% CI: 1.44 to 2.01), and blood pressure reductions, though LDL responses were variable with increases observed in some studies. Safety profiles were generally favorable with transient adverse effects (constipation, fatigue, headaches) and no serious adverse events requiring medical attention. Discussion: LCD effectiveness is mediated through multiple mechanisms including glycogen depletion, ketosis-induced appetite suppression, spontaneous caloric reduction, and improved insulin dynamics. Effectiveness moderators include baseline characteristics (diabetes status, sex, central obesity), carbohydrate restriction intensity, adherence levels, and support intensity. Long-term convergence reflects decreasing adherence, metabolic adaptation, and similar energy intake between groups. Population-specific advantages favor LCD in type 2 diabetes and metabolic syndrome. Conclusion: Low-carbohydrate diets represent effective short-to-intermediate term interventions for weight loss in morbidly obese patients, with particularly robust benefits in diabetic populations. Optimal implementation requires intensive behavioral support, appropriate patient selection, regular monitoring of metabolic parameters (especially LDL cholesterol), and realistic expectations regarding long-term weight maintenance challenges. Future research should focus on strategies to enhance long-term adherence and identify genetic/biological predictors of differential response.
Is there a relationship between fasting blood glucose levels and the incidence of polyhydramnios in pregnant women with gestational diabetes? : A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The Indonesian Journal of General Medicine Vol. 35 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/vehvp648

Abstract

Introduction: Gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes, including polyhydramnios. However, the direct relationship between fasting blood glucose levels and the incidence of polyhydramnios in GDM populations remains debated. This systematic review aimed to evaluate the association between fasting glucose levels and polyhydramnios occurrence in pregnant women with GDM. Methods: A systematic review of observational studies examining the relationship between glucose parameters and polyhydramnios in GDM pregnancies was conducted. Thirty-five studies published to 2026 were identified,. Data extraction focused on study characteristics, GDM populations, glucose measurements, polyhydramnios occurrence, and statistical associations. Results: Polyhydramnios rates among GDM women ranged from 8.3% to 56.8%. Direct evidence from Dashe et al. and Xu et al. demonstrated significant positive correlations between amniotic fluid glucose concentration and amniotic fluid index (AFI) in diabetic populations (r=0.32, p=0.04; r=0.330, p=0.002). Xu et al. further showed strong correlation between amniotic fluid glucose and maternal fasting glucose (r=0.589, p<0.01). Critically, well-controlled GDM demonstrated significantly lower AFI (13.9±4.2 cm) compared to uncontrolled GDM (16.4±4.4 cm, p<0.05). Bartha et al. showed early GDM screening reduced hydramnios rates from 12.7% to 2.1% (p<0.0001). Late-onset GDM was identified in 4.8-11.8% of women with third-trimester polyhydramnios and prior negative screening. Discussion: The evidence supports an osmotic mechanism whereby maternal hyperglycemia leads to elevated amniotic fluid glucose, increasing amniotic fluid volume. The glucose-polyhydramnios relationship is modifiable through glycemic control, explaining apparent contradictions between studies. Studies failing to detect associations typically examined narrow glycemic ranges in normoglycemic populations. Conclusion: Fasting blood glucose levels are positively associated with polyhydramnios in GDM, mediated through amniotic fluid glucose concentration. Early detection and strict glycemic control significantly reduce polyhydramnios incidence and severity.
Is a sedentary lifestyle associated with a decrease in semen quality in adult men aged 18-50 years? A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The Indonesian Journal of General Medicine Vol. 35 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/njxa1z45

Abstract

Introduction: Global declines in semen quality over recent decades have raised concerns about the impact of modern lifestyles on male fertility. Sedentary behavior, increasingly prevalent in occupational and leisure settings, has been hypothesized as a potential contributing factor. This systematic review aims to evaluate whether a sedentary lifestyle is associated with decreased semen quality in healthy adult men aged 18-50 years. Methods: A systematic review was conducted following predefined screening criteria. Sixteen studies were included randomized controlled trial, etc. Studies were required to assess sedentary behavior (directly or indirectly), evaluate semen quality parameters (concentration, motility, morphology, volume, DNA fragmentation), and include healthy adult men aged 18-50 years. Data were extracted on study characteristics, sedentary behavior definitions, semen parameters, association findings, confounding factors, and limitations. Results: Direct evidence from two studies specifically measuring sedentary behavior showed inconsistent findings. Sterpi et al. (2024) reported mixed results across 13,509 men: three studies found declines in sperm concentration with high sedentary time, but most studies showed no significant associations with concentration, motility, or morphology. Eisenberg et al. (2015) found no association between occupational prolonged sitting and any semen parameter after adjustment for confounders. Indirect evidence from physical activity studies suggested that moderate physical activity benefits semen quality, while intense exercise may be detrimental (Montano et al., 2021; Nesello et al., 2020; Zańko et al., 2022). Obesity, strongly correlated with sedentary behavior, consistently predicted impaired semen quality (Magoutas et al., 2025; Venishetty et al., 2024; Бобков et al., 2020). Discussion: The available evidence does not demonstrate a robust independent association between sedentary behavior and decreased semen quality. Methodological limitations include heterogeneous definitions of sedentary behavior, reliance on self-report measures, inadequate adjustment for confounders (particularly BMI/obesity), and selection bias across study populations. The pathway linking sedentary behavior to semen quality appears mediated primarily through metabolic consequences (obesity, hormonal imbalances) rather than direct effects. Conclusion: Current evidence is insufficient to establish a causal relationship between sedentary lifestyle and decreased semen quality in healthy adult men aged 18-50 years. High-quality prospective studies using objective sedentary behavior measures (accelerometry) with adequate adjustment for adiposity and confounders are needed. Future research should distinguish between sedentary behavior's independent effects and those mediated through obesity.
What is the effectiveness of early palliative care integration on quality of life and symptom management in women with advanced gynecologic cancer? : A Systematic Review Amanda Ezra Natasya Napitupulu; Jenary Immanuel Surbakti
The Indonesian Journal of General Medicine Vol. 36 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/cx5yyf87

Abstract

Introduction: Advanced gynecologic cancers are associated with significant symptom burden and impaired quality of life (QoL). While early palliative care integration has demonstrated benefits in other oncology populations, its effectiveness specifically in women with advanced gynecologic malignancies remains uncertain. This systematic review aimed to evaluate the effectiveness of early palliative care integration on QoL and symptom management in women with advanced gynecologic cancer. Methods: A systematic review was conducted following PRISMA guidelines. We included randomized controlled trials, etc examining early palliative care (initiated within 8 weeks of advanced cancer diagnosis or concurrently with active treatment) in adult women with stage III/IV or recurrent gynecologic cancers. Studies were required to report QoL, symptom management, or healthcare utilization outcomes. Data were extracted on study characteristics, interventions, and outcomes. Results: Thirty-five studies met inclusion criteria, encompassing diverse designs and populations (sample sizes 23–8,297). Ovarian cancer was most commonly studied. QoL findings were mixed: while several smaller studies reported significant improvements across FACT-G domains (p<0.05) [6,19,32], the largest RCTs in recurrent ovarian cancer failed to demonstrate significant overall QoL improvements [1,2]. A meta-analysis of four RCTs found non-significant pooled QoL effects (SMD=0.26; 95% CI -0.29–0.80) [4]. Symptom management showed more consistent benefits, particularly for acute symptom relief [8] and psychological symptoms [6]. Healthcare utilization outcomes demonstrated the most robust improvements, including reduced aggressive end-of-life care [9], increased hospice enrollment [10,11], and cost-effectiveness [17]. However, persistent underutilization (referral rates <50%) [13,14] and racial disparities [13,15] were identified. Conclusion: Early palliative care integration in advanced gynecologic cancer consistently improves healthcare utilization outcomes and shows benefits for psychological symptoms, but QoL improvements remain inconsistent across well-controlled trials. System-level interventions and standardized referral protocols may optimize real-world effectiveness. Further research should address implementation barriers and disparities.
What is the comparative effectiveness of pharmacological versus lifestyle-based management strategies for menopausal symptoms in postmenopausal women? : A Systematic Review Amanda Ezra Natasya Napitupulu; Jenary Immanuel Surbakti
The Indonesian Journal of General Medicine Vol. 36 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/s7y8kp11

Abstract

Introduction: Menopausal symptoms significantly impact quality of life for postmenopausal women. With growing concerns about hormone therapy safety and increasing interest in lifestyle approaches, evidence-based guidance on comparative effectiveness is urgently needed. This systematic review evaluates the comparative effectiveness of pharmacological versus lifestyle-based management strategies for menopausal symptoms. Methods: We systematically searched databases for randomized controlled trials, systematic reviews, meta-analyses, and prospective cohort studies published up to 2026 comparing pharmacological interventions (hormone therapy, SSRIs/SNRIs, gabapentin, clonidine) with lifestyle interventions (dietary modifications, exercise, cognitive behavioral therapy, acupuncture, herbal supplements) in postmenopausal women. Studies required ≥4 weeks duration and direct comparative design. Data extraction followed standardized protocols with quality assessment. Results: Eighty studies encompassing over 8,000 women were included. Hormone therapy demonstrated superior efficacy for vasomotor symptoms (70-90% reduction) compared to lifestyle interventions (1-3). SSRIs/SNRIs reduced symptoms by 40-60% (2,6). Among lifestyle interventions, acupuncture showed comparable effectiveness to pharmacological approaches (8,9,12), with additional cardiovascular benefits (12). Phytoestrogens demonstrated variable effectiveness (13,14), while exercise showed limited vasomotor benefits but improved quality of life (7,20). Combined approaches (pharmacological plus lifestyle) demonstrated superior outcomes (17,18). Safety profiles favored lifestyle interventions, with hormone therapy carrying highest serious adverse event risks (13,14). Discussion: Treatment selection should be individualized based on symptom severity, contraindications, and patient preferences. Hormone therapy remains most effective for severe symptoms in eligible women, while non-hormonal pharmacological and lifestyle options provide valuable alternatives. Acupuncture emerges as the most promising lifestyle intervention with comparable efficacy. Combined approaches may optimize outcomes. Conclusion: Pharmacological interventions, particularly hormone therapy, demonstrate superior efficacy for vasomotor symptoms, while lifestyle interventions offer favorable safety profiles and broader health benefits. An individualized, shared decision-making approach integrating both modalities is recommended.
The Relationship between Environmental Tobacco Smoke Exposure and Decreased Lung Function in Adolescents : A Comprehensive Systematic Review Nydia Ayu Ulima; Rajmil Shafira Salsabila
The Indonesian Journal of General Medicine Vol. 36 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ep7bwr84

Abstract

Introduction: Environmental tobacco smoke (ETS) exposure remains a significant public health concern, particularly for adolescents whose lungs are undergoing critical development. Despite declining smoking rates in many countries, millions of adolescents worldwide continue to be exposed to ETS in their homes and communities. This systematic review aims to comprehensively evaluate the relationship between ETS exposure and decreased lung function in adolescents aged 10-19 years. Methods: A systematic review was conducted following established guidelines. Twenty sources were included after screening based on predefined criteria: adolescent population age range (10-19 years), validated ETS exposure measurement, standardized lung function assessment, appropriate observational study design, focus on passive exposure, objective outcome measurement, and general population health status. Data extraction encompassed study characteristics, ETS exposure assessment methods, lung function measures, primary associations, effect sizes, dose-response evidence, effect modifiers, and confounding control. Results: The predominant finding across studies was a negative association between ETS exposure and lung function parameters. Small airway measures (FEF25-75, FEF25) were most consistently affected, with He et al. reporting β = −0.104 (p=0.020) for FEF25-75 growth rate. FEV1 annual growth reduction of −0.34% (95% CI: −0.64% to −0.04%) was documented by Milanzi et al. Dose-response relationships were demonstrated in multiple studies. Critical effect modifiers included sex (girls showing greater vulnerability with FEV1 reduction of −272 ml/s in perinatally exposed females), genetic polymorphisms (β2-adrenoceptor and GSTP1 variants), timing of exposure (prenatal and early childhood windows most critical), and synergistic interactions with active smoking. Discussion: The evidence consistently supports a negative association between ETS exposure and adolescent lung function, with biological plausibility strengthened by acute exposure studies demonstrating immediate effects. Heterogeneity in effect sizes is explained by differences in exposure timing, measurement methods, and population susceptibility. Methodological limitations include variability in confounding control and exposure assessment. Conclusion: ETS exposure is significantly associated with decreased lung function in adolescents, with evidence of dose-response relationships and modification by sex, genetics, and exposure timing. Recommendations include strengthening smoke-free legislation, targeted interventions for vulnerable populations, routine clinical screening, and further research with standardized methodologies.
Nilai Prognostik Parameter Hematologi Rutin pada Pasien dengan Kanker Padat : Sebuah Tinjauan Sistematis Putu Putri Andiyani Dewi; I Putu Candra Yogiswara
The Indonesian Journal of General Medicine Vol. 37 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/wckm2e27

Abstract

Latar Belakang: Respons inflamasi sistemik memainkan peran kunci dalam progresi kanker. Parameter hematologi rutin seperti Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), dan Lymphocyte-to-Monocyte Ratio (LMR) telah muncul sebagai biomarker prognosis potensial yang murah dan mudah diakses. Metode: Tinjauan sistematis ini dilakukan dengan mensintesis bukti dari 200 studi meta-analisis dan penelitian observasional besar yang mengevaluasi nilai prognosis parameter hematologi pada pasien dengan berbagai jenis tumor solid. Pencarian literasis dilakukan secara komprehensif. Data mengenai jenis parameter, nilai cut-off, luaran klinis (overall survival/OS, progression-free survival/PFS), dan konteks pengobatan diekstraksi dan dianalisis secara naratif. Hasil: Neutrophil-to-Lymphocyte Ratio (NLR) merupakan parameter yang paling banyak diteliti dan secara konsisten terbukti sebagai prediktor independen untuk luaran yang lebih buruk pada berbagai keganasan, termasuk kanker kolorektal (HR 1,92 untuk OS), payudara (HR 2,56 untuk OS), paru (HR 1,46 untuk OS), ovarium (HR 1,69 untuk OS), dan urothelial (HR 1,72 untuk OS). Platelet-to-Lymphocyte Ratio (PLR) dan LMR juga menunjukkan nilai prognosis yang signifikan pada berbagai jenis kanker. Nilai cut-off sangat bervariasi, dengan NLR 3-5 dan PLR 150-200 sebagai batas yang umum digunakan. Yang penting, perubahan dinamis parameter ini selama pengobatan (misalnya, pada minggu ke-6 atau 12) seringkali memberikan informasi prognosis yang lebih unggul daripada nilai dasar saja, terutama pada pasien yang menerima imunoterapi dan terapi target. Diskusi: Parameter hematologi mencerminkan keseimbangan antara inflamasi pro-tumor (neutrofil, trombosit) dan imunitas anti-tumor (limfosit). Kekuatan prognostiknya bervariasi tergantung pada jenis kanker, stadium, dan modalitas terapi, dengan efek yang paling kuat terlihat pada pengobatan imunoterapi. Meskipun hasilnya menjanjikan, standardisasi nilai cut-off dan waktu pengukuran sangat diperlukan sebelum implementasi klinis rutin. Kesimpulan: Parameter hematologi rutin, terutama NLR, PLR, dan LMR, merupakan biomarker prognosis yang berharga pada pasien tumor solid. Pengukurannya yang sederhana dan murah dapat membantu stratifikasi risiko, memandu keputusan klinis, dan memantau respons terapi. Penelitian prospektif dengan metodologi terstandar diperlukan untuk mengintegrasikan biomarker ini ke dalam praktik klinis sehari-hari.
ROBOTIC FLEXIBLE URETEROSCOPY VERSUS CONVENTIONAL FLEXIBLE URETEROSCOPY FOR THE MANAGEMENT OF RENAL CALCULI: EFFICACY, SAFETY, AND COST EFFICIENCY A SYSTEMATIC REVIEW Anita Arum Wijayatri; John M.Sangkai
The Indonesian Journal of General Medicine Vol. 37 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/fge2ym11

Abstract

Introduction: Robotic flexible ureteroscopy (R-fURS) has been developed to overcome ergonomic and technical limitations of conventional flexible ureteroscopy (C-fURS) for renal calculi. This systematic review compares the efficacy, safety, and cost efficiency of R-fURS versus C-fURS. Methods: A systematic search of PubMed, Scopus, Cochrane Library, Web of Science, and ClinicalTrials.gov (up to April 2026) was conducted following PRISMA 2020 guidelines. Risk of bias was assessed using RoB 2 (RCT) and ROBINS-I (observational studies). Certainty of evidence was evaluated using GRADE. Meta-analysis was not performed due to clinical and methodological heterogeneity. Results: Four studies comprising 518 patients were included: one head-to-head RCT (Geavlete 2016, N=132) and three single-arm R-fURS studies (Salah 2024, Kim 2025, Klein 2021). R-fURS stone-free rates ranged 73–92.4%, comparable to C-fURS (89.4% in direct comparison). Major complications (Clavien-Dindo ≥III) were 0–1%. Operative time ranged 51–116 minutes; length of stay was 9.3 hours–1.5 days. No study reported explicit cost data. Consistent advantages of R-fURS included improved surgeon ergonomics and reduced radiation exposure. Overall GRADE certainty: Very Low to Low. Discussion: R-fURS achieves comparable stone-free rates and safety to C-fURS, with superior ergonomics and radiation protection as its most robust benefits. However, evidence is limited by heterogeneity in stone-free rate definitions, lack of direct comparative data, and absence of cost-effectiveness analyses. Conclusion: R-fURS is a feasible alternative to C-fURS with acceptable efficacy and safety. Large-scale multicentre RCTs with standardised outcomes and formal cost analyses are required before strong clinical recommendations can be made.
The Relationship Between Spinal Curvature Angle on Radiography and Pulmonary Function Impairment in Scoliosis Patients : A Systematic Review Mekko Pebin; Desi Megafini; Cecep Kurnia Suhayat; Selvaning Oktania
The Indonesian Journal of General Medicine Vol. 37 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/1yhn2h38

Abstract

Introduction: Scoliosis is a three-dimensional spinal deformity that may impair pulmonary function through mechanical restriction of thoracic volume. The precise relationship between radiographic curvature magnitude and pulmonary impairment remains debated, particularly regarding whether surgical correction reliably improves lung function. Methods: This systematic review synthesised 80 studies examining the relationship between spinal curvature measurements (primarily Cobb angle) and pulmonary function tests (spirometry, lung volumes) in scoliosis patients. Studies included idiopathic, congenital, and neuromuscular aetiologies, with sample sizes ranging from 11 to 8,723 patients. Key outcomes were correlation coefficients, effect sizes, and changes in percent-predicted FVC and FEV1. Results: A significant inverse linear relationship exists between thoracic Cobb angle and pulmonary function in untreated idiopathic scoliosis. Kempen et al. (2021) demonstrated a decrease of approximately 1% predicted pulmonary function per 2.6–4.5 degrees of scoliosis (p<0.001). Kan et al. (2022) confirmed significant negative correlations: %FVC (r=−0.302), %FEV1 (r=−0.348), and %TLC (r=−0.183), all p<0.001. Thoracic kyphosis showed a positive correlation with %FVC (r=+0.180, p<0.05), indicating hypokyphosis independently worsens restriction. Surgical correction significantly improves percent-predicted FVC only in severe curves (>100°), with Grabala et al. (2023) reporting improvement from 51.2% to 69.9% (p<0.001). In moderate curves (50°–70°), Burgos et al. (2025) found no significant change in %FVC at 10+ years follow-up (MD −2.90, 95% CI −5.98 to 0.18). Posterior-only approaches preserve function better than thoracotomy or thoracoplasty. Preoperative halo-pelvic traction improved FVC by 15.6% (p=0.024). In Duchenne muscular dystrophy, surgery reduced FVC decline from 7.80%/year to 4.26%/year (p<0.001). Baseline FVC% was the strongest predictor of postoperative pulmonary complications (OR=0.91 per unit increase, p=0.013). Discussion: The curvature-PF relationship is real but explains only 5–8% of variance in pulmonary impairment. The apparent paradox of significant correlation without consistent surgical improvement is reconciled by threshold effects (only severe curves benefit), surgical approach (chest wall violation negates benefits), and growth confounding. Three-dimensional deformity parameters (apical rotation, kyphosis, rib anomalies) independently predict PF beyond coronal Cobb angle. Conclusion: Thoracic Cobb angle demonstrates a significant negative correlation with pulmonary function in untreated scoliosis, with approximately 1% FVC loss per 3–4 degrees of curvature. However, surgical correction reliably improves percent-predicted pulmonary function only in patients with severe deformity (>100°) and baseline impairment. For moderate idiopathic curves, posterior-only fusion preserves rather than improves function. Neuromuscular scoliosis surgery attenuates decline rather than achieving improvement. Preoperative pulmonary function is the dominant prognostic factor across all etiologies.

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