We acknowledge the importance of sample size estimation in ensuring statistical power. Our study included 59 patients based on the available cohort from our institution during the study period (August 2012–June 2022). While we did not use software such as G*Power (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) for sample size calculation, we conducted a post-hoc power analysis, which confirmed adequate statistical power (>80%) for detecting significant differences in complication rates and curve progression between the two groups. Future prospective studies will benefit from formal sample size estimation to enhance methodological rigor.

We agree that adherence to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines enhances transparency in observational studies. Our study followed key STROBE recommendations, including clear reporting of objectives, methodology, and results. A STROBE flowchart was not included due to the straightforward inclusion criteria and single-center design. We will consider incorporating such flowcharts in future manuscripts to improve clarity.

The authors rightly noted the absence of scoliosis classification details, such as the Lenke Classification. Our study focused on early-onset scoliosis (EOS), which encompasses diverse etiologies beyond idiopathic scoliosis. While the Lenke Classification is widely used for adolescent idiopathic scoliosis, its applicability to EOS is limited due to the heterogeneity of the condition. Future studies may benefit from incorporating etiology-specific classifications to further stratify patient subgroups.

We appreciate the suggestion to specify that patients must have undergone at least two procedures (insertion followed by lengthening). Our inclusion criteria aimed to capture all eligible patients who underwent growing rod surgery, including those with at least one lengthening procedure. This approach ensured a broader representation of real-world clinical scenarios. However, we recognize that focusing exclusively on patients with multiple lengthening procedures may better align with the study’s objectives, and we will consider this in future research.

We agree that rehabilitation plays a critical role in patient outcomes. Our study did not detail post-operative physiotherapy protocols due to the retrospective nature of the data and variability in rehabilitation practices across patients. Prospective studies should systematically document rehabilitation protocols to evaluate their impact on long-term outcomes.

We thank the authors again for their constructive feedback, which highlights important methodological considerations for future research. Their insights will undoubtedly contribute to advancing the study of EOS management. We look forward to further collaborative efforts to improve clinical outcomes for patients with early-onset scoliosis.