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Scoliosis diagnosis and treatment

Works Count: 38874

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Description

This cluster of papers focuses on the impact of spinal deformities, such as scoliosis, on the health and function of individuals. It covers topics such as sagittal alignment, pelvic incidence, pedicle subtraction osteotomy, proximal junctional kyphosis, and orthopaedic treatment for adolescent idiopathic scoliosis. The research aims to understand the classification, complications, surgical techniques, and long-term outcomes related to spinal deformities.

Keywords

Spinal Deformity; Scoliosis; Sagittal Alignment; Pelvic Incidence; Pedicle Subtraction Osteotomy; Proximal Junctional Kyphosis; Adolescent Idiopathic Scoliosis; Spinal Fusion; Sagittal Balance; Orthopaedic Treatment

Idiopathic scoliosis

1981-06-01

Stuart L. Weinstein , Donald C. Zavala , Ignacio V. Ponseti

Two hundred and nineteen patients with untreated adolescent idiopathic scoliosis who were seen at the University of Iowa between 1932 and 1948 were studied, and recent information was available on … Two hundred and nineteen patients with untreated adolescent idiopathic scoliosis who were seen at the University of Iowa between 1932 and 1948 were studied, and recent information was available on 194 of the patients. The mortality rate was 15 per cent. Backache was somewhat more common in these patients than in the general population, although it was never disabling. The backache was unrelated to the presence of osteoarthritic changes on roentgenograms. Many curves continued to progress slightly in adult life, particularly thoracic curves that had reached between 50 and 80 degrees at skeletal maturity. The lumbar components of combined curves between 50 and 74 degrees also tended to progress. Pulmonary function was affected only in patients with thoracic curves.

Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error.

1990-03-01

Raymond T. Morrissy , G S Goldsmith , editors-in-chief Chittaranjan Kole and Timothy C. Hall +2 more

To quantitate the intrinsic error in measurement, fifty anteroposterior radiographs of patients who had scoliosis were each measured on six separate occasions by four orthopaedic surgeons using the Cobb method. … To quantitate the intrinsic error in measurement, fifty anteroposterior radiographs of patients who had scoliosis were each measured on six separate occasions by four orthopaedic surgeons using the Cobb method. For the first two measurements (Set I), each observer selected the end-vertebrae of the curve; for the next two measurements (Set II), the end-vertebrae were pre-selected and constant. The last two measurements (Set III) were obtained in the same manner as Set II, except that each examiner used the same protractor rather than the one that he carried with him. The pooled results of all four observers suggested that the 95 per cent confidence limit for intraobserver variability was 4.9 degrees for Set I, 3.8 degrees for Set II, and 2.8 degrees for Set III. The interobserver variability was 7.2 degrees for Set I and 6.3 degrees for Sets II and III. The mean angles differed significantly between observers, but the difference was smaller when the observers used the same protractor.

Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves

1998-05-05

Jean Legaye , G. Duval-Beaup�re , C. Marty +1 more

Comparative Analysis of Pedicle Screw Versus Hook Instrumentation in Posterior Spinal Fusion of Adolescent Idiopathic Scoliosis

2004-09-01

Yongjung J. Kim , Lawrence G. Lenke , Samuel K. Cho +3 more

In Brief Study Design. A retrospective matched cohort study. Objective. To comprehensively compare the 2-year postoperative results of posterior correction and fusion with segmental pedicle screw instrumentation versus those with … In Brief Study Design. A retrospective matched cohort study. Objective. To comprehensively compare the 2-year postoperative results of posterior correction and fusion with segmental pedicle screw instrumentation versus those with hook constructs in adolescent idiopathic scoliosis (AIS) treated at a single institution. Summary of Background Data. Despite the reports of satisfactory correction and maintenance of scoliotic curves by pedicle screw instrumentation compared to hook constructs, few reports on the comprehensive comparison of segmental pedicle screw instrumentation versus hook instrumentation exist Materials and Methods. A total of 52 patients with AIS at a single institution who underwent a posterior spinal fusion with segmental pedicle screw (26) or hook (26) instrumentation were sorted and matched according to four criteria: similar age at surgery (14.8 years in pedicle screw group and 14.2 years in hook group), identical Lenke curve types, same number of fused vertebrae (11.7 in each group), and identical operative methods (18 posterior spinal fusions with thoracoplasty, 4 posterior spinal fusions with iliac crest bone graft, and 4 anterior and posterior spinal fusions in each group). Patients were evaluated before surgery, immediate after surgery, and at the 2-year follow-up according to radiographic changes in curve correction, pulmonary function tests, operative time, intraoperative blood loss, implant costs, and SRS-24 scores. Results. After surgery, the average major curve correction was 76% in the screw group and 50% in the hook group (P < 0.001). At the 2-year follow-up, loss of the major curve correction was less in the screw group (5.4%) compared with the hook group (8.0%) (P = 0.35). Postoperative global coronal and sagittal balance was similar in both groups. An average of 0.8 levels from the distal end vertebra was saved using pedicle screws compared with hook constructs (P = 0.002). Postoperative 2-year proximal junctional change in the sagittal plane (angle between uppermost instrumented vertebra and two verte bral bodies above the uppermost-instrumented vertebra) was 9° in the screw group and 6° in the hook group (P = 0.19). Postoperative 2-year distal junctional change in the sagittal plane was similar in both groups. Operative time averaged 341 minutes in the screw group and 338 minutes in the hook group (P = 0.86), and intraoperative blood loss was similar in both groups (879 mL in screw group vs. 896 mL in hook group) (P = 0.12). Average implant cost in the hook group (11.8 fixation points; 5,816 U.S. dollars) was significantly lower than that of the screw group (17.1 fixation points; 11,508 U.S. dollars) (P < 0.001). Two years following surgery, the screw group demonstrated improved percent predicted pulmonary function values compared with that of the hook group (FVC, 80%→ 79% in screw group vs. 82%→ 74% in hook group, P = 0.0056; FEV-1, 73%→ 76% in screw group vs. 80%→ 79% in hook group, P = 0.017). Postoperative 2-year SRS-24 scores were similar in both groups (screw group [97] vs. hook group [101]) (P = 0.15). There were no neurologic or visceral complications related to hook or pedicle screw instrumentation. Conclusion. Pedicle screw instrumentation, although more expensive, offers a significantly better major and minor curve correction without neurologic problems and improved pulmonary function values in the operative treatment of AIS and enables a slightly shorter fusion length than segmental hook instrumentation. This comparison study of 52 patients with adolescent idiopathic scoliosis at a single institution that underwent posterior fusion with exclusive pedicle screw (26) or segmental hook (26) instrumentation were sorted matched according to four criteria: age, curve type, fusion level, operative method. Segmental pedicle screw instrumentation offered maintained a significantly better coronal curve correction without neurologic problems improved pulmonary function values enabled a shorter distal fusion level than segmental hook instrumentation in the operative treatment of adolescent idiopathic scoliosis.

A barycentremetric study of the sagittal shape of spine and pelvis: The conditions required for an economic standing position

1992-07-01

G Duval-Beaupère , Carolin Schmidt , Paul Georges Cosson

Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis

2005-09-22

C. Boulay , Christine Tardieu , J. Hecquet +7 more

Scoliosis Research Society—Schwab Adult Spinal Deformity Classification

2011-11-01

Frank Schwab , Benjamin Ungar , Benjamin Blondel +7 more

Inter- and intra-rater variability study.On the basis of a Scoliosis Research Society effort, this study seeks to determine whether the new adult spinal deformity (ASD) classification system is clear and … Inter- and intra-rater variability study.On the basis of a Scoliosis Research Society effort, this study seeks to determine whether the new adult spinal deformity (ASD) classification system is clear and reliable.A classification of adult ASD can serve several purposes, including consistent characterization of a clinical entity, a basis for comparing different treatments, and recommended treatments. Although pediatric scoliosis classifications are well established, an ASD classification is still being developed. A previous classification developed by Schwab et al has met with clinical relevance but did not include pelvic parameters, which have shown substantial correlation with health-related quality of life measures in recent studies.Initiated by the Scoliosis Research Society Adult Deformity Committee, this study revised a previously published classification to include pelvic parameters. Modifier cutoffs were determined using health-related quality of life analysis from a multicenter database of adult deformity patients. Nine readers graded 21 premarked cases twice each, approximately 1 week apart. Inter- and intra-rater variability and agreement were determined for curve type and each modifier separately. Fleiss' kappa was used for reliability measures, with values of 0.00 to 0.20 considered slight, 0.21 to 0.40 fair, 0.41 to 0.60 moderate, 0.61 to 0.80 substantial, and 0.81 to 1.00 almost perfect agreement.Inter-rater kappa for curve type was 0.80 and 0.87 for the 2 readings, respectively, with modifier kappas of 0.75 and 0.86, 0.97 and 0.98, and 0.96 and 0.96 for pelvic incidence minus lumbar lordosis (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), respectively. By the second reading, curve type was identified by all readers consistently in 66.7%, PI-LL in 71.4%, PT in 95.2%, and SVA in 90.5% of cases. Intra-rater kappa averaged 0.94 for curve type, 0.88 for PI-LL, 0.97 for PT, and 0.97 for SVA across all readers.Data from this study show that there is excellent inter- and intra-rater reliability and inter-rater agreement for curve type and each modifier. The high degree of reliability demonstrates that applying the classification system is easy and consistent.

The prevalence of vertebral deformity in European men and women: The european vertebral osteoporosis study

1996-07-01

Terence W O’Neill , Dieter Felsenberg , J. Varlow +3 more

Abstract Our aim was to determine the prevalence of radiographically defined vertebral deformity, as a marker of vertebral osteoporosis, in different regions and populations within Europe. We used a cross-sectional … Abstract Our aim was to determine the prevalence of radiographically defined vertebral deformity, as a marker of vertebral osteoporosis, in different regions and populations within Europe. We used a cross-sectional population-based survey. Population-based sampling frames were obtained from 36 centers in 19 European countries. Stratified random sampling was used to recruit 15,570 males and females aged 50–79 years. Lateral spinal radiographs were taken according to a standardized protocol, and all X-rays were evaluated centrally. Vertebral deformity was morphometrically defined according to the published methods of McCloskey and Eastell. Based on the McCloskey method, the mean center prevalence of all deformities was 12% in females (range 6–21%) and 12% in males (range 8–20%). The prevalence increased with age in both sexes though the gradient was steeper in females. There was substantial geographical variation, with the highest rates in Scandinavian countries. Radiographically defined vertebral deformity is a common disorder and equally frequent in males and females. Using standardized methodology, there is important variation in occurrence across Europe, which might suggest clues to pathogenesis. (J Bone Miner Res 1996;11:1010–1018)

Proximal Junctional Kyphosis in Adult Spinal Deformity Following Long Instrumented Posterior Spinal Fusion

2005-07-01

R. Chris Glattes , Keith H. Bridwell , Lawrence G. Lenke +3 more

In Brief Study Design. To analyze patient outcomes and risk factors associated with proximal junctional kyphosis (PJK) in adults undergoing long posterior spinal fusion. Objectives. To determine the incidence of … In Brief Study Design. To analyze patient outcomes and risk factors associated with proximal junctional kyphosis (PJK) in adults undergoing long posterior spinal fusion. Objectives. To determine the incidence of PJK and its effect on patient outcomes and to identify any risk factors associated with developing PJK. Summary of Background Data. The incidence of PJK and its affect on outcomes in adult deformity patients is unknown. No study has concentrated on outcomes of patients with PJK. Risk factors for developing PJK are unknown. Methods. Radiographic data on 81 consecutive adult deformity patients with minimum 2-year follow-up (average 5.3 years, range 2–16 years) treated with long instrumented segmental posterior spinal fusion was collected. Preoperative diagnosis was adult scoliosis, sagittal imbalance or both. Radiographic measurements analyzed included the sagittal Cobb angle at the proximal junction on preoperative, early postoperative, and final follow-up standing long cassette radiographs. Additional measurements used for analysis included the C7-Sacrum sagittal plumb and the T5–T12 sagittal Cobb. Postoperative SRS-24 scores were available on 73 patients. Results. Incidence of PJK as defined was 26%. Patients with PJK did not have lower outcomes scores. PJK did not produce a more positive sagittal C7 plumb. PJK was more common at T3 in the upper thoracic spine. Conclusions. Incidence of proximal junctional kyphosis was high, but SRS-24 scores were not significantly affected in patients with PJK. The sagittal C7 plumb was not significantly more positive in PJK patients. No patient, radiographic, or instrumentation variables were identified as risk factors for developing PJK. A medium-term follow-up study was performed examining proximal junctional kyphosis (PJK) in adult deformity patients following instrumented segmental posterior spinal fusion. Outcomes scores (SRS-24) were not affected by PJK. PJK was more common at T3 in the upper thoracic spine.

Health and Function of Patients With Untreated Idiopathic Scoliosis

2003-02-05

Stuart L. Weinstein , Lori A. Dolan , Kevin F. Spratt +3 more

<h3>Context</h3> Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic … <h3>Context</h3> Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. <h3>Objective</h3> To present the outcomes related to health and function in untreated patients with LIS. <h3>Design, Setting, and Patients</h3> Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). <h3>Main Outcome Measures</h3> Mortality, back pain, pulmonary symptoms, general function, depression, and body image. <h3>Results</h3> The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80° and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (<i>P</i>= .003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. <h3>Conclusions</h3> Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

Analysis of the Sagittal Balance of the Spine and Pelvis Using Shape and Orientation Parameters

2005-02-01

Éric Berthonnaud , J. Dimnet , Pierre Roussouly +1 more

Objective: The purpose of this study is to introduce a method to analyze and characterize the global sagittal balance of the human trunk using indexes derived from the shape and … Objective: The purpose of this study is to introduce a method to analyze and characterize the global sagittal balance of the human trunk using indexes derived from the shape and orientation of the pelvis and cervical, thoracic, and lumbar spine. Methods: Standing lateral x-rays of a cohort of 160 asymptomatic young adult volunteers were obtained. On each radiograph, a simplified model of the spine and pelvis was created using a dedicated computer software, and the following shape and orientation variables were calculated at each anatomic level: pelvic incidence, pelvic tilt, sacral slope, cervical curvature and tilt, thoracic curvature and tilt, and lumbar curvature and tilt. Results: Significant linear correlations were found between each single adjacent shape parameter as well as between each single adjacent orientation parameter at all anatomic levels. Significant correlations were also found between some shape and orientation parameters at the same anatomic level as well as between adjacent anatomic areas. In general, the linear correlations were stronger between shape and orientation variables at the pelvic, lumbar, and cervical areas and weaker at the thoracic level and between the thoracic and lumbar areas. Conclusions: These results confirm that the pelvis and spine in the sagittal plane can be considered as a linear chain linking the head to the pelvis where the shape and orientation of each anatomic segment are closely related and influence the adjacent segment to maintain a stable posture with a minimum of energy expenditure. Changes in shape or orientation at one level will have a direct influence on the adjacent segment. Knowledge of these normal relationships is of prime importance for the comprehension of sagittal balance in normal and pathologic conditions of the spine and pelvis.

Complications of Growing-Rod Treatment for Early-Onset Scoliosis

2010-10-02

Shay Bess , Behrooz A. Akbarnia , George H. Thompson +7 more

Background: Previous reports have indicated high complication rates associated with non-fusion surgery in patients with early-onset scoliosis. This study was performed to evaluate the clinical and radiographic complications associated with … Background: Previous reports have indicated high complication rates associated with non-fusion surgery in patients with early-onset scoliosis. This study was performed to evaluate the clinical and radiographic complications associated with growing-rod treatment. Methods: Data from the multicenter Growing Spine Study Group database were evaluated. Inclusion criteria were growing-rod treatment for early-onset scoliosis and a minimum of two years of follow-up. Patients were divided into treatment groups according to rod type (single or dual) and rod location (subcutaneous or submuscular). Complications were categorized as wound, implant, alignment, and general (surgical or medical). Surgical procedures were classified as planned and unplanned. Results: Between 1987 and 2005, 140 patients met the inclusion criteria and underwent a total of 897 growing-rod procedures. The mean age at the initial surgery was six years, and the mean duration of follow-up was five years. Eighty-one (58%) of the 140 patients had a minimum of one complication. Nineteen (27%) of the seventy-one patients with a single rod had unplanned procedures because of implant complications, compared with seven (10%) of the sixty-nine patients with dual rods (p ≤ 0.05). Thirteen (26%) of the fifty-one patients with subcutaneous rod placement had wound complications compared with nine of the eighty-eight patients (10%) with submuscular rod placement (p ≤ 0.05). The patients with subcutaneous dual rods had more wound complications, more prominent implants, and more unplanned surgical procedures than did those with submuscular dual rods (p ≤ 0.05). The risk of complications occurring during the treatment period decreased by 13% for each year of increased patient age at the initiation of treatment. The complication risk increased by 24% for each additional surgical procedure performed. Conclusions: Regardless of treatment modality, the management of early-onset scoliosis is prolonged; therefore, complications are frequent and should be expected. Complications can be reduced by delaying initial implantation of the growing rods if possible, using dual rods, and limiting the number of lengthening procedures. Submuscular placement reduces wound and implant-prominence complications and reduces the number of unplanned operations. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Classification of the Normal Variation in the Sagittal Alignment of the Human Lumbar Spine and Pelvis in the Standing Position

2005-01-28

Pierre Roussouly , Sohrab Gollogly , Éric Berthonnaud +1 more

A prospective radiographic study of 160 volunteers without symptoms of spinal disease was conducted.The objective of this study was to describe, quantify, and classify common variations in the sagittal alignment … A prospective radiographic study of 160 volunteers without symptoms of spinal disease was conducted.The objective of this study was to describe, quantify, and classify common variations in the sagittal alignment of the spine, sacrum, and pelvis.Previous publications have documented the high degree of variability in the sagittal alignment of the spine. Other studies have suggested that specific changes in alignment and the characteristics of the lumbar lordosis are responsible for degenerative changes and symptomatic back pain.In the course of this study, anteroposterior and lateral radiographs of 160 volunteers in a standardized standing position were taken. A custom computer application was used to analyze the alignment of the spine and pelvis on the lateral radiographs. A four-part classification scheme of sagittal morphology was used to classify each patient.Reciprocal relationships between the orientation of the sacrum, the sacral slope, the pelvic incidence, and the characteristics of the lumbar lordosis were evident. The global lordotic curvature, lordosis tilt angle, position of the apex, and number or lordotic vertebrae were determined by the angle of the superior endplate of S1 with respect to the horizontal axis.Understanding the patterns of variation in sagittal alignment may help to discover the association between spinal balance and the development of degenerative changes in the spine.

The adult scoliosis

2005-11-17

Max Aebi

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Radiographical Spinopelvic Parameters and Disability in the Setting of Adult Spinal Deformity

2013-05-31

Frank J. Schwab , Benjamin Blondel , Shay Bess +7 more

In Brief Study Design. Prospective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD). Objective. Evaluate correlations between spinopelvic parameters and health-related quality of life … In Brief Study Design. Prospective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD). Objective. Evaluate correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with ASD. Summary of Background Data. Sagittal spinal deformity is commonly defined by an increased sagittal vertical axis (SVA); however, SVA alone may underestimate the severity of the deformity. Spinopelvic parameters provide a more complete assessment of the sagittal plane but only limited data are available that correlate spinopelvic parameters with disability. Methods. Baseline demographic, radiographical, and HRQOL data were obtained for all patients enrolled in a multicenter consecutive database. Inclusion criteria were: age more than 18 years and radiographical diagnosis of ASD. Radiographical evaluation was conducted on the frontal and lateral planes and HRQOL questionnaires (Oswestry Disability Index [ODI], Scoliosis Research Society-22r and Short Form [SF]-12) were completed. Radiographical parameters demonstrating highest correlation with HRQOL values were evaluated to determine thresholds predictive of ODI more than 40. Results. Four hundred ninety-two consecutive patients with ASD (mean age, 51.9 yr) were enrolled. Patients from the OP group (n = 178) were older (55 vs. 50.1 yr, P < 0.05), had greater SVA (5.5 vs. 1.7 cm, P < 0.05), greater pelvic tilt (PT; 22° vs. 11°, P < 0.05), and greater pelvic incidence/lumbar lordosis PI/LL mismatch (PI-LL; 12.2 vs. 4.3; P < 0.05) than NONOP group (n = 314). OP group demonstrated greater disability on all HRQOL measures compared with NONOP group (ODI = 41.4 vs. 23.9, P < 0.05; Scoliosis Research Society score total = 2.9 vs. 3.5, P < 0.05). Pearson analysis demonstrated that among all parameters, PT, SVA, and PI-LL correlated most strongly with disability for both OP and NONOP groups (P < 0.001). Linear regression models demonstrated threshold radiographical spinopelvic parameters for ODI more than 40 to be: PT 22° or more (r = 0.38), SVA 47 mm or more (r = 0.47), PI − LL 11° or more (r = 0.45). Conclusion. ASD is a disabling condition. Prospective analysis of consecutively enrolled patients with ASD demonstrated that PT and PI-LL combined with SVA can predict patient disability and provide a guide for patient assessment for appropriate therapeutic decision making. Threshold values for severe disability (ODI > 40) included: PT 22° or more, SVA 47 mm or more, and PI − LL 11° or more. Sagittal malalignment analyses require spinopelvic parameters for complete assessment. Multicenter, prospective analysis of patients with adult spinal deformity demonstrated pelvic tilt (PT) and pelvic incidence/lumbar lordosis mismatch (PI-LL) combined with sagittal vertical axis (SVA) predict patient disability and provide a guide for patient assessment. Threshold values for Oswestry Disability Index more than 40 included: PT 22° or more, SVA 47 mm or more, and PI-LL 11° or more.

Correlation of Radiographic Parameters and Clinical Symptoms in Adult Scoliosis

2005-03-01

Steven D. Glassman , Sigurd Berven , Keith H. Bridwell +2 more

In Brief Study Design. This study is a retrospective review of the initial enrollment data from a prospective multicentered study of adult spinal deformity. Objectives. The purpose of this study … In Brief Study Design. This study is a retrospective review of the initial enrollment data from a prospective multicentered study of adult spinal deformity. Objectives. The purpose of this study is to correlate radiographic measures of deformity with patient-based outcome measures in adult scoliosis. Summary of Background Data. Prior studies of adult scoliosis have attempted to correlate radiographic appearance and clinical symptoms, but it has proven difficult to predict health status based on radiographic measures of deformity alone. The ability to correlate radiographic measures of deformity with symptoms would be useful for decision-making and surgical planning. Methods. The study correlates radiographic measures of deformity with scores on the Short Form-12, Scoliosis Research Society-29, and Oswestry profiles. Radiographic evaluation was performed according to an established positioning protocol for anteroposterior and lateral 36-inch standing radiographs. Radiographic parameters studied were curve type, curve location, curve magnitude, coronal balance, sagittal balance, apical rotation, and rotatory subluxation. Results. The 298 patients studied include 172 with no prior surgery and 126 who had undergone prior spine fusion. Positive sagittal balance was the most reliable predictor of clinical symptoms in both patient groups. Thoracolumbar and lumbar curves generated less favorable scores than thoracic curves in both patient groups. Significant coronal imbalance of greater than 4 cm was associated with deterioration in pain and function scores for unoperated patients but not in patients with previous surgery. Conclusions. This study suggests that restoration of a more normal sagittal balance is the critical goal for any reconstructive spine surgery. The study suggests that magnitude of coronal deformity and extent of coronal correction are less critical parameters. This study correlates radiographic measures of deformity with patient-based outcome measures in adult scoliosis. This study demonstrates that sagittal balance is the most important and reliable radiographic predictor of clinical health status, as patients with sagittal imbalance reported worse self-assessment in pain function and self-image domains.

An Analysis of Sagittal Spinal Alignment in 100 Asymptomatic Middle and Older Aged Volunteers

1995-06-01

Daniel E. Gelb , Lawrence G. Lenke , Keith H. Bridwell +2 more

Study Design. A radiographic evaluation of 100 adult volunteers over age 40 and without a history of significant spinal abnormality was done to determine indices of sagittal spinal alignment. Objectives. … Study Design. A radiographic evaluation of 100 adult volunteers over age 40 and without a history of significant spinal abnormality was done to determine indices of sagittal spinal alignment. Objectives. To determine the sagittal contours of the spine in a population of adults older than previously reported in the literature and to correlate age and overall sagittal balance to other measures of segmental spinal alignment. Summary of Background Data. Previous studies of sagittal alignment have focused on adolescent and young adult populations before the onset of degenerative changes that may affect sagittal alignment. Methods. Radiographic measurements were collected and subjected to statistical analysis. Results. Mean sagittal vertical axis fell 3.2 ± 3.2 cm behind the front of the sacrum. Total lumbar lordosis (T12-S1) averaged −64° ± 10°. Lordosis increased incrementally with distal progression through the lumbar spine. Lordosis at L5-S1 and the position of the apices of the thoracic and lumbar curves were most closely correlated to sagittal vertical axis. Increasing age correlated to a more forward sagittal vertical axis with loss of distal lumbar lordosis but without an increase in thoracic or thoracolumbar kyphosis. Conclusions. The majority of asymptomatic individuals are able to maintain their sagittal alignment despite advancing age. Loss of distal lumbar lordosis is most responsible for sagittal imbalance in those individuals who do not maintain sagittal alignment. Spinal fusion for deformity should take into account the anticipated loss of lordosis that may occur with age.

Sagittal plane deformity: an overview of interpretation and management

2010-06-21

Pierre Roussouly , Colin Nnadi

Adult Scoliosis: Prevalence, SF-36, and Nutritional Parameters in an Elderly Volunteer Population

2005-04-20

Frank Schwab , Ashok Dubey , Lorenzo Gamez +4 more

In Brief Study Design. A prospective self-assessment analysis and evaluation of nutritional and radiographic parameters in a consecutive series of healthy adult volunteers older than 60 years. Objectives. To ascertain … In Brief Study Design. A prospective self-assessment analysis and evaluation of nutritional and radiographic parameters in a consecutive series of healthy adult volunteers older than 60 years. Objectives. To ascertain the prevalence of adult scoliosis, assess radiographic parameters, and determine if there is a correlation with functional self-assessment in an aged volunteer population. Summary of Background Data. There exists little data studying the prevalence of scoliosis in a volunteer aged population, and correlation between deformity and self-assessment parameters. Methods. There were 75 subjects in the study. Inclusion criteria were: age ≥60 years, no known history of scoliosis, and no prior spine surgery. Each subject answered a RAND 36-Item Health Survey questionnaire, a full-length anteroposterior standing radiographic assessment of the spine was obtained, and nutritional parameters were analyzed from blood samples. For each subject, radiographic, laboratory, and clinical data were evaluated. The study population was divided into 3 groups based on frontal plane Cobb angulation of the spine. Comparison of the RAND 36-Item Health Surveys data among groups of the volunteer population and with United States population benchmark data (age 65−74 years) was undertaken using an unpaired t test. Any correlation between radiographic, laboratory, and self-assessment data were also investigated. Results. The mean age of the patients in this study was 70.5 years (range 60−90). Mean Cobb angle was17° in the frontal plane. In the study group, 68% of subjects met the definition of scoliosis (Cobb angle >10°). No significant correlation was noted among radiographic parameters and visual analog scale scores, albumin, lymphocytes, or transferrin levels in the study group as a whole. Prevalence of scoliosis was not significantly different between males and females (P > 0.03). The scoliosis prevalence rate of 68% found in this study reveals a rate significantly higher than reported in other studies. These findings most likely reflect the targeted selection of an elderly group. Although many patients with adult scoliosis have pain and dysfunction, there appears to be a large group (such as the volunteers in this study) that has no marked physical or social impairment. Conclusions. Previous reports note a prevalence of adult scoliosis up to 32%. In this study, results indicate a scoliosis rate of 68% in a healthy adult population, with an average age of 70.5 years. This study found no significant correlations between adult scoliosis and visual analog scale scores or nutritional status in healthy, elderly volunteers. This study analyzed the prevalence of adult scoliosis in a volunteer, healthy elderly (older than 60 years) population (75 subjects). Radiographic studies, nutritional laboratory profiles, and the RAND 36-Item Health Surveys were analyzed. The prevalence of adult scoliosis was higher than previously reported (68%). No correlations existed among adult scoliosis and visual analog scale scores, or nutritional status in this healthy, elderly volunteer population. In one subgroup (group II) alone, 3 of the 8 RAND 36-Item Health Survey categories were significantly different from the United States population benchmark data (age 65–74 years).

The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

2015-02-18

Jessica A. Tang , Justin K. Scheer , Justin S. Smith +7 more

Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.To evaluate the relationship between regional cervical sagittal alignment and postoperative … Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion.From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores.Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r =-0.43, P< .001 and r =-0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant.Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.

Sagittal Plane Considerations and the Pelvis in the Adult Patient

2009-07-28

Frank J. Schwab , Virginie Lafage , Ashish Patel +1 more

Research update, focused review.Identify the role of the pelvis in the setting of adults with spinal deformity.Sagittal plane alignment is increasingly recognized as a critical parameter in the setting of … Research update, focused review.Identify the role of the pelvis in the setting of adults with spinal deformity.Sagittal plane alignment is increasingly recognized as a critical parameter in the setting of adult spinal deformity. Additionally, pelvic parameters reveal to be a key component in the regulation of sagittal alignment.Analysis of the pelvis in the sagittal plane is commonly assessed by 3 angular measurements: the pelvic incidence (morphologic parameter directly linked to sagittal morphotypes), the pelvic tilt (or pelvis retroversion used to maintain an upright posture in the setting of spinal deformity), and the sacral slope. Recent work using force plate technology has revealed that in the setting of anterior trunk inclination ("spinal imbalance"), the pelvis shifted posteriorly (toward the heels) in order to maintain a balanced mass distribution. The complex relationship between pelvic and spinal parameter were investigated in order to construct predictive formulas of postoperative spinopelvic alignment. It has emerged that pelvic tilt is highly correlated with patient self reported function (ODI, SF-12, and SRS).It has become evident that good clinical outcome in the treatment of spinal deformity requires proper alignment. Pelvis parameters play an essential role not only in terms of spine morphotypes but also in regulating standing balance and postoperative alignment. Thus, optimal treatment of a patient with spinal deformity requires integration of the pelvis in the preoperative evaluation and treatment plan.

The Impact of Positive Sagittal Balance in Adult Spinal Deformity

2005-09-01

Steven D. Glassman , Keith H. Bridwell , John R. Dimar +3 more

In Brief Study Design. This study is a retrospective review of 752 patients with adult spinal deformity enrolled in a multicenter prospective database in 2002 and 2003. Patients with positive … In Brief Study Design. This study is a retrospective review of 752 patients with adult spinal deformity enrolled in a multicenter prospective database in 2002 and 2003. Patients with positive sagittal balance (N = 352) were further evaluated regarding radiographic parameters and health status measures, including the Scoliosis Research Society patient questionnaire, MOS short form-12, and Oswestry Disability Index. Objectives. To examine patients with adult deformity with positive sagittal balance to define parameters within that group that might differentially predict clinical impact. Summary of Background Data. In a multicenter study of 298 adults with spinal deformity, positive sagittal balance was identified as the radiographic parameter most highly correlated with adverse health status outcomes. Methods. Radiographic evaluation was performed according to a standarized protocol for 36-inch standing radiographs. Magnitude of positive sagittal balance and regional sagittal Cobb angle measures were recorded. Statistical correlation between radiographic parameters and health status measures were performed. Potentially confounding variables were assessed. Results. Positive sagittal balance was identified in 352 patients. The C7 plumb line deviation ranged from 1 to 271 mm. All measures of health status showed significantly poorer scores as C7 plumb line deviation increased. Patients with relative kyphosis in the lumbar region had significantly more disability than patients with normal or lordotic lumbar sagittal Cobb measures. Conclusions. This study shows that although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms increases in a linear fashion with progressive sagittal imbalance. The results also show that kyphosis is more favorable in the upper thoracic region but very poorly tolerated in the lumbar spine. This study examines 352 patients with adult deformity with positive sagittal balance. Although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms was noted to increase in a linear fashion with progressive sagittal imbalance.

Pelvic Tilt and Truncal Inclination

2009-07-28

Virginie Lafage , Frank J. Schwab , Ashish Patel +2 more

Prospective radiographic and clinical analysis.Investigate the relationship between spino-pelvic parameters and patient self reported outcomes on adult subjects with spinal deformities.It is becoming increasingly recognized that the study of spinal … Prospective radiographic and clinical analysis.Investigate the relationship between spino-pelvic parameters and patient self reported outcomes on adult subjects with spinal deformities.It is becoming increasingly recognized that the study of spinal alignment should include pelvic position. While pelvic incidence determines lumbar lordosis, pelvic tilt (PT) is a positional parameter reflecting compensation to spinal deformity. Correlation between plumbline offset (sagittal vertical axis [SVA]) and Health Related Quality of Life (HRQOL) measures has been demonstrated, but such a study is lacking for PT.This prospective study was carried out on 125 adult patients suffering from spinal deformity (mean age: 57 years). Full-length free-standing radiographs including the spine and pelvis were available for all patients. HRQOL instruments included: Oswestry Disability Index, Short Form-12, Scoliosis Research Society. Correlation analysis between radiographic spinopelvic parameters and HRQOL measures was pursued.Correlation analysis revealed no significance pertaining to coronal plane parameters. Significant sagittal plane correlations were identified. SVA and truncal inclination measured by T1 spinopelvic inclination (T1-SPI) (angle between T1-hip axis and vertical) correlated with: Scoliosis Research Society (appearance, activity, total score), Oswestry Disability Index, and Short Form-12 (physical component score). Correlation coefficients ranged from 0.42 < r < 0.55 (P < 0.0001). T1-SPI revealed greater correlation with HRQOL compared to SVA. PT showed correlation with HRQOL (0.28 < r < 0.42) and with SVA (r = 0.64, P < 0.0001).This study confirms that pelvic position measured via PT correlates with HRQOL in the setting of adult deformity. High values of PT express compensatory pelvic retroversion for sagittal spinal malalignment. This study also demonstrates significant T1-SPI correlation with HRQOL measures and outperforms SVA. This parameter carries the advantage of being an angular measurement which avoids the error inherent in measuring offsets in noncalibrated radiographs.

New Universal Instrumentation in Spinal Surgery

1988-02-01

Y Cotrel , J. Dubousset , M Guillaumat

A new instrumentation for posterior spinal surgery consists of metallic rods carved with diamond-shaped asperities on which vertebral hooks or screws can be screwed in any position, level, or degree … A new instrumentation for posterior spinal surgery consists of metallic rods carved with diamond-shaped asperities on which vertebral hooks or screws can be screwed in any position, level, or degree of rotation. The rods are interlocked by means of devices for transverse traction (DTTs), rectangular constructs with multiple vertebral grips, the stability of which allows suppression of any postoperative external support. Initially designed to treat scoliosis, this instrumentation design allows mobilization of the vertebrae located at the apex of the curve and obtains a three-dimensional correction. Correction of the areas of the most important structural deformation can also be obtained at the level of the end vertebrae, without any need to resort to an important distraction force. The technique varies according to the various types of curvatures. Approximately 250 patients were operated upon from 1983 to 1985. In idiopathic scoliotic curvatures, the mean percentage of correction was 66%. An important improvement of the associated sagittal deformations and of the apical derotation was observed in flexible curves. In paralytic curves, particularly with a pelvic obliquity, the percentage of correction of the frontal deformation is 77%. All of the spine patients were ambulatory in the first postoperative week, without any external support, and returned to their school or family activities. In 43 patients with follow-up periods longer than two years, there were no technical errors in 38. The final angular loss of correction was less than 2 degrees in the error-free group.

Segmental Analysis of the Sagittal Plane Alignment of the Normal Thoracic and Lumbar Spines and Thoracolumbar Junction

1989-07-01

Mark Bernhardt , Keith H. Bridwell

Recent advances in spinal instrumentation have brought about a new emphasis on the three-dimensional spinal deformity of scoliosis and especially on the restoration of normal sagittal plane contours. Normal alignment … Recent advances in spinal instrumentation have brought about a new emphasis on the three-dimensional spinal deformity of scoliosis and especially on the restoration of normal sagittal plane contours. Normal alignment in the coronal and transverse planes is easily defined; however, normal sagittal plane alignment is not so simple. This retrospective study was undertaken to increase the understanding of the normal alignment of the spine in the sagittal plane, with a special emphasis on the thoracolumbar junction. Measurements were made from the lateral radiographs of 102 subjects with clinically and radiographically normal spines. Cobb measurements of the thoracic kyphosis (T3–T12), the thoracolumbar junction (T10–T12 and T12–L2), and the lumbar lordosis (L1–L5) were determined. The apices of the thoracic kyphosis and lumbar lordosis also were determined. Using a computerized digltalizing table, the segmental angulatlon was determined at each level from T1–2 to L5–S1. In conclusion, there is a wide range of normal sagittal alignment of the thoracic and lumbar spines. When using composite measurements of the combined frontal and sagittal plane deformity of scoliosis, this wide range of sagittal variance should be taken into consideration. Using norms established here for segmental alignment, areas of hypokyphosis and hypolordosis commonly seen in scoliosis can be more objectively evaluated. The thoracolumbar junction is for all practical purposes straight; lumbar lordosis usually starts at L1–2 and gradually increases at each level caudally to the sacrum.

Postural Stability and Associated Physiological Factors in a Population of Aged Persons

1991-05-01

Stephen R. Lord , Russ Clark , I. Webster

A battery of 13 visual, vestibular, sensorimotor, and balance tests was administered to 95 elderly persons (mean age 82.7 years) to examine the relationships between specific sensorimotor functions and measures … A battery of 13 visual, vestibular, sensorimotor, and balance tests was administered to 95 elderly persons (mean age 82.7 years) to examine the relationships between specific sensorimotor functions and measures of postural stability. When subjects stood on a firm surface, increased body sway was associated with poor tactile sensitivity and poor joint position sense. When subjects stood on a compliant surface (which reduced peripheral sensation) with their eyes open, increased body sway was associated with poor visual acuity and contrast sensitivity, reduced vibration sense, and decreased ankle dorsiflexion strength as well as reduced joint position sense. Increased body sway with eyes closed on the compliant surface was associated with poor tactile sensation, reduced quadriceps and ankle dorsiflexion strength, and increased reaction time. Poor performance in two clinical measures of postural stability was associated with reduced sensation in the lower limbs as measured by joint position sense, tactile sensitivity and vibration sense, reduced quadriceps and ankle dorsiflexion strength, and slow reaction times. The prevalence of vestibular impairments was high in this group, but vestibular function was not significantly associated with sway under any of the test conditions. The results suggest that reduced sensation, muscle weakness in the legs, and increased reaction time are all important factors associated with postural instability. An analysis of the percentage increases in sway under conditions where visual and peripheral sensation systems are removed or diminished, compared with sway under optimal conditions, indicated that peripheral sensation is the most important sensory system in the maintenance of static postural stability.

Adult Spinal Deformity—Postoperative Standing Imbalance

2010-11-23

Frank J. Schwab , Ashish Patel , Benjamin Ungar +2 more

Current concepts review.Outline the basic principles in the evaluation and treatment of adult spinal deformity patients with a focus on goals to achieve during surgical realignment surgery.Proper global alignment of … Current concepts review.Outline the basic principles in the evaluation and treatment of adult spinal deformity patients with a focus on goals to achieve during surgical realignment surgery.Proper global alignment of the spine is critical in maintaining standing posture and balance in an efficient and pain-free manner. Outcomes data demonstrate the clinical effect of spinopelvic malalignment and form a basis for realignment strategies.Correlation between certain radiographic parameters and patient self-reported pain and disability has been established. Using normative values for several important spinopelvic parameters (including sagittal vertical axis, pelvic tilt, and lumbar lordosis), spinopelvic radiographic realignment objectives were identified as a tool for clinical application. Because of the complex relationship between the spine and the pelvis in maintaining posture and the wide range of "normal" values for the associated parameters, a focus on global alignment, with proportionality of individual parameters to each other, was pursued to provide clinical relevance to planning realignment for deformity across a range of clinical cases.Good clinical outcome requires achieving proper spinopelvic alignment in the treatment of adult spinal deformity. Although variations in pelvic morphology exist, a framework has been established to determine ideal values for regional and global parameter in an individualized patient approach. When planning realignment surgery for adult spinal deformity, restoring low sagittal vertical axis and pelvic tilt values are critical goals, and should be combined with proportional lumbar lordosis to pelvic incidence.

The Reliability and Concurrent Validity of the Scoliosis Research Society-22 Patient Questionnaire for Idiopathic Scoliosis

2003-01-01

Marc A. Asher , Sue Min Lai , Doug Burton +1 more

Study Design. Outcome study to determine response distribution, internal consistency, reproducibility, and concurrent validity of the Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire. Objectives. Further refinement of an HRQL … Study Design. Outcome study to determine response distribution, internal consistency, reproducibility, and concurrent validity of the Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire. Objectives. Further refinement of an HRQL questionnaire specific for idiopathic scoliosis. Summary of Background Data. Previous experience with the original and modified SRS HRQL questionnaires suggested a need for further refinement and more complete validation. Methods. The SRS-22 and Short Form 36 (SF-36) HRQL questionnaires were mailed to 83 previously surveyed postoperative idiopathic scoliosis patients. Results. Fifty-eight (70%) patients returned the first set of questionnaires. Their average age at surgery was 14.6 years, and their average follow-up interval since surgery was 10.8 years. Fifty-one (88%) of the 58 returned the second set of questionnaires an average of 28 days later. The psychometric attributes of the instruments were comparable: score distribution, SRS-22 56.9% ceiling and 1.7% floor, SF-36 79.3% ceiling and 1.7% floor; internal consistency (Cronbach α), SRS-22 0.92 to 0.75, SF-36 0.91 to 0.36; and reproducibility (intraclass correlation coefficient), SRS-22 0.96 to 0.85, SF-36 0.92 to 0.61. Concurrent validity, determined by Pearson Correlation Coefficients between SRS-22 and SF-36 domains, was 0.70 or greater (P < 0.0001) for 17 relevant comparisons. Conclusion. The SRS-22 HRQL questionnaire is reliable with internal consistency and reproducibility comparable to SF-36. In addition, it demonstrated concurrent validity when compared to SF-36. It is shorter and more focused on the health issues related to idiopathic scoliosis than SF-36.

Biomechanical analysis of the spino-pelvic organization and adaptation in pathology

2011-08-01

Pierre Roussouly , João Luiz Pinheiro-Franco

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Radiographic Analysis of Sagittal Plane Alignment and Balance in Standing Volunteers and Patients with Low Back Pain Matched for Age, Sex, and Size

1994-07-01

Roger P. Jackson , Anne McManus

Study Design. A globe and segmental study on standing lateral radiographs of 100 volunteers and 100 patients who had low back pain was undertaken to further define sagittal plane alignment … Study Design. A globe and segmental study on standing lateral radiographs of 100 volunteers and 100 patients who had low back pain was undertaken to further define sagittal plane alignment and balance. The volunteer control group and the patient group were matched for age, sex, and size. Methods. Measurements and determinations made on the standing radiographs included the following: segmental and total lordosis L1-S1 (Cobb method); thoracic kyphosis; thoracic apex; plumbline dropped from the center of C7; and sacral inclination measured between the plumbline and a line drawn along the back of the proximal sacrum. Results. Segmental lordoses were significantly different between each motion segment in both groups. Approximately two-thirds of total lordosis occurred at the bottom two discs, i.e., L4–5 and L5-S1. Total lordosis was significantly less in the patients and was not age- or sex-related in either group. Patients tended to stand with less distal segmental lordosis, but more proximal lumbar lordosis, a more vertical sacrum and, therefore, more hip extension. This may be related to compensation as C7 sagittal plumb lines were comparable in both groups. Both groups had similar thoracic kyphosis. A much higher percenttage of smokers was found in the low back pain patient population studied. Because of the significant amount of angulation in the lower lumbar spine, measurement of lordosis should include the L5-S1 motion segment and be done standing to better assess balance. Sacral inclination is a determinate of both standing pelvic rotation and hip extension. It is strongly correlated with segmental and total lordosis in both volunteers and patients. Conclusions. Definitions of sagittal balance are provided as well additional sagittal plane data by which to compare corrections and fusions for different spinal disorders.

Radiographic Analysis of the Sagittal Alignment and Balance of the Spine in Asymptomatic Subjects

2005-02-01

Raphaël Vialle , N Levassor , L. Rillardon +3 more

Background: There is an increasing recognition of the clinical importance of the sagittal plane alignment of the spine. A prospective study of several radiographic parameters of the sagittal profile of … Background: There is an increasing recognition of the clinical importance of the sagittal plane alignment of the spine. A prospective study of several radiographic parameters of the sagittal profile of the spine was conducted to determine the physiological values of these parameters, to calculate the variations of these parameters according to epidemiological and morphological data, and to study the relationships among all of these parameters. Methods: Sagittal radiographs of the head, spine, and pelvis of 300 asymptomatic volunteers, made with the subject standing, were evaluated. The following parameters were measured: lumbar lordosis, thoracic kyphosis, T9 sagittal offset, sacral slope, pelvic incidence, pelvic tilt, intervertebral angulation, and vertebral wedging angle from T9 to S1. The radiographs were digitized, and all measurements were performed with use of a software program. Two different analyses, a descriptive analysis characterizing these parameters and a multivariate analysis, were performed in order to study the relationships among all of them. Results: The mean values (and standard deviations) were 60° ± 10° for maximum lumbar lordosis, 41° ± 8.4° for sacral slope, 13° ± 6° for pelvic tilt, 55° ± 10.6° for pelvic incidence, and 10.3° ± 3.1° for T9 sagittal offset. A strong correlation was found between the sacral slope and the pelvic incidence (r = 0.8); between maximum lumbar lordosis and sacral slope (r = 0.86); between pelvic incidence and pelvic tilt (r = 0.66); between maximum lumbar lordosis and pelvic incidence, pelvic tilt, and maximum thoracic kyphosis (r = 0.9); and, finally, between pelvic incidence and T9 sagittal offset, sacral slope, pelvic tilt, maximum lumbar lordosis, and thoracic kyphosis (r = 0.98). The T9 sagittal offset, reflecting the sagittal balance of the spine, was dependent on three separate factors: a linear combination of the pelvic incidence, maximum lumbar lordosis, and sacral slope; the pelvic tilt; and the thoracic kyphosis. Conclusions and Clinical Relevance: This description of the physiological spinal sagittal balance should serve as a baseline in the evaluation of pathological conditions associated with abnormal angular parameter values. Before a patient with spinal sagittal imbalance is treated, the reciprocal balance between various spinal angular parameters needs to be taken into account. The correlations between angular parameters may also be useful in calculating the corrections to be obtained during treatment.

Dual Growing Rod Technique for the Treatment of Progressive Early-Onset Scoliosis

2005-08-31

Behrooz A. Akbarnia , David Marks , Oheneba Boachie-Adjei +2 more

In Brief Study Design. A retrospective case review of children treated with dual growing rod technique at our institutions. Patients included had no previous surgery and a minimum of 2 … In Brief Study Design. A retrospective case review of children treated with dual growing rod technique at our institutions. Patients included had no previous surgery and a minimum of 2 years follow-up from initial surgery. Objectives. To determine the safety and effectiveness of the previously described dual growing rod technique in achieving and maintaining scoliosis correction while allowing spinal growth. Summary of Background Data. Historically, the growing rod techniques have used a single rod and the reported results have been variable. There has been no published study exclusively on the results of dual growing rod technique for early-onset scoliosis. Methods. From 1993 to 2001, 23 patients underwent dual growing rod procedures using pediatric Isola instrumentation and tandem connectors. Diagnoses included infantile and juvenile idiopathic scoliosis, congenital, neuromuscular, and other etiologies. All had curve progression over 10° following unsuccessful bracing or casting. Of 189 total procedures within the treatment period, 151 were lengthenings with an average of 6.6 lengthenings per patient. Analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographic evaluation included measured changes in scoliosis Cobb angle, kyphosis, lordosis, frontal and sagittal balance, length of T1–S1 and instrumentation over the treatment period, and space available for lung ratio. Results. The mean scoliosis improved from 82° (range, 50°–130°) to 38° (range, 13°–66°) after initial surgery andwas 36° (range, 4°–53°) at the last follow-up or post-finalfusion. T1-S1 length increased from 23.01 (range, 13.80–31.20) to 28.00 cm (range, 19.50–35.50) after initial surgery and to 32.65 cm (range, 25.60–41.00) at last follow-up or post-final fusion with an average T1–S1 length increase of 1.21 cm per year (range, 0.13–2.59). Seven patients reached final fusion. The space available for lung ratio in patients with thoracic curves improved from 0.87 (range, 0.7–1.1) to 1.0 (range, 0.79–1.23, P = 0.01). During the treatment period, complications occurred in 11 of the 23 patients (48%), and they had a total of 13 complications. Four of these patients (17%) had unplanned procedures. Following final fusion, 2 patients required extensions of their fusions because of curve progression and lumbosacral pain. Conclusion. The dual growing rod technique is safe and effective. It maintains correction obtained at initial surgery while allowing spinal growth to continue. It provides adequate stability, increases the duration of treatment period, and has an acceptable rate of complication compared with previous reports using the single rod technique. We evaluated the results of dual growing rod technique in 23 patients with progressive early onset scoliosis followed for a minimum of 2 years after initial surgery. Curve correction obtained at initial surgery was maintained and growth was observed following periodic lengthenings.

The assessment of vertebral deformity: A method for use in population studies and clinical trials

1993-05-01

Eugène McCloskey , Tim D. Spector , K. Eyres +4 more

Reciprocal Angulation of Vertebral Bodies in a Sagittal Plane: Approach to References for the Evaluation of Kyphosis and Lordosis

1982-07-01

P Stagnara , Jean Claude de Mauroy , GEORGES DRAN +4 more

In order to establish a sagittal plane curve reference table for standing subjects examined laterally, we determined an easily reproducible standard posture. A sample of 100 healthy subjects from 20 … In order to establish a sagittal plane curve reference table for standing subjects examined laterally, we determined an easily reproducible standard posture. A sample of 100 healthy subjects from 20 to 29 years of age, was chosen (43 women, 57 men). The reciprocal angulations of each vertebral body in relation to the others were fed into a digitalizer and studied by computer. The study particularly concerns maximum kyphosis, maximum lordosis, sacral base slopes, and the tilt of intermediate vertebral bodies. The dispersion of the results is remarkably wide and, within the extreme values, the distribution is irregular. Individual correlations of these values are often dispersed, but spinal morphotypology. For considerable lengths, average values cannot be used as norms, given the wide span of values. Only the extreme limits are useful for the appreciation of curves as excessive, insufficient, or inverted.

Adolescent idiopathic scoliosis: natural history and long term treatment effects

2006-03-31

Marc A. Asher , Douglas C. Burton

Adolescent idiopathic scoliosis is a lifetime, probably systemic condition of unknown cause, resulting in a spinal curve or curves of ten degrees or more in about 2.5% of most populations. … Adolescent idiopathic scoliosis is a lifetime, probably systemic condition of unknown cause, resulting in a spinal curve or curves of ten degrees or more in about 2.5% of most populations. However, in only about 0.25% does the curve progress to the point that treatment is warranted.Untreated, adolescent idiopathic scoliosis does not increase mortality rate, even though on rare occasions it can progress to the >100 degrees range and cause premature death. The rate of shortness of breath is not increased, although patients with 50 degrees curves at maturity or 80 degrees curves during adulthood are at increased risk of developing shortness of breath. Compared to non-scoliotic controls, most patients with untreated adolescent idiopathic scoliosis function at or near normal levels. They do have increased pain prevalence and may or may not have increased pain severity. Self-image is often decreased. Mental health is usually not affected. Social function, including marriage and childbearing may be affected, but only at the threshold of relatively larger curves.Non-operative treatment consists of bracing for curves of 25 degrees to 35 degrees or 40 degrees in patients with one to two years or more of growth remaining. Curve progression of >/= 6 degrees is 20 to 40% more likely with observation than with bracing. Operative treatment consists of instrumentation and arthrodesis to realign and stabilize the most affected portion of the spine. Lasting curve improvement of approximately 40% is usually achieved.In the most completely studied series to date, at 20 to 28 years follow-up both braced and operated patients had similar, significant, and clinically meaningful reduced function and increased pain compared to non-scoliotic controls. However, their function and pain scores were much closer to normal than patient groups with other, more serious conditions.Risks associated with treatment include temporary decrease in self-image in braced patients. Operated patients face the usual risks of major surgery, a 6 to 29% chance of requiring re-operation, and the remote possibility of developing a pain management problem.Knowledge of adolescent idiopathic scoliosis natural history and long-term treatment effects is and will always remain somewhat incomplete. However, enough is know to provide patients and parents the information needed to make informed decisions about management options.

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Epidemiology of adolescent idiopathic scoliosis

2012-12-10

Markus Rafael Konieczny , Hüsseyin Senyurt , Rüdiger Krauspe

Adolescent idiopathic scoliosis is a common disease with an overall prevalence of 0.47-5.2 % in the current literature. The female to male ratio ranges from 1.5:1 to 3:1 and increases … Adolescent idiopathic scoliosis is a common disease with an overall prevalence of 0.47-5.2 % in the current literature. The female to male ratio ranges from 1.5:1 to 3:1 and increases substantially with increasing age. In particular, the prevalence of curves with higher Cobb angles is substantially higher in girls than in boys: The female to male ratio rises from 1.4:1 in curves from 10° to 20° up to 7.2:1 in curves >40°. Curve pattern and prevalence of scoliosis is not only influenced by gender, but also by genetic factors and age of onset. These data obtained from school screening programs have to be interpreted with caution, since methods and cohorts of the different studies are not comparable as age groups of the cohorts and diagnostic criteria differ substantially. We do need data from studies with clear standards of diagnostic criteria and study protocols that are comparable to each other.

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Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases

2007-01-08

Cédric Barrey , J. Jund , Olivier Noseda +1 more

Adolescent idiopathic scoliosis

2008-05-01

Stuart L. Weinstein , Lori A. Dolan , Jack C. Y. Cheng +2 more

Sagittal morphology and equilibrium of pelvis and spine

2001-06-26

G. Vaz , Pierre Roussouly , Éric Berthonnaud +1 more

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The selection of fusion levels in thoracic idiopathic scoliosis.

1983-12-01

H A King , JOHN H. MOE , David S. Bradford +1 more

From the material and data reviewed in our study of 405 patients, it appears that postoperative correction of the thoracic spine approximately equals the correction noted on preoperative side-bending roentgenograms. … From the material and data reviewed in our study of 405 patients, it appears that postoperative correction of the thoracic spine approximately equals the correction noted on preoperative side-bending roentgenograms. Selective thoracic fusion can be safely performed on a Type-II curve of less than 80 degrees, but care must be taken to use the vertebra that is neutral and stable so that the lower level of the fusion is centered over the sacrum. The lumbar curve spontaneously corrects to balance the thoracic curve when selective thoracic fusion is performed and the lower level of fusion is properly selected. In Type-III, IV, and V thoracic curves the lower level of fusion should be centered over the sacrum to achieve a balanced, stable spine.

Effects of Bracing in Adolescents with Idiopathic Scoliosis

2013-09-19

Stuart L. Weinstein , Lori A. Dolan , James G. Wright +1 more

The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial.

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Outlines for the study of scoliosis

1948-01-01

Cobb , J. L. Cobb , John R. Cobb

Curve progression in idiopathic scoliosis.

1983-04-01

Stuart L. Weinstein , Ignacio V. Ponseti

One hundred and thirty-three curves in 102 patients who were followed for an average of 40.5 years were evaluated to quantitate curve progression after skeletal maturity and for prognostic factors … One hundred and thirty-three curves in 102 patients who were followed for an average of 40.5 years were evaluated to quantitate curve progression after skeletal maturity and for prognostic factors leading to curve progression. Sixty-eight per cent of the curves progressed after skeletal maturity. In general, curves that were less than 30 degrees at skeletal maturity tended not to progress regardless of curve pattern. In thoracic curves the Cobb angle, apical vertebral rotation, and the Mehta angle were important prognostic factors. In lumbar curves the degree of apical vertebral rotation, the Cobb angle, the direction of the curve, and the relationship of the fifth lumbar vertebra to the intercrest line were of prognostic value. Translatory shifts played an important role in curve progression. Curves that measured between 50 and 75 degrees at skeletal maturity, particularly thoracic curves, progressed the most.

The prediction of curve progression in untreated idiopathic scoliosis during growth.

1984-09-01

John E. Lonstein , J. Martin Carlson

We reviewed the cases of 727 patients with idiopathic scoliosis in whom the initial curve measured from 5 to 29 degrees. The patients were followed either to the end of … We reviewed the cases of 727 patients with idiopathic scoliosis in whom the initial curve measured from 5 to 29 degrees. The patients were followed either to the end of skeletal growth or until the curve progressed. One hundred and sixty-nine patients (23.2 per cent) showed progression of the curve. The incidence of curve progression was found to be related to the pattern and magnitude of the curve, the patient's age at presentation, the Risser sign, and the patient's menarchal status. We found no correlation between progression of the curve and the patient's sex, Harrington factor, rotational prominence, family history, or radiographic measurements. A progression factor was calculated using the three strongest correlations available at initial examination: the magnitude of the curve, the Risser sign, and the patient's chronological age. A graph and nomogram are presented that can serve as a guide for advising patients' families and for planning continuing care.

Adolescent idiopathic scoliosis

2015-09-23

Jack C. Y. Cheng , René M. Castelein , Chiu‐Wing Winnie Chu +7 more

2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth

2018-01-10

Stefano Négrini , Sabrina Donzelli , Angelo Gabriele Aulisa +7 more

The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect … The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.

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Outline for study of scoliosis

1948-01-01

John R. Cobb

ADOLESCENT IDIOPATHIC SCOLIOSIS

1988-09-01

NULL AUTHOR_ID

Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society.

1995-06-01

A L Nachemson , L. E. Peterson

In a prospective study by the Scoliosis Research Society, 286 girls who had adolescent idiopathic scoliosis, a thoracic or thoracolumbar curve of 25 to 35 degrees, and a mean age … In a prospective study by the Scoliosis Research Society, 286 girls who had adolescent idiopathic scoliosis, a thoracic or thoracolumbar curve of 25 to 35 degrees, and a mean age of twelve years and seven months (range, ten to fifteen years) were followed to determine the effect of treatment with observation only (129 patients), an underarm plastic brace (111 patients), and nighttime surface electrical stimulation (forty-six patients). Thirty-nine patients were lost to follow-up, leaving 247 (86 per cent) who were followed until maturity or who were dropped from the study because of failure of the assigned treatment. The end point of failure of treatment was defined as an increase in the curve of at least 6 degrees, from the time of the first roentgenogram, on two consecutive roentgenograms. As determined with use of this end point, treatment with a brace failed in seventeen of the 111 patients; observation only, in fifty-eight of the 129 patients; and electrical stimulation, in twenty-two of the forty-six patients. According to survivorship analysis, treatment with a brace was associated with a success rate of 74 per cent (95 per cent confidence interval, 52 to 84) at four years; observation only, with a success rate of 34 per cent (95 per cent confidence interval, 16 to 49); and electrical stimulation, with a success rate of 33 per cent (95 per cent confidence interval, 12 to 60).(ABSTRACT TRUNCATED AT 250 WORDS)

Expectation fulfillment, MCID achievement and postoperative outcomes in elderly patients with degenerative spinal deformity: minimum two-year evaluation

2025-06-26

Qingyang Huang , Peng Cui , Peng Wang +1 more | European Spine Journal

Abdominal wall tension after spinal deformity correction compromises postoperative biomechanics and may contribute to proximal junctional kyphosis

2025-06-26

Elisa Jolas , Fabio Galbusera , T. Fekete +7 more | European Spine Journal

Abstract Purpose Proximal junctional kyphosis (PJK) is a common complication after fusion surgery for adult spinal deformity (ASD). Tissue adaptation to deformity may cause abdominal wall shortening/stiffening. This study evaluated, … Abstract Purpose Proximal junctional kyphosis (PJK) is a common complication after fusion surgery for adult spinal deformity (ASD). Tissue adaptation to deformity may cause abdominal wall shortening/stiffening. This study evaluated, using musculoskeletal modeling, the effect of these adaptations and sarcopenia on trunk muscle effort required to maintain postoperative alignment in PJK patients versus controls. Methods ASD patient data was grouped by mechanical complication status: PJK (N=44), other (N=56), none (N=260). Spinopelvic landmarks were annotated in pre-op, post-op, and follow-up X-ray images. Patient-specific musculoskeletal models of corresponding alignments were built. Forces due to stretching of the abdominal wall beyond pre-op length (assumed slack) were applied, representing abdominal wall stiffness. Sarcopenia was implemented by reducing paraspinal muscle strength based on patient age and gender. Inverse-static simulations predicted overall muscle effort by summing muscle activities. Results Postoperatively, the abdominal wall was more elongated in the PJK group (+8.4%[-0.3;20.0]) versus the no-complication group (+2.4%[-4.9;10.2], p<0.01) due to larger preoperative deformities and greater surgical correction. This elongation correlated more with pelvic tilt change (r=-0.53) than lumbar lordosis correction (r=0.16). Greater muscle effort was estimated for post-op alignment in the PJK group (12.40[6.42;28.6]) versus the no-complication group (8.42[4.34;13.3], p<0.05). Muscle effort was reduced at follow-up in groups with mechanical complications. Conclusion Alignment restoration tensions abdominal structures, requiring increased extensor muscle forces to maintain postoperative alignment. Patients might develop PJK to reduce unsustainable muscle effort or due to spinal structure failure. More attention should be given to pelvic reciprocal changes to improve surgical planning and perioperative rehabilitation.

The T4-L1-Hip Axis Objectifies the Roussouly Classification Using Continuous Measures

2025-06-25

Jeffrey M. Hills , Camilo A. Molina , Lawrence G. Lenke +7 more | Journal of Bone and Joint Surgery

Background: The Roussouly classification is a popular system for the categorization of spinal alignment, although the categorization of continuous measures may compromise efforts toward a precision-medicine approach to sagittal alignment … Background: The Roussouly classification is a popular system for the categorization of spinal alignment, although the categorization of continuous measures may compromise efforts toward a precision-medicine approach to sagittal alignment in spine surgery. Vertebral-pelvic angles provide continuous measures of sagittal alignment without the risk of misclassification. Methods: We performed a cross-sectional study of asymptomatic adult volunteers with normal spines (no evidence of disc degeneration or scoliosis). Full-spine radiographs were obtained, and radiographic parameters were collected, including pelvic incidence (PI), sacral slope, lumbar lordosis, the apex of lordosis, the L1-pelvic angle (L1PA), and the T4-pelvic angle (T4PA). All spines were classified as Roussouly Type 1, 2, 3, or 4 on the basis of sacral slope and the apex of lumbar lordosis. Associations between the L1PA and PI, the L1PA and T4PA, and the T4-L1PA mismatch and PI were assessed for the whole cohort and when stratified by Roussouly type. A multinomial logistic regression model was fit to estimate Roussouly type based on PI, the L1PA, and the T4PA. Agreement (weighted κ), accuracy, and area under the receiver operating characteristic curve (1 type versus the rest) were computed. A subanalysis assessed potential variations in the relationships when Roussouly Type-3 spines were further classified as Type 3A (anteverted) versus Type 3. Results: The 320 included volunteers had a median age of 37 years (interquartile range [IQR], 27 to 47 years), and 193 (60%) were female. By self-reported race or ethnicity, the highest percentage of patients were Caucasian (White, 38%) or East Asian (36%), followed by Arabo-Bèrbère (16%). Spines were classified as Roussouly Type 1 in 18 (6%) of the volunteers, as Type 2 in 63 (20%), as Type 3 in 161 (50%), and as Type 4 in 78 (24%). The L1PA was strongly associated with PI across Roussouly types (weakest in Roussouly Type-1 spines). A multinomial logistic regression model estimating Roussouly type by PI, the L1PA, and the T4PA showed strong agreement (weighted κ, 0.84), excellent discrimination, and overall accuracy of 0.82. Conclusions: The T4-L1-Hip axis is conceptually aligned with the description of spinal shapes in the Roussouly classification but with the advantage of utilizing continuous measures of spinal alignment. Goals of surgical realignment incorporating the T4-L1-Hip axis will be comparable with alignment planning using the Roussouly classification but with improved accuracy and precision. Level of Evidence: Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Gender differences in trunk appearance perception and health-related quality of life (HRQoL) in the patients with moderate adolescent idiopathic scoliosis (AIS) undergoing orthotic treatment: An observational study

2025-06-25

JoJo Yiying ZOU , Tung LI , Man Sang Wong | PLoS ONE

Background Orthotic treatment is commonly used as a non-surgical intervention for managing moderate adolescent idiopathic scoliosis (AIS). Although prior studies have evaluated various factors influencing health-related quality of life (HRQoL) … Background Orthotic treatment is commonly used as a non-surgical intervention for managing moderate adolescent idiopathic scoliosis (AIS). Although prior studies have evaluated various factors influencing health-related quality of life (HRQoL) in the patients with AIS, the association between trunk appearance perception and HRQoL, including potential gender differences, remains insufficiently defined. This study investigated gender differences in trunk appearance perception and its relationship with QoL among the patients with moderate AIS undergoing orthotic treatment. Methods Patients with moderate AIS undergoing orthotic treatment were included, and HRQoL evaluations were conducted before treatment, as well as one and seven months after the initiation of orthotic treatment. The evaluation tools included the Trunk Appearance Perception Scale (TAPS), Scoliosis Research Society-22r (SRS-22r), and Brace Questionnaire (BrQ). The study time points were selected to capture baseline conditions, initial adaptation, and longer-term treatment effects. Results A total of 34 females and 11 males participated in the study. No significant gender differences were observed in global HRQoL, with both groups consistently reporting low self-image and self-esteem. In females, increasing age was negatively correlated with TAPS scores, whereas in males, it showed a positive correlation. For females, higher compliance was associated with higher bodily pain scores on the BrQ (ρ = 0.417), indicating reduced pain levels. In contrast, among males, greater compliance was associated with poor trunk appearance perception after seven months (ρ = −0.619). While TAPS was unrelated to SRS-22r and BrQ in females, a more favorable trunk appearance in males was strongly related to better function and self-image scores on the SRS-22r after seven months (ρ = 0.614 and 0.703, respectively). Conclusion Trunk appearance perception and overall HRQoL were similar between females and males in this study. However, the score related to self-image was lower than other HRQoL domains.

Neural network-based multi-task learning to assist planning of posterior spinal fusion surgery for adolescent idiopathic scoliosis

2025-06-24

Caroline Constant , A. Noelle Larson , David W. Polly +1 more | Spine Deformity

In Search of a Safe Zone for Sagittal Split Ramus Osteotomy: A CBCT Study

2025-06-24

Hui Wen Tay , Ngeow Wei Cheong | International Journal of Oral and Maxillofacial Surgery

Pelvic Incidence-Dependent Clustering of Sagittal Spinal Alignment in Asymptomatic Middle-Aged and Elderly Adults: A Machine Learning Approach

2025-06-24

Qijun Wang , Dongfan Wang , Xiangyu Li +7 more | Spine

A cross-sectional cohort study. This study aimed to refine the sagittal morphological classification of the spine in asymptomatic middle-aged and elderly adult populations using the unsupervised machine learning (ML) techniques … A cross-sectional cohort study. This study aimed to refine the sagittal morphological classification of the spine in asymptomatic middle-aged and elderly adult populations using the unsupervised machine learning (ML) techniques and, by leveraging these findings, to propose and validate a surgical correction reference for adult spinal deformity (ASD) patients across different morphological subtypes. Restoration of sagittal alignment is the key to preventing mechanical complications and achieving good clinical outcomes in ASD surgery. However, high variations in the reported incidence of mechanical complications and clinical outcomes under current ASD realignment strategies have severely impeded the decision-making process for the optimal surgical plan. This study cross-sectionally enrolled asymptomatic middle-aged and elderly Chinese adults. Sagittal spinal morphology clusters and pelvic incidence-based correction criteria for ASD realignment surgery were derived from whole spine radiographs using unsupervised ML algorithms. To externally validate the realignment strategy identified in asymptomatic adults, a consecutive cohort of ASD patients with sagittal deformity who underwent realignment surgery was examined for postoperative mechanical complications, unplanned reoperation, unplanned readmission, and clinical outcomes during follow-up. A total of 635 asymptomatic adults were enrolled for morphological stratification, and 103 ASD patients with sagittal deformity were included for validation. The unsupervised ML algorithm successfully stratified spinal morphology into four clusters. The pelvic incidence-based surgical correction criteria computed by the regression algorithm demonstrated plausible clinical relevance, evidenced by the significantly lower incidence of postoperative mechanical complications, unplanned reoperation, unplanned readmission, and superior patient-reported outcomes in the restored group (conforming to the correction criteria) during follow-up. In this study, unsupervised ML algorithm effectively partitioned asymptomatic sagittal spinal morphology into four distinct clusters. Using the pelvic incidence-based proportional correction criteria, ASD patients can anticipate a reduced incidence of mechanical complications and improved clinical outcomes following spinal realignment surgery. Ⅲ.

Long-term follow-up reveals non-utility of nonsurgical management in moderate adolescent idiopathic scoliosis: a comprehensive meta-analysis

2025-06-24

Eduardo Hevia Sierra , Jesús Burgos , Vicente García +4 more | Asian Spine Journal

This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management of moderate adolescent idiopathic scoliosis (AIS), focusing on long-term curve behavior, surgical rates, patient-reported outcomes, and the … This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management of moderate adolescent idiopathic scoliosis (AIS), focusing on long-term curve behavior, surgical rates, patient-reported outcomes, and the influence of follow-up duration. A comprehensive literature search was conducted adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Statistical analyses, using Review Manager, encompassed mean differences, risk ratios, pooled incidences, and random-effects models. Heterogeneity was assessed using the I2 statistic. The outcome measures were radiographic curve progression, percentage of patients with significant (>5°) progression, surgery rates, sagittal profile changes, back pain rates, quality of life scales, and functional outcomes. Thirteen studies involving 1,492 patients with AIS curves within 30°-45°, treated conservatively, with a minimum 10-year follow-up, were included. At 20+ years of follow-up (mean age, 34.5 years), curves worsened by an average of -5.69° (95% confidence interval [CI], -11.66 to 0.29). At 25+ years of follow-up (mean age, 49.8 years), curves worsened by an average of -14.32° (95% CI, -20.14 to -8.50). The incidence of significant progression was 35.68% (95% CI, 22.85 to 48.50). The surgery rate was 14.20% (95% CI, 0.87 to 27.53). Sagittal alignment (thoracic kyphosis and lumbar lordosis) remained within normal ranges at the final follow-up, with no significant changes from baseline. Back pain rate was 63.35% (95% CI, 38.36 to 88.34). These findings highlight the alarming incidence of curve progression and pain in conservatively managed AIS patients. A critical re-evaluation of conservative versus operative indications is imperative to mitigate long-term impacts and improve outcomes for this population.

Iliac screw failures compromise long-term radiographic and clinical outcomes of adult spinal deformity surgery without impeding fusion at the lumbosacral junction: a retrospective study in Korea

2025-06-24

Se‐Jun Park , Kyunghun Jung , Jin-Sung Park +3 more | Asian Spine Journal

A retrospective study. To investigate the effects of iliac screw failure (ISF) on L5-S1 fusion and long-term radiographic and clinical outcomes in adult spinal deformity (ASD) surgery. Iliac fixation is … A retrospective study. To investigate the effects of iliac screw failure (ISF) on L5-S1 fusion and long-term radiographic and clinical outcomes in adult spinal deformity (ASD) surgery. Iliac fixation is crucial for long-segmental fusion in ASD surgery to prevent mechanical failure at the lumbosacral junction. Despite numerous studies on ISF, its impact on surgical outcomes remains unclear. We included 192 patients (mean age, 69.2 years; mean follow-up, 57.8 months) who underwent ≥5-level fusion with interbody fusion at L5-S1 and pelvic fixation using bilateral iliac screws between 2014 and 2022. Patients were categorized into no-ISF and ISF groups. Fusion status at L5-S1 was evaluated using computed tomography (CT) images at 2 years postoperatively. Mechanical failures (evaluated in terms of rod fractures and related revision surgery), radiographic outcomes, and clinical outcomes were compared between the groups. ISFs developed in 66 patients (34.4%) by 13.4 months post-surgery on average. At 2-year CT follow-up, no significant differences in fusion grades were observed between the two groups. ISF rates did not differ according to mechanical failure development in terms of rod fracture at L5-S1 (p =0.273) or at ≥L4-5 (p =0.432), or revision surgery at L5-S1 (p =0.144) or at ≥L4-5 (p =0.886). However, at the final follow-up, sagittal parameters, including pelvic incidence, were significantly worse in the ISF group than in the no-ISF group. The final clinical outcomes were also poorer in the ISF group. ISF occurred in over one-third of patients after long-segment fusion. While ISF did not adversely affect radiographic and clinical fusion achievement at the lumbosacral junction, it was associated with inferior long-term radiographic and clinical outcomes.

Does Socioeconomic Status Affect Severity of Neuromuscular Scoliosis at the Time of Surgery?

2025-06-24

Margaret Crownover , Petya Yorgova , M. Wade Shrader +1 more | Journal of the American Academy of Orthopaedic Surgeons

Introduction: Pediatric patients with severe neuromuscular scoliosis (NMS) often require posterior spinal fusion (PSF) surgery. Curve magnitude, among other comorbidities, is a risk factor for worse postoperative outcomes, but social … Introduction: Pediatric patients with severe neuromuscular scoliosis (NMS) often require posterior spinal fusion (PSF) surgery. Curve magnitude, among other comorbidities, is a risk factor for worse postoperative outcomes, but social determinants of health also have large effects on patient outcomes. Our hypothesis was that lower socioeconomic status (SES), race, and public insurance status independently affect preoperative diagnosis severity for children with NMS. Methods: We used the area deprivation index (ADI) and insurance type to stratify groups for analysis. Higher ADI indicates higher socioeconomic deprivation. We studied 216 patients with NMS who underwent PSF of >13 levels from 2015 to 2020 at our institution. χ 2 tests for independence α < 0.05, T-tests, analysis of variance, and Pearson correlations were used to analyze clinical variables to determine whether diagnosis severity at presentation depended on ADI, insurance type, or race. Results: Patients with higher ADI had larger preoperative curves ( P = 0.002) and higher outpatient no-show rates ( P < 0.001) were more likely to be from single caregiver households ( P = 0.031), publicly insured ( P < 0.001), and non-White ( P < 0.001). Publicly insured patients had more comorbidities ( P = 0.029), higher outpatient no-show rates ( P < 0.001), and mean ADI ( P < 0.001) were less likely to seek second opinions ( P < 0.001) and more likely to be from single caregiver households ( P < 0.001). Non-White patients had a higher mean ADI ( P < 0.001) and higher no-show rates ( P < 0.001) were more likely to be publicly insured ( P < 0.001) and presented with more comorbidities ( P = 0.014). Conclusion: SES has notable effects on patients with NMS, as those with lower SES and public insurance presented with greater preoperative curve magnitudes, more comorbidities, and higher outpatient no-show rates. Greater diagnosis severity at presentation may affect outcomes afforded by surgery and pose a higher risk of postoperative complications. This population at risk should be identified preoperatively and provided education and resources to mitigate the effect of SES on diagnosis severity before PSF for NMS. Level of Evidence: III

Assessment of Pulmonary Function After Treatment of Scoliosis: Meta-Analysis and Review Article

2025-06-23

Majdi Hashem | Medicina

Background and Objectives: Pulmonary function is a key outcome in scoliosis management, as both the condition and its treatments can impact respiratory mechanics. This systematic review aimed to assess the … Background and Objectives: Pulmonary function is a key outcome in scoliosis management, as both the condition and its treatments can impact respiratory mechanics. This systematic review aimed to assess the effects of scoliosis interventions on pulmonary function, focusing on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF). Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library to identify studies evaluating pulmonary function before and after scoliosis treatment. Data on respiratory parameters, intervention types, and follow-up periods were extracted. Meta-analyses were performed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. Results: The meta-analysis revealed no significant overall effect of scoliosis interventions on FVC or FEV1. For FVC, the pooled effect size was 0.0126 (95% CI: −0.0161 to 0.0413; p = 0.3728), and for FEV1, it was 0.0034 (95% CI: −0.0452 to 0.0519; p = 0.8869). Heterogeneity was minimal (I2 = 0.0%) for both metrics. Individual studies showed variability: some reported increases in FVC and FEV1 by over 1.5 L, while others observed decreases in percent predicted values and absolute volumes. PEF generally improved, with some interventions showing statistically significant gains (p < 0.001). Conclusions: Non-invasive rehabilitation methods, such as breathing exercises and aquatic therapy, were associated with more consistent improvements in pulmonary function. In contrast, the effects of surgical interventions were variable and often not statistically significant. These findings suggest a promising role for conservative therapies in enhancing long-term respiratory outcomes in scoliosis patients, though further high-quality research is warranted.

Risk Factors for Scoliosis Progression in Children with Idiopathic Short Stature on Growth Hormone Therapy

2025-06-23

Xinkai Zhang , Haiping Ouyang , Xueben Han +7 more | Research Square (Research Square)

<title>Abstract</title> <bold>Objective</bold>: To analyze the clinical characteristics of scoliosis in children with idiopathic short stature after growth hormone treatment, and to explore the influence of growth hormone treatment on the … <title>Abstract</title> <bold>Objective</bold>: To analyze the clinical characteristics of scoliosis in children with idiopathic short stature after growth hormone treatment, and to explore the influence of growth hormone treatment on the progression of scoliosis and the risk factors for the progression of scoliosis. <bold>Methods</bold>: A retrospective study of children with scoliosis treated with growth hormone between January 2021 and June 2024 was conducted, analyzing the clinical characteristics of scoliosis and comparing the progression rate of scoliosis between the exposure group and the control group. Independent risk factors for exacerbation of scoliosis were determined by univariate and multifactorial logistic regression analysis. <bold>Results</bold>: In this study, the median Cobb Angle at the initial diagnosis of scoliosis in all children was 11°. Scoliosis mostly occurred at the thoracolumbar junction, and its apical vertebrae were distributed in thoracic 10- lumbar 1 (64.17%). The progression rate of scoliosis in the exposure group was significantly higher than that in the control group, and the risk ratiowas 4.26. Univariate and multivariate logistic regression analyses showed that continued growth hormone treatment and the initial Cobb Angle were independent risk factors for scoliosis progression. <bold>Conclusion</bold>: 1. Scoliosis developing in children with idiopathic short stature (ISS) receiving growth hormone (GH) therapy predominantly manifests as mild curvature. 2. If scoliosis develops during GH therapy, continued treatment may increase the risk of scoliosis progression. 3. Patients with smaller initial Cobb Angles are at higher risk of progression, necessitating closer clinical monitoring for this subgroup.

Perspectives on quality-of-life priorities for caregivers and children with neuromuscular, syndromic, and skeletal dysplasia scoliosis: a CPCHILD questionnaire analysis

2025-06-22

Carlos Monroig-Rivera , David Thornberg , Daniel J. Sucato +3 more | Spine Deformity

SCaRES – scoliosis caregiver response and emotional scale: a Rasch-validated questionnaire to measure the psychological impact of children’s scoliosis on their parents

2025-06-21

Fabio Zaina , Irene Ferrario , Hadeel R. Bakhsh +2 more | European Spine Journal

Jean Dubousset, MD

2025-06-21

Jay R. Shapiro , Andrew G. King , George H. Thompson +5 more | Spine Deformity

Use of a Hybrid Technique in the Surgical Correction of Severe Neuromuscular Scoliosis (Curves ≥85 Degrees): A Retrospective Study and Review of the Literature

2025-06-21

Donald C Hefelfinger , Joseph Henningsen , Sierra L Lindsey +5 more | Cureus

Digital tomosynthesis enhances cervicothoracic sagittal alignment assessment: are cervicothoracic sagittal parameters correlated with the occurrence of cervical spondylotic myelopathy?

2025-06-21

Shengbiao Ma , Xi‐Qin Ding , Zhenhai Zhou +3 more | European Spine Journal

Correlation/Compatibility of DIERS postural analysis data with radiographic findings in patients with idiopathic scoliosis

2025-06-21

Fatma Kumbara , Alparslan Turan , Elif Yalçın | European Spine Journal

Quality of life of adolescents with idiopathic scoliosis according to the Croatian version of the SRS-22r questionnaire

2025-06-20

Josip Ivanda , Slavica Janković , Martina Maričić | Hrvatska revija za rehabilitacijska istraživanja

Introduction: Adolescent idiopathic scoliosis is a threedimensional developmental deformity of the spine that usually develops during periods of abrupt growth, mostly during the adolescent years. Given that the process of … Introduction: Adolescent idiopathic scoliosis is a threedimensional developmental deformity of the spine that usually develops during periods of abrupt growth, mostly during the adolescent years. Given that the process of psychological and physical development during adolescence is often turbulent, the SRS-22r questionnaire serves as a specific and valuable tool for assessing the quality of life in adolescents with idiopathic scoliosis. The Croatian translation and cultural adaptation of this tool was completed in 2021. Although it has been translated, validated, and culturally adapted, it has not yet been widely used in research for assessing the quality of life of adolescents in Croatia, hence, literature on the Croatian version remains limited. Objectives: The study aimed to examine the quality of life of Croatian adolescents with idiopathic scoliosis based on age, gender, school type, recreational activities, place of residence, and orthotics use. Methods: This cross-sectional study involved 119 participants aged 10 to 18 years. The Croatian version of the SRS-22r questionnaire was used to assess their quality of life. Results: Participants were most satisfied with function, pain domain, and overall quality of life, while they were least satisfied with body image. Participants attending primary school had significantly better function than those attending secondary school (P = 0.04). Participants engaged in recreational activities had significantly better overall quality of life (P = 0.01), as well as better function and body image(P = 0.04 for both); they were also more satisfied with their treatment (P = 0.03). Participants living in urban areas had significantly better overall quality of life (P = 0.009), better function (P = 0.005), experienced significantly less pain (P = 0.03), had significantly better body image (P = 0.04), and were significantly more satisfied with their treatment (P = 0.05). Conclusion: Based on the statistically significant differences observed in the quality of life of participants with respect to their place of residence and involvement in recreational activities, we suggest conducting further research to better understand these differences in the context of the adolescent population with idiopathic scoliosis from the Croatian-speaking area.

Comparing Three and Four-Rod Constructs in Adult Spinal Deformity Patients With Long Fusions to the Pelvis

2025-06-20

Fthimnir M. Hassan , Sarthak Mohanty , Erik Lewerenz +7 more | Clinical Spine Surgery A Spine Publication

Study Design: Single-center retrospective cohort study. Objective: To determine if the 4-rod construct (4RC) is protective against the occurrence of rod fractures when compared with the 3-rod construct (3RC) in … Study Design: Single-center retrospective cohort study. Objective: To determine if the 4-rod construct (4RC) is protective against the occurrence of rod fractures when compared with the 3-rod construct (3RC) in adult spinal deformity (ASD) patients with long fusions to the sacrum. Summary of Background Data: Past studies have explored the different outcomes in subjects with dual-rod versus multirod constructs. There is a lack of literature distinguishing the ramifications of 3RC versus 4RC, particularly in the prevalence of rod fractures and rod fractures requiring subsequent revision surgery as a result of pseudarthrosis. Methods: ASD patients undergoing long instrumented fusions to the sacrum were dichotomized between the 3RC and 4RC cohorts. Outcomes of interest include the occurrence of rod fractures (RFs) and RFs requiring revision (RFR). Two-tailed independent-sample t test with Welch's correction and χ 2 /Fisher exact test were used for continuous and categorical variables, respectively. Multivariable logistic regression analysis was performed to assess whether the 4RC is protective against rod fractures when compared with the 3RC. Results: One hundred forty-five patients with a minimum 2-year follow-up were included (3RC=57, 4RC=88). Four RC had a greater body mass index (BMI) ( P =0.002), longer operating room (OR) time ( P =0.002), greater estimated blood loss (EBL) ( P =0.002), total instrumented levels (TIL) ( P =0.028), and more 3-column osteotomies (3COs) performed ( P =0.028). Four RC had greater baseline coronal vertical axis (CVA) (28.2±24.9 vs. 18.5±16.9 mm, P =0.006) and sagittal vertical axis (SVA) (55.1±64.8 vs. 30.4±41.8 mm, P =0.006). Three RC had a greater rate of RF (28.1% vs. 14.8%, P =0.0506) and RFR (14.9% vs. 10.2%, P =0.486) when compared with 4RC, but these findings were not statistically significant. After controlling for BMI, the use of 3-column osteotomies, total instrumented levels, change in coronal alignment (∆CVA), change in sagittal alignment (∆SVA), use of bone morphogenetic protein, and number of interbody fusions, 3RC was associated with 4.93× greater odds of experiencing RFs ( P =0.0078). However, significance fell short when adjusting for the occurrence of RFR [OR=2.58 (0.60–11.19), P =0.2067]. Conclusion: ASD patients having long fusions to the sacrum with 4RC across the lumbosacral junction are shown to be at lesser risk of developing rod fractures but not revision surgery as compared with 3RC at 2-year follow-up.

Rod options to outcomes: comparing sagittal correction in pediatric posterior spinal fusion by rod size and material

2025-06-20

Julia E. Todderud , Hans Kristian Nugraha , Michael P. Kelly +7 more | Spine Deformity

Curve magnitude and vertebral rotation influence the MRI predictability of pedicle dimensions in adolescent idiopathic scoliosis: an analysis of 1,860 pedicles

2025-06-19

Karthik Ramachandran , Ashish Shankar Naik , Pushpa Bhari Thippeswamy +3 more | Spine Deformity

Severe scoliotic deformities: results of surgical treatment and complications in a multicentric series of children and young adults

2025-06-19

Alice Baroncini , Aude Kerdoncuff , Daniel Larrieu +7 more | Spine Deformity

Does Vertebral Body Tethering Cause Coronal Hypermobility at Adjacent Noninstrumented Levels? A Preliminary Study

2025-06-19

Hans Kristian Nugraha , Todd A. Milbrandt , A. Noelle Larson | Journal of Pediatric Orthopaedics

Background: Fusion into the lumbar spine with lower instrumented vertebra (LIV) of L2 and below can result in increased mobility or hypermobility of the unfused segments, potentially contributing to early … Background: Fusion into the lumbar spine with lower instrumented vertebra (LIV) of L2 and below can result in increased mobility or hypermobility of the unfused segments, potentially contributing to early disk and joint wear and subsequent degenerative arthritis. Vertebral body tethering (VBT) is a motion-preserving surgery for scoliosis, but no data is available about its effect on disk motion for the uninstrumented segments distal to the LIV. We hypothesize that VBT preserves the coronal arc of motion distal to the LIV in AIS patients without the development of hypermobility which has been observed following fusion surgery. Methods: A single-center retrospective review was completed of adolescent idiopathic scoliosis patients who underwent VBT. Standing bending films were collected as standard of care preoperatively and at 1-year postoperatively with maximum effort on side bending according to an institutional protocol. To evaluate the coronal arc of motion, radiographic measurement of the intervertebral angles was measured at each level from the disk directly distal to LIV-S1, as described in previous literature. Results: A total of 95 patients had clinical preoperative and postoperative bending radiographs and were included in the study. In total, there were 2086 segments measured. Sixteen patients had bilateral tether procedures and were analyzed separately. Compared with preoperative values over the same levels, paired t test showed no significant difference in the coronal arc of motion for the distal uninstrumented segments. Conclusions: Normal segmental motion on lateral bend was preserved on the noninstrumented segments following VBT. In contrast to fusion, there was no evidence of lumbar hypermobility following VBT in scoliosis patients. This provides early evidence for preserved normal motion which could be protective against adjacent segment disease and early arthritis reported with long fusions. Level of Evidence: Level III—retrospective cohort study.

Biomarker Longitudinal Idiopathic Scoliosis Study: Predicting Growth in Idiopathic Scoliosis

2025-06-19

Michelle C. Welborn , Amer F. Samdani , Michal Szczodry +7 more | Journal of Pediatric Orthopaedics

Background: Growth has been theorized as one of the main risk factors for idiopathic scoliosis (IS) progression. Determining the amount and timing of growth is surprisingly challenging. Radiographic measures of … Background: Growth has been theorized as one of the main risk factors for idiopathic scoliosis (IS) progression. Determining the amount and timing of growth is surprisingly challenging. Radiographic measures of skeletal maturity do not provide insight into the amount that individuals will grow. In addition, anthropometrics do not differentiate between early versus late growers. Biological measures have historically been nonspecific for growth, however, Collagen X Biomarker (CXM) is a direct measure of endochondral ossification and longitudinal bone growth. The aims of this study were (1) to determine the best anthropometric measure of growth in patients with idiopathic scoliosis (IS) and (2) to determine the best surrogate measure of height velocity. Methods: A prospective IRB-approved multicenter study of IS was followed every 6 months to measure anthropometrics and assess radiographic measures of skeletal maturity. Anthropometrics were assessed to determine linear measures of growth potential. Radiographs of the spine and hands were assessed for major curve magnitude (Cobb), Risser Sign (RS), Greulich and Pyle bone age (BA), Sanders Maturity Score (SMS), and Thumb Ossification Composite Index (TOCI). CXM levels were assessed with serial dried blood spots (DBS) collected on 3 consecutive days, every 1 to 2 months, based on SMS. Results: Two hundred fifty-four patients (193 female/61 male) with IS (Cobb ≥20) were recruited between 2018 and 2024. Average age at 12.9 years (range: 7 to 17), with the mean time of involvement 12 months (range: 1 to 63 mo). Standing height and height velocity (HtV) determined by standing height had the highest correlations with all other measures of length and length changes. CXM, SMS, RS, BA, TOCI, and age in months were all significant independent predictors of HtV. CXM accounted for the largest percentage of the explained variance in HtV at 50%. Multiple regression analysis was performed examining each measure independently and with the biomarker, and showed that the combination of CXM and RS explained the greatest amount of variance in height velocity at 55%. Conclusion: While there continues to be much that we do not know with regards to patient-specific measures of growth and growth potential, this study found that absolute height was the best measure of growth in adolescents with IS who are braced and CXM is the best measure of growth potential. Further study using advanced analytics will determine whether CXM in combination with other radiographic measures provides enhanced information from which to make clinical decisions regarding bracing and surgical intervention.

How Does Anterior Vertebral Body Tethering Compare to Posterior Spinal Fusion for Thoracic Idiopathic Scoliosis? A Nonrandomized Clinical Trial

2025-06-19

Carina Lott , Anthony Capraro , Catherine Qiu +5 more | Clinical Orthopaedics and Related Research

Background Recently, there has been an increased interest in alternative surgical options for treating idiopathic scoliosis. For instance, anterior vertebral body tethering (AVBT) is an emerging surgical solution used in … Background Recently, there has been an increased interest in alternative surgical options for treating idiopathic scoliosis. For instance, anterior vertebral body tethering (AVBT) is an emerging surgical solution used in lieu of posterior spinal fusion (PSF). This technology has been gaining in popularity because of its potential benefits of preservation of spinal growth, motion, and functional activity. Although prior retrospective studies have indicated the potential efficacy of AVBT in patients with primary thoracic curves, a direct comparison to PSF, the most widely used definitive treatment for pediatric scoliosis, has yet to be conducted. Differences in efficacy, quality of life, and revision risk may exist across the techniques. Questions/purposes We compared AVBT to PSF in terms of (1) the proportion of patients whose main thoracic curve was corrected to < 50° without a return to the operating room for revision within 2 years, (2) residual thoracic and lumbar curve magnitude at 2 years, (3) health-related quality of life (HRQoL) scores, and (4) the frequency of serious complications and healthcare resource utilization. Methods From 2017 to 2022, patients (n = 87) were assessed for eligibility to participate in an FDA-approved investigational device exemption clinical trial for AVBT based on presenting to the clinic with a diagnosis of adolescent idiopathic scoliosis that had entered into surgical range. Based on clinical characteristics and the family’s stated goals of care, AVBT and PSF were both discussed, but ultimately the patient and their family selected their preferred treatment. Under guidance from the FDA, a sample of 20 patients who met the inclusion criteria of a Lenke Type 1 or 2 curve classification, a thoracic curve between 35° and 60°, a lumbar curve < 35°, and a skeletal maturity score of either Risser 0 or Sanders bone age of ≤ 4 were eligible to participate in the trial and undergo AVBT. Patients with Lenke 1 and 2 curves who elected to undergo PSF (n = 27) were prospectively analyzed for comparison. No patients who underwent AVBT and 22% (n = 6) of those who underwent PSF were lost prior to the minimum study follow-up of 2 years, leaving 100% (20) and 78% (n = 21) in each group, respectively, for analysis. All patients in the PSF group who were lost to follow-up did not report any complications at 1 year. Patients who underwent AVBT (80% [16] girls) were generally younger, more skeletally immature, and had smaller preoperative curvature at the time of surgery compared with patients who underwent PSF (81% [17] girls). No differences in gender, height, or revised Scoliosis Research Society-22 (SRS-22) patient questionnaire scores were observed across the two groups at baseline. Patients in both cohorts were followed at the preoperative, first erect, and 2-year time points. Radiographic, health-related quality of life, unplanned return to the operating room, complications, and healthcare resource utilization outcomes were compared. Results Scoliosis curves were reduced to < 50°, without unplanned return to the operating room, at 2 years in 70% (14 of 20) of patients who underwent AVBT and 100% (21 of 21) of patients who had PSF (p < 0.001). No patients who had PSF underwent revisions. Although both groups showed postoperative curve correction, patients who had AVBT showed less curve correction at first erect (35% versus 65% correction; p < 0.001) and at 2 years (34% versus 61% correction; p < 0.001). No differences were found in any revised SRS-22 domains or total score at 2 years between the AVBT and PSF groups (4.3 ± 0.5 versus 4.5 ± 0.4; p = 0.14). No instrumentation complications occurred in the PSF group. Thirty-five percent (7) of patients who received AVBT experienced a tether rupture, and 30% (6) of patients who received a tether required a revision procedure prior to the 2-year follow-up. Intraoperative data revealed that AVBT resulted in a shorter length of stay (2 ± 1 versus 3 ± 1 days; p = 0.02) and fewer levels instrumented (7 ± 1 versus 10 ± 1 levels; p < 0.001); however, there was increased operative time when compared with PSF (231 ± 41 versus 194 ± 26 minutes; p = 0.001). Conclusion Pediatric orthopaedic spine surgeons should carefully consider discussing the use of vertebral body tethering with their patients who have adolescent idiopathic scoliosis, as this evidence points to the more established technique of PSF leading to better outcomes. Additional research supporting AVBT as noninferior to PSF in radiographic and safety measures is needed before the procedure becomes widely available to patients and their families. Level of Evidence Level III, therapeutic study.

The influence of sarcopenia on clinical and radiological features in patients with single-segment degenerative lumbar spondylolisthesis at L4/5 level

2025-06-18

Tao Feng , Congyu Wang , Xinyu Yang +5 more | European Spine Journal

Incidence of neurological deficits following proximal junctional kyphosis or failure in adult spinal deformity surgery: a systematic review and meta-analysis

2025-06-18

Abdullah M Alharran , Muteb N. Alotaibi , Nizar Algarni +4 more | Spine Deformity

Pelvic fixation in pediatric spinal fusion for neuromuscular scoliosis is associated with increased short-term complications but no long-term risk

2025-06-18

Yoli Meydan , Gregory Sacks , James Barsi | Research Square (Research Square)

<title>Abstract</title> Purpose Pelvic fixation is frequently employed in posterior spinal fusion for neuromuscular scoliosis (NMS) to improve alignment and construct stability, particularly in cases with significant pelvic obliquity. However, concerns … <title>Abstract</title> Purpose Pelvic fixation is frequently employed in posterior spinal fusion for neuromuscular scoliosis (NMS) to improve alignment and construct stability, particularly in cases with significant pelvic obliquity. However, concerns remain regarding its association with increased surgical complexity and postoperative morbidity. This study aimed to compare short- and long-term postoperative outcomes between pediatric NMS patients who underwent posterior spinal fusion with and without pelvic fixation. Methods A retrospective cohort study was conducted using the TriNetX Research Network. Pediatric patients (≤ 21 years) with NMS who underwent posterior spinal fusion with or without pelvic fixation were identified. Propensity score matching was used to control for differences in demographics, comorbidities, number of vertebral levels fused, and neuromuscular diagnosis. Postoperative complications were assessed at two time windows: short-term (1–365 days) and long-term (≥ 365 days). Results Pelvic fixation was associated with significantly higher rates of short-term complications, including surgical site infection, wound breakdown, and overall postoperative infection. In contrast, no significant differences were observed between groups in long-term complication rates. Mechanical and hardware-related complications—such as device failure, pseudarthrosis, revision surgery, and additional instrumentation—were similar between groups during both follow-up periods. Conclusion Pelvic fixation in pediatric posterior spinal fusion for NMS is associated with increased short-term morbidity but does not lead to higher rates of long-term complications or hardware-related failure. These findings suggest that the short-term risks of pelvic fixation diminish over time and that its long-term safety profile is comparable to constructs that do not include the pelvis.

Serial Casting for Early-Onset Scoliosis

2025-06-18

Jakub Grzegorz Adamczyk , Sławomir Duda , Wojciech Kącki +2 more | Journal of Clinical Medicine

Background: Early-onset scoliosis (EOS) is a severe spinal deformity that can compromise thoracic development and pulmonary function if left untreated. While Mehta casting is widely used to manage deformity non-surgically … Background: Early-onset scoliosis (EOS) is a severe spinal deformity that can compromise thoracic development and pulmonary function if left untreated. While Mehta casting is widely used to manage deformity non-surgically in young children, its effects on spinal and thoracic growth remain underexplored. Methods: In this retrospective case series, 15 children with EOS underwent serial elongation-derotation-flexion (EDF) Mehta casting. Radiographic assessments were performed pre-treatment, post-casting, and at follow-up, including measurements of Cobb angle, rib-vertebral angle difference (RVAD), Th1-Th12 spinal length, coronal chest width (CCW), and space available for lung (SAL). Growth rates were estimated based on the duration of treatment. Correlation analyses were conducted to examine associations between baseline deformity and structural outcomes. Results: Serial casting reduced the mean Cobb angle by 22.2° and RVAD by 15.5°. During treatment, measurable increases were observed in Th1-Th12 length (mean: 2.93 cm), CCW (1.12 cm), SAL-L (2.60 cm), and SAL-R (2.98 cm). Estimated annual growth was significantly greater in children with lower initial Cobb and RVAD values. In contrast, total casting duration showed no consistent correlation with growth outcomes. Conclusions: Mehta casting is effective not only in correcting spinal deformity but also in supporting thoracic and axial growth in children with EOS. Early application in flexible, less severe curves may optimize structural outcomes and preserve thoracic development during early growth.

Digital study and correlation analysis of sagittal balance parameters in adolescents with idiopathic scoliosis: A comparative study with healthy adolescents

2025-06-18

Zhijie Kang , Guopeng Shi , Yunfeng Zhang +7 more | PLoS ONE

Purpose This study aimed to compare sagittal spinal parameters between healthy adolescents and those with adolescent idiopathic scoliosis (AIS), identify factors influencing disease progression, and provide insights for optimizing preoperative … Purpose This study aimed to compare sagittal spinal parameters between healthy adolescents and those with adolescent idiopathic scoliosis (AIS), identify factors influencing disease progression, and provide insights for optimizing preoperative assessments. Methods Sagittal full-spine radiographs from 40 healthy adolescents and 41 AIS patients (aged 10–18 years) were analyzed using Mimics 21.0 software. Fifteen parameters, including spinopelvic angle (SPA), thoracic kyphosis (TK), lumbar lordosis (LL), and pelvic tilt (PT), were measured. Statistical analyses included logistic regression to identify predictors of AIS and sex-based subgroup comparisons. Results SPA was significantly higher in AIS patients compared to controls (median: 176.48° vs. 169.64°, P = 0.008) and emerged as the sole predictor of AIS (odds ratio = 1.568, 95% CI = 1.129–2.177, P = 0.007). Sex differences revealed higher spinal tilt (ST) in female AIS patients (P = 0.034), while males exhibited elevated TK (P = 0.006) and SPA (P = 0.002). Correlations among parameters highlighted strong associations between LL and pelvic incidence (PI, r = 0.682) and between SPA and pelvic tilt (PT, r=−0.537). Conclusion Increased SPA is a critical indicator of AIS, necessitating preoperative evaluation of sagittal spinopelvic alignment. Female patients require heightened attention to spinal tilt. Future studies should expand sample sizes and integrate multi-planar analyses to refine clinical strategies.

Surgical vs non-surgical management of adolescent idiopathic scoliosis: a 10-year narrative review of health-related quality of life and radiographic progression in 3315 patients

2025-06-18

Shuhao Zhang , Liancheng Wang , Yue He +5 more | European Spine Journal

Prevalence and determinants of adolescent idiopathic scoliosis from school screening in Xiaoshan District, Hangzhou, China

2025-06-18

Qiang Tu , XU Wen-bin , Yong Feng +2 more | Frontiers in Public Health

Objective This large-scale epidemiological study aimed to determine the prevalence and associated risk factors of Adolescent Idiopathic Scoliosis (AIS) through school-based screening in Xiaoshan District, Hangzhou, China. Methods A prospective … Objective This large-scale epidemiological study aimed to determine the prevalence and associated risk factors of Adolescent Idiopathic Scoliosis (AIS) through school-based screening in Xiaoshan District, Hangzhou, China. Methods A prospective cross-sectional study was conducted from 2023 to 2024, involving a total of 172,127 students aged between 7 and 18 years. A two-phase screening protocol was implemented: Phase I included physical examinations (assessing shoulder asymmetry and spinal curvature) alongside the Adams Forward Bend Test (with an angle of trunk rotation [ATR] ≥ 5°), while Phase II confirmed diagnoses through radiographic evaluation (Cobb angle ≥10°). Multivariate logistic regression analysis was employed to evaluate demographic, postural, and lifestyle factors. Results The overall prevalence of AIS was found to be 1.23%, with a significant gender disparity observed (female: 1.71% vs. male: 0.92%, p &lt; 0.001). Among the initial cohort of 4,482 screen-positive cases, hospital confirmation was obtained for 422 individuals, identifying a total of 199 AIS patients (146 mild cases, 47 moderate cases, and one severe case). Key risk factors identified included female gender (odds ratio [OR] = 2.742), postural abnormalities such as kyphosis (OR = 5.741), enrollment in junior high school (OR = 0.414), prolonged sedentary behavior exceeding 8 h per day (OR = 0.231), and family history of scoliosis (OR = 0.467). Notably, the prone position test effectively reduced false-positive rates by approximately 70.3%. Twin studies indicated no significant concordance regarding AIS diagnosis among siblings ( p = 0.16). Conclusion This study establishes that the prevalence of AIS in Xiaoshan District is consistent with national data reporting an incidence rate of approximately 1.2%. It highlights specific susceptibility based on gender as well as modifiable lifestyle risks associated with this condition. The integrated screening protocol that combines postural assessment with the Adams test demonstrates clinical utility for early detection efforts in schools. These findings underscore the necessity for preventive strategies within educational settings that focus on promoting proper posture education and encouraging increased physical activity among students.

Assessment and Referral of Patients With Short Stature at Primary Care Buraidah, Saudi Arabia

2025-06-17

Fatemah Almutairi , Unaib Rabbani | Cureus

Current Concepts of Sagittal Alignment in Adult Thoracolumbar Spinal Deformity

2025-06-17

Zeeshan M. Sardar , Justin Reyes , Josephine R. Coury +1 more | Journal of the American Academy of Orthopaedic Surgeons

Sagittal spinopelvic alignment plays a crucial role in the clinical course and surgical treatment of adult spinal deformity. Knowledge pertaining to adult thoracolumbar spinal deformity and corrective surgery continues to … Sagittal spinopelvic alignment plays a crucial role in the clinical course and surgical treatment of adult spinal deformity. Knowledge pertaining to adult thoracolumbar spinal deformity and corrective surgery continues to advance. Much of this is due to recent advances in understanding in sagittal alignment. In this review article, we review standard principles related to sagittal alignment in adult thoracolumbar spinal deformity surgery. In addition, we will review recent philosophies and schools of thought.

C2 Pelvic Angle as a Predictive Measure for Decompensated Spinopelvic Alignment and Its Impact on Health-Related Quality of Life

2025-06-17

Jun Ouchida , Hiroaki Nakashima , Sadayuki Ito +4 more | Spine

Study Design. Retrospective cohort. Objective. To evaluate the C2 pelvic angle (C2PA) as a novel compensatory parameter integrating C2 (center of gravity) and pelvic morphology, and its association with physical … Study Design. Retrospective cohort. Objective. To evaluate the C2 pelvic angle (C2PA) as a novel compensatory parameter integrating C2 (center of gravity) and pelvic morphology, and its association with physical function and health-related quality of life (HRQOL). The T4-L1-Hip axis concept was applied to assess individualized spinal alignment. Background. Adult spinal deformity (ASD) impairs physical function and HRQOL in older adults. Pelvic retroversion compensates for spinal degeneration to maintain posture, but standardized evaluative indices linking pelvic parameters to outcomes remain limited. Methods. Cross-sectional analysis of 383 community-dwelling adults (mean age 64.1 ± 10.3 y). Whole-spine radiographs, physical function tests (Timed Up and Go, 10-meter walk), and SF-36 HRQOL scores were analyzed. C2PA mismatch (measured C2PA minus normative value [0.4 × pelvic incidence − 13]) and thoracolumbar decompensation (T4PA-L1PA ≥4°) were assessed. ROC analysis identified optimal C2PA mismatch thresholds; propensity score matching (age/sex/BMI) compared groups. Results. C2PA mismatch correlated strongly with lumbar (r=0.668) and thoracolumbar (r=0.707) mismatches. A 13° C2PA mismatch threshold optimally identified decompensated thoracolumbar alignment (AUC=0.819). Participants with>13° C2PA mismatch demonstrated decreased physical function (Timed Up and Go: 6.4 vs. 5.8 seconds; 10-meter walk: 1.4 vs. 1.5 m/s) and lower SF-36 scores (physical functioning: 65.9 vs. 72.8; bodily pain: 63.1 vs. 70.8; physical component summary: 41.8 vs. 45.7). Conclusions. C2PA is a reliable indicator of decompensated spinopelvic alignment, with>13° mismatch (measured C2PA>0.4 × pelvic incidence) The C2PA threshold correlates with decreased physical function and lower HRQOL, providing a clinical benchmark for evaluating and managing patients with spinal alignment degeneration. Level of Evidence: 3

Surgical Strategies and Challenges in Scheuermann’s Kyphosis: A Comprehensive Review

2025-06-16

Angelos Kaspiris , Ioannis Spyrou , Fotis Panagopoulos +7 more | Journal of Clinical Medicine

Background: Scheuermann's kyphosis (SK) is characterized by anterior wedging of >5 degrees at three or more contiguous vertebrae associated with severe back pain and cosmetic disfigurement. Different surgical interventions have … Background: Scheuermann's kyphosis (SK) is characterized by anterior wedging of >5 degrees at three or more contiguous vertebrae associated with severe back pain and cosmetic disfigurement. Different surgical interventions have been applied for SK correction, but the optimal operational treatment remains controversial. Objectives: The aim of our study is to analyze all the current indications for the surgical correction of SK, as well as to describe the instrumentation methods and techniques in order to detect the ideal operational management and accompanied complications. Methods: This comprehensive review investigates the up-to-date surgical indications and approaches for SK, the current trends, and the associated postoperative functional outcomes. A detailed search of PubMed, Web of Science and Google Scholar databases in English literature was performed for articles during the last 20 years. Additional criteria were peer-reviewed original studies that provided the type of interventions for SK and the clinical outcomes. Results: Thirty studies that met our induction criteria were analyzed. The up-to-date surgical indications such as back pain, failure of conservative treatment, progression of deformity, and neurological complications were described. Anterior (AO) and posterior-only (PO), and combined anterior-posterior (AP) approaches and instrumentation techniques were outlined. The most common side effects of the above interventions were hardware failure, loss of correction and Proximal Junctional Kyphosis. Contrariwise, in PO, reduced blood loss and operational duration was noted. Conclusions: Although the published studies reported contradictory results of the effectiveness of the various techniques applied for SK treatment, the PO fusion was correlated with a decreased rate of complications that resulted in its current increase in popularity.

Congenital scoliosis with truncus arteriosus type 1 in a preterm neonate: A case report

2025-06-16

Pius Omullo , Khulud Nurani , Kimiya Shahabi +2 more | World Journal of Clinical Pediatrics

BACKGROUND Congenital scoliosis (CS) is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis. It occurs in 0.5%-1% in 1000 births and may rarely occur … BACKGROUND Congenital scoliosis (CS) is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis. It occurs in 0.5%-1% in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system. Truncus arteriosus (TA) is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation, leading to complications such as pulmonary hypertension, heart failure, and severe hypoxia. Although rare individually, the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges, with limited documentation in medical literature. CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1, presenting with respiratory distress, cyanosis, and altered spinal curvature. This case demonstrates the complexity of managing neonates with multiple congenital defects. Here, the patient was managed with oxygen supplementation, heart failure medication, nasogastric feeding, and multidisciplinary care to optimize her for surgical corrections. A coordinated, interdisciplinary approach was employed to optimize outcomes, particularly in a resource-limited setting. Immediate respiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival. CONCLUSION Recognizing co-existing congenital anomalies and their embryological interrelation is critical in holistic patient care, particularly during neonatal and infancy.

Differences in Functional Treadmill Tests in Patients with Adult Symptomatic Lumbar Scoliosis Treated Operatively and Non-operatively at a Minimum Five-Year Follow-up

2025-06-16

Leah Y. Carreon , Steven D. Glassman , Justin S. Smith +4 more | Spine

Study Design. Prospective Longitudinal Cohort Objectives. To present the long-term Functional Treadmill Test (FTT) results in patients with Adult Symptomatic Lumbar Scoliosis (ASLS) treated operatively (Op) and non-operatively (Non-Op). Summary … Study Design. Prospective Longitudinal Cohort Objectives. To present the long-term Functional Treadmill Test (FTT) results in patients with Adult Symptomatic Lumbar Scoliosis (ASLS) treated operatively (Op) and non-operatively (Non-Op). Summary of Background Data. A previous study on this cohort showed that at two years after intervention, FTT time ambulated deteriorated in Non-Op patients but improved in Op patients. Post-FTT back and leg pain improved in both groups with greater gains in the Op group. Methods. 168 (62%) of 272 surviving subjects who underwent Operative (Op, N=115) or Non-operative treatment (N=53) were included with mean follow-up 7.49 ± 1.61 years. FTT parameters included maximum speed, time to onset of symptoms, distance ambulated, time ambulated, and back and leg pain severity before and after testing. Results. Both groups had deterioration from the two-year to final FTT in maximum selected speed, time ambulated and time to onset of symptoms but the decline was greater in NonOp patients. Patients in the Op group had worse Post-FTT back and leg pain at baseline but improved more than the NonOp at two years and maintained at final FTT. Op patients with two or more revisions had less improvement at two years and at final FTT compared to those who had no revision or only one revision. Conclusion. Patients treated surgically had greater improvements in FTT parameters compared to patients treated nonsurgically at two years that persisted to the final FTT performed at 7 years after their intervention. There was slight deterioration in some parameters from the two year to final FTT but these may be due to aging of the cohort. Patients who had two or more revisions had worse FTT parameters compared to patients with one or no revisions.

Outcomes after vertebral body tethering for Lenke type 5 scoliosis continue to improve: analysis of different surgical techniques

2025-06-16

Per Trobisch , Hong Jin Kim , Jil Frank +2 more | Spine Deformity

Postoperative L1 tilt as a Predictor of Proximal Junctional Kyphosis Following Lower Thoracic Spine-To-Pelvis Fusion for Adult Spinal Deformity

2025-06-16

Se-Jun Park , Jin‐Sung Park , Dong-Ho Kang +3 more | Spine

Study Design. Retrospective study Objective. To investigate the association between postoperative orientation of the L1 vertebra and proximal junctional kyphosis (PJK) occurrence in adult spinal deformity (ASD) surgery Summary of … Study Design. Retrospective study Objective. To investigate the association between postoperative orientation of the L1 vertebra and proximal junctional kyphosis (PJK) occurrence in adult spinal deformity (ASD) surgery Summary of Background Data. PJK remains a common complication, with various risk factors identified. However, the role of the orientation of L1 vertebra has not been well studied. Methods. A total of 312 patients who underwent fusion from the pelvis to the lower thoracic spine (T9–12) were analyzed. Patient, surgical, and radiographic variables were evaluated for risk factor analysis of PJK. L1 tilt and L1 slope at six weeks postoperatively were included to represent the L1 orientation. Multivariate logistic regression analysis was performed to identify risk factors for PJK. Receiver operating characteristics (ROC) curve analysis was used to calculate the cutoff value of predictors for PJK. Results. PJK developed in 109 patients (34.9%). Multivariate regression analysis identified postoperative L1 tilt as the only independent risk factor for PJK (odds ratio=1.173, P <0.001). The cutoff value of L1 tilt for predicting PJK was determined as 8.1° based on ROC curve analysis (area under the curve=0.736, P <0.001). The rates of PJK (50.7% vs. 22.1%, P <0.001) and revision surgery (17.1% vs. 5.2%, P <0.001) were significantly higher in the high L1 tilt group than in the low L1 tilt group. The high L1 tilt group also exhibited significantly greater pelvic tilt, thoracic kyphosis, and T1 pelvic angle, as well as worse clinical outcomes at two years compared to the low L1 tilt group. Conclusions. An L1 tilt greater than 8.1° was associated with a higher risk of PJK, suboptimal sagittal alignment, and worse clinical outcomes at 2 years. Therefore, optimizing L1 orientation may reduce PJK risk and improve long-term surgical outcomes.

Preoperative Low Lumbar Hounsfield Units and Global Alignment Predict Postoperative Mechanical Complications After Adult Spinal Deformity Surgery: A Multicenter Retrospective Study

2025-06-16

Ippei Yamauchi , Hiroaki Nakashima , Sadayuki Ito +7 more | Journal of Clinical Medicine

Objectives: This study investigated the potential of Hounsfield unit (HU) values obtained from computed tomography (CT) scans as predictors of mechanical complications (MCs) in patients undergoing long-segment spinal fusion involving … Objectives: This study investigated the potential of Hounsfield unit (HU) values obtained from computed tomography (CT) scans as predictors of mechanical complications (MCs) in patients undergoing long-segment spinal fusion involving the pelvis. Additionally, it identified a threshold HU value associated with an increased risk of MCs. Methods: We conducted a retrospective, multicenter review of patients who underwent long-segment spinal fusion involving the pelvis, with a minimum follow-up period of two years. Patients were categorized based on the presence or absence of postoperative MCs. Both preoperative and postoperative radiographic parameters were analyzed, and HU values were quantified from CT images. Logistic regression modeling was used to identify independent risk factors for MCs. Results: Among 129 patients, 33 (25.6%) developed MCs, including proximal and distal junctional failures, rod fractures, and cases necessitating re-operation. The HU values were significantly lower in the MC group, whereas conventional bone mineral density (BMD) measurements showed no significant difference. Global alignment parameters, such as the sagittal vertical axis (SVA) and global tilt (GT), were consistently higher in patients with MCs. Receiver operating characteristic analysis identified 131 HU as the optimal cut-off, yielding a sensitivity of 56.4% and a specificity of 69.7%. Multivariate analysis confirmed that lower HU values were independently associated with the occurrence of MCs. Conclusions: Lower HU values and larger radiological global alignment parameters are significant predictors of MCs in patients undergoing surgery for adult spinal deformity. These findings underscore the importance of CT-based quantitative assessments in preoperative planning.

Surgical outcome of adolescent idiopathic scoliosis who are Vitamin D deficient

2025-06-15

Ujjwal K. Debnath , Shweta Bhyri , Biplab Maji +3 more | IP Journal of Paediatrics and Nursing Science

Preoperative Evaluation of Adolescent Idiopathic Scoliosis: The Relevance of Routine Magnetic Resonance Imaging

2025-06-14

Majdi M Abu Awida , Awni A Shyyab , Shaher A Aletan +4 more | Cureus

Examining the impact of adolescent idiopathic scoliosis on psychosocial well-being and physical function: revealing insights from patient-reported outcomes

2025-06-14

Donna Oeffinger , Henry J. Iwinski , Vishwas Talwalkar +3 more | Spine Deformity

Answer to the letter to the editor of M. Ashouri, et al. concerning “Risk factors for mortality after 3-column osteotomy” by Carbone J, et al. (Eur spine J [2024]: https://doi.org/10.1007/s00586-024-08616-9)

2025-06-13

Julio J. Jauregui , Hershil Patel , Steven C. Ludwig | European Spine Journal

Risk Factors for Postoperative Coronal Malalignment in Degenerative Lumbar Scoliosis and Its Impact on Clinical Outcomes

2025-06-13

Dongfan Wang , Yan Zhang , Stone Sima +4 more | Spine

Study Design. Systematic review and meta-Analysis Objective. To identify risk factors for postoperative coronal malalignment (CM) and evaluate its impact on clinical outcomes in patients with degenerative lumbar scoliosis (DLS). … Study Design. Systematic review and meta-Analysis Objective. To identify risk factors for postoperative coronal malalignment (CM) and evaluate its impact on clinical outcomes in patients with degenerative lumbar scoliosis (DLS). Background. Postoperative CM is a common complication after DLS surgery, with an incidence ranging from 20.7% to 38.9%. Identifying its risk factors and impact on surgical outcomes may enhance understanding of the condition and help optimize clinical management strategies. Methods. This systematic review was conducted in accordance with the PRISMA guidelines. Relevant studies were retrieved from PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov. The inclusion criteria were: (1) comparative studies analyzing CM versus non-CM in DLS patients, (2) outcomes reported including demographic data, surgical details, radiographic parameters, and patients-reported outcomes, and (3) observational studies published in English from the inception of the databases to January 2024. Results. Seven studies with a total of 617 patients (191 CM, 426 non-CM) were included. Compared to the non-CM group, patients in the CM group had a higher proportion of females ( P =0.03), larger major Cobb angle ( P =0.005), greater LS curve Cobb angle ( P <0.001), increased L4 tilt angle ( P =0.01), L5 tilt angle ( P <0.001), and AVT ( P <0.001) preoperatively. Postoperatively, CM patients showed higher residual LS curve Cobb angle ( P =0.02), L4 tilt angle ( P =0.04), and L5 tilt angle ( P <0.001), as well as a lower LS curve Cobb angle correction rate ( P =0.005). Additionally, the CM group exhibited higher ODI score ( P =0.003). Conclusion. Female sex, more severe preoperative coronal deformity, and insufficient correction of the lumbosacral curve are significant factors for postoperative CM following DLS surgery. The presence of CM is associated with diminished functional improvement after surgery.