Transforaminal full-endoscopic spine surgery (TF-FESS) is a minimally invasive surgical procedure for lumbar spinal disease; however, it is technically demanding in patients with foraminal stenosis because of anatomical problems. This procedure has unique surgery-related complications, such as exiting nerve root injury, causing postoperative dysesthesia or muscle weakness, resulting in a poor clinical outcome. Therefore, we have to avoid this complication. The objective of this study was to analyze the morphology of the intervertebral foramen and assess the feasibility of TF-FESS. We retrospectively reviewed the multiplanar abdominal computed tomography (CT) scans obtained for 800 consecutive patients (400 consecutive males, 400 consecutive females) at our hospitals between January 2016 and December 2018. Patients with lumbar scoliosis (Cobb angle >5 degrees), spondylolisthesis, or vertebral fracture, as well as those with a history of lumbar spinal surgery, were excluded. We evaluated the average values for disc height, position of the superior articular process (SAP), foraminal distance, foraminal area, and SAP facet contact from L1/L2 to L5/S1 on both sides in reconstructed sagittal views. A total of 8,000 intervertebral foramina were analyzed. The correlation between the disc height and these parameters was assessed at each spinal level. At the L1/L2, L2/L3, L3/L4, L4/L5, and L5/S1 levels, the mean disc height was 5.4 mm, 6.4 mm, 7.1 mm, 7.1 mm, and 5.9 mm, respectively. The SAP position, as the distance above the line of the inferior margin of the upper vertebral body, decreased from L1/L2 to L3/L4 and increased from L3/L4 to L5/S1. The respective foraminal distances were the shortest at L4/L5. The foraminal area decreased toward the lower levels. The SAP facet contact was decreasing from L1/L2 to L4/L5. There was a negative correlation between the disc height and the SAP position, and positive correlations of disc height with the foraminal area and the SAP facet contact. The results of the SAP position, the foraminal distance, and the foraminal area suggest that TF-FESS would be technically more difficult at a lower intervertebral disc level because of resection of a larger amount of the SAP. Foraminal stenosis would develop easily when a disc has collapsed. About half of the facet contact could be maintained even if the SAP is resected completely during TF-FESS, especially at a lower lumbar level.

Kinetic-functional assessment of the adolescent idiopathic scoliosis: a cohort study.

Retrospective cohort study. To evaluate the safety and efficacy of polymethyl methacrylate bone cement combined with calcium phosphate bone cement in percutaneous vertebroplasty for postmenopausal women, compared with polymethyl methacrylate bone cement alone. We analyzed the clinical data of 114 postmenopausal female patients who underwent single-level thoracolumbar PVP surgery at the Orthopedics Department of Baiyun Hospital, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2023 to June 2024.A total of 55 patients were included in the conventional group and 59 patients were assigned to the combined group, based on the type of filler used during the procedure.Comparative assessments included general demographic characteristics, low back pain Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, perioperative parameters (e.g., operative duration, intraoperative blood loss, time to ambulation), imaging findings, postoperative complications, and adverse events. All patients successfully underwent the procedure and were followed up for at least one year. No significant differences were observed in baseline data between the two groups.At postoperative follow-up, both groups showed significantly lower low-back pain Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores compared with preoperative values (P < 0.05). At 1day and 1 month after surgery, the combined group had significantly lower VAS and ODI scores than the conventional group (P < 0.05). However, by 1 year postoperatively, there were no significant differences in VAS or ODI scores between the two groups (P > 0.05).Compared with preoperative measurements, both groups exhibited significant improvement in lumbar lordosis angle, sagittal Cobb angle, thoracic kyphosis angle, thoracolumbar kyphosis angle, coronal Cobb angle, and vertebral body height at postoperative follow-up (P < 0.05).Furthermore, compared with the conventional group, the combined group demonstrated a lower incidence of cement leakage and adjacent vertebral refracture after PVP, as well as less residual postoperative back pain. In percutaneous vertebroplasty (PVP) for thoracolumbar vertebral compression fractures in postmenopausal women, the application of methyl methacrylate (PMMA) combined with calcium phosphate cement (CPC) is safe and effective. It significantly alleviates pain, improves surgical outcomes, and enhances patient satisfaction. The efficacy and safety of this combined approach are comparable to PMMA cement alone, with advantages in reducing back pain, improving quality of life, lowering the risk of cement leakage, and decreasing the incidence of adjacent vertebral fractures.

This study investigated the neurophysiological mechanisms linking visual body perception to motor output in females with adolescent idiopathic scoliosis (AIS), specifically examining how altered body schema influences corticospinal excitability. A two-stage paradigm was employed in participants with AIS and healthy controls. First, psychophysical thresholds for detecting spinal curvature were estimated. Second, single-pulse transcranial magnetic stimulation (TMS) was applied over the primary motor cortex (100-125 ms post-stimulus) to assess motor system reactivity to body-relevant stimuli. Corticospinal excitability was recorded via motor evoked potentials (MEPs) from intrinsic hand muscles as a proxy for motor readiness during the observation of spinal distortions. Results revealed that AIS patients exhibited significantly lower perceptual thresholds than controls, indicating hypersensitivity to spinal curvature that correlated with subjective self-perception (Trunk Appearance Perception Scale; TAPS). TAPS scores did not correlate significantly with participants' Cobb angles, indicating that subjective body schema distortion operates independently of mechanical deformity severity. In addition, TMS revealed that AIS patients reached peak corticospinal excitability at their lower perceptual threshold, whereas healthy controls demonstrated peak excitability only when spinal curvatures exceeded their detection thresholds. These findings suggest that AIS involves an increased corticospinal gain in response to body-relevant stimuli. Rather than serving purely as a detection mechanism, the motor system in AIS exhibits a heightened readiness that is tightly coupled with the perception of spinal distortions. Such sensorimotor reorganization suggests that motor excitability is adaptively recalibrated to the patient's lived physical experience.

To investigate the asymmetrical sacroiliac joint degeneration (SIJD) in degenerative lumbar scoliosis (DLS), and to evaluate the correlation between SIJ degeneration, spinopelvic parameters and clinical outcomes. We retrospectively reviewed 183 DLS patients. Preoperative measurements were measured on full-length plain radiographs. Backlund's protocol was used to assess SIJD on CT scans. Patient-reported outcome measures (PROMs) including the Visual analogue scale for back pain (VAS-BP) and leg pain (VAS-LP), Oswestry Disability Index (ODI), and Scoliosis Research Society-22r (SRS-22r) were recorded at baseline. Correlation analyses were performed to investigate the relationship between the SIJD and spinopelvic parameters and between the SIJD and PROMs. SIJ degeneration was more severe on the convex side than on the concave side (p = 0.013). The asymmetry degree of SIJD between the concave side and the convex side was significantly associated with Cobb angle (r = 0.251, p = 0.012) and lumbosacral coronal angle (r = 0.426, p = 0.001). Multivariate regression analysis showed that factors associated with SIJ degeneration were the PIA (coefficient B = 0.153), and LSLA (coefficient B=-0.118). SIJ degeneration was significantly correlated with preoperative VAS-BP, SRS-22 pain, SRS-22 activity and SF-36 PCS (all p < 0.05). SIJ degeneration was more severe on the convex side compared to the concave side in DLS, and the asymmetry degree increased with both the Cobb angle and the lumbosacral coronal angle. PIA and LSLA were significantly associated with SIJ degeneration score. These findings highlight the importance of considering the SIJ during preoperative assessment and surgical planning for DLS, particularly in patients with severe SIJ degeneration, which may contribute to low back pain and functional limitation.

This study explores the relationship between thoracic sagittal kyphotic alignment, quantified by the Cobb angle, and postoperative shoulder function, specifically assessing whether the presence and severity of thoracic kyphosis influence clinical outcomes and range of motion (ROM) in patients undergoing reverse shoulder arthroplasty (rTSA). A retrospective review was conducted on 110 patients who underwent rTSA from 2020 to 2022 at a single institution. Sagittal kyphosis was quantified on preoperative chest radiographs. Clinical outcomes were measured using the visual analog scale (VAS), constant score (CS), simple shoulder test, Single Assessment Numeric Evaluation (SANE) score, and pre- and postoperative ROM. Patients were separated into three groups based on Cobb angle severity (0-36°, 37-46°, ≥47°) and followed for a minimum follow-up of 2 years. A p-value <0.05 was considered statistically significant. Patients with a Cobb angle ≥47° exhibited a significant reduction in flexion (132.7° vs 149.4° for Cobb ≤36°; p = 0.031) and abduction (122.9° vs 142.1°; p = 0.035). This group also showed lower mean CSs (75.1 vs 83.3; p = 0.048). No significant differences were observed among groups in SANE or VAS pain scores. Greater thoracic kyphosis is associated with reduced functional outcomes and diminished flexion and abduction following rTSA. These findings suggest that sagittal spinal alignment may influence postoperative shoulder performance. Retrospective Cohort Comparison III.

Study designSystematic review and meta-analysis of randomized controlled trials and cohort studies directly comparing full-endoscopic posterior cervical decompression (PECD) with anterior cervical discectomy and fusion (ACDF) in adults with degenerative cervical disease.ObjectiveTo compare full-endoscopic posterior cervical decompression with anterior cervical discectomy and fusion for degenerative cervical disease.MethodsPubMed, Embase, and CENTRAL were searched through September 2025 for randomized and cohort studies in adults with ≥ 6 months' follow-up directly comparing PECD and ACDF. NDI, VAS neck/arm pain in short-term and long-term follow up, C2-C7 Cobb angle, peri-operative metrics, and adverse events were pooled using random-effects models with 95% confidence intervals.ResultsTen studies (2 RCTs, 8 cohorts) comprising 862 patients (PECD 433; ACDF 429) with 6 months to 2.5 years of follow-up were included. NDI and VAS arm pain scores did not differ significantly at final follow-up. PECD showed greater short-term functional improvement (NDI MD 2.46, 95% CI 1.55-3.36), whereas ACDF achieved slightly greater long-term neck pain improvement (VAS neck MD -0.24, 95% CI -0.43 to -0.04). C2-C7 Cobb angle and operative time did not differ. PECD was associated with a shorter hospital stay (MD -1.64 days, 95% CI -2.31 to -0.97) and lower blood loss (MD -44.85 mL, 95% CI -79.8 to -9.89), though these perioperative outcomes demonstrated substantial heterogeneity. Additionally, PECD was associated with a significantly lower risk of postoperative complications (RR 0.53, 95% CI 0.34-0.81); whereas ASD and index-level re-operation rate did not differ.ConclusionsPECD provides comparable mid-term disability and arm pain relief to ACDF with faster early recovery and lower perioperative morbidity, while ACDF offers marginally better long-term axial neck pain improvement.

Excessive distraction (ED) during anterior cervical spine surgeries may improve cervical alignment but higher the risk of postoperative complications. To date, no comprehensive reviews has evaluated the overall impacts of ED across anterior cervical spine surgeries. This study aims to evaluate the impact of excessive distraction (ED) on clinical and radiological outcomes during anterior cervical spine surgeries. A systematic search (PubMed, Europe PMC, Embase, Scopus, Google Scholar; up to March 2025) identified studies reporting distraction and postoperative outcomes after ACDF or CDR. Studies without clinical/radiological outcomes, incomplete statistical reporting, case reports or animal and cadaveric studies were excluded. Data were stratified into early (< 6 months) and late (≥ 6 months) post-operative. Meta-analyses were conducted using Cochrane Review Manager 5.4.1 and R-Studio 4.5.2. A total of 19 cohort studies encompassing of 1877 patients were included. Excessive distraction was associated with greater post operative neck pain (nVAS: early SMD 0.46; late SMD 0.4, both p < 0.00001), arm pain (aVAS: early SMD 0.28, p = 0.007; late SMD 0.36, p = 0.004), and disability (NDI: early SMD 0.28, p = 0.002; late SMD 0.46, p < 0.00001). No significant differences were found in mJOA or SF-36 scores. Radiologically, ED improved cervical lordosis (C2-C7 Cobb angle: SMD 0.27, p = 0.0005) and range of motion (SMD 0.62, p < 0.00001). However, ED increases risks of adjacent segment degeneration (ASD) (RR 2.98, p < 0.00001), cage subsidence (RR 1.63, p < 0.00001) and heterotopic ossification (HO) (RR 1.99, p = 0.009). Excessive distraction in anterior cervical spine surgeries improves cervical alignment and mobility but worsens pain, disability, and long-term complications. Optimal, not maximal distraction should be targeted to balance alignment benefits with functional outcomes and mechanical safety.

Minimally invasive scoliosis surgery (MISS) may address both recovery and cosmetic concerns of young adult idiopathic scoliosis (YAdIS) patients through minimized surgical incisions, while increased rigidity of curves associated with skeletal maturation has limited the application of MISS in this population. The aim of this study was to compare surgical outcomes after posterior-based MISS across different age groups, with particular emphasis on the effectiveness in YAdIS patients. A retrospective analysis was conducted of 354 patients with moderate-to-severe, flexible idiopathic scoliosis who underwent posterior-based MISS between 2015 and 2023. Patients were stratified into 3 groups according to age at the time of surgery: younger adolescent idiopathic scoliosis (AIS) (10-14 years, n = 118), older AIS (15-18 years, n = 109), and YAdIS (19-40 years, n = 127). Demographics, perioperative metrics, radiographic correction, and complication rates were compared across the groups. Although YAdIS patients exhibited a lower correction rate than younger AIS patients (mean difference, -8.0%; 95% CI, -10.9 to -5.1) and older AIS patients (mean difference, -4.4%; 95% CI, -7.1 to -1.7), they achieved a clinically acceptable final Cobb angle (younger AIS: 19.4° ± 7.4°, older AIS: 21.6° ± 6.9°, YAdIS: 23.7° ± 7.7°). YAdIS and older AIS patients required longer operative times and underwent a higher number of rib resections by thoracoplasty than younger patients. Crucially, however, there were no significant differences in estimated blood loss, length of hospital stays, or major complication rates among the groups (P > .05). While age-related rigidity results in slightly diminished correction and longer operative times, MISS maintains equivalent overall outcomes in YAdIS patients to those of adolescents. Therefore, MISS presents a safe and effective surgical option for YAdIS patients with retained curve flexibility.

3D back surface asymmetry reflects radiographic deformity but not patient perception in Lenke type 1 adolescent idiopathic scoliosis.

Axial pain can occur as a complication following anterior cervical discectomy and fusion (ACDF), which is frequently regarded as a complication of posterior cervical surgery and is often overlooked after ACDF. However, the risk factors of postoperative axial pain (PAP) remain incompletely elucidated. This study aimed to analyze the risk factors and radiological assessment of PAP in patients undergoing ACDF. Individuals undergoing ACDF between January 2020 to March 2023 were included. Participants were categorized into two groups by PAP presence. Clinical parameters were collected, and radiographic parameters measured included pre- and postoperative C2 ~ 7 Cobb angle, C2 ~ 7 sagittal vertical axis, T1 slope, intervertebral disc height, facet joint distance (FJD), and interspinous distance. Spinal cord function was evaluated using the Japanese Orthopaedic Association score. Univariate/multivariable analyses identified independent risk factors for PAP after ACDF. Diagnostic performance of postoperative C2 ~ 7 Cobb angle change and postoperative relative FJD change was evaluated via Receiver Operating Characteristic curve analysis. Optimal cutoff values were determined using the Youden index. In ACDF patients, PAP prevalence was 15.5% in single-level surgery and 19.8% in multi-level surgery. For single-level ACDF, logistic regression analysis identified postoperative relative FJD change as a PAP risk factor (Area Under the Curve [AUC] = 0.809, optimal cutoff = 27.95%). For multi-level ACDF, postoperative C2 ~ 7 Cobb angle change was a risk factor (AUC = 0.773, optimal cutoff = 3°). During ACDF procedures, minimizing FJD in single-level surgery and avoiding excessive C2 ~ 7 Cobb angle correction in multi-level surgery may reduce PAP prevalence.

Pectus excavatum (PE) is commonly associated with spinal abnormalities. However, the effect of the Nuss procedure on thoracic scoliosis remains unclear. This study therefore aimed to characterize the dynamic changes in the thoracic Cobb angle (tCA) among adult PE patients undergoing Nuss procedure. A total of 186 Patients with PE who underwent the Nuss procedure and subsequent bar removal (BR) were retrospectively analyzed. Clinical data were collected, including serial tCA measurements from posteroanterior chest radiographs taken preoperatively, at 1 month, 3-6 months, and 1 year postoperatively, as well as 1day before and 1 week after BR for analysis. Subgroups were stratified by sex, Haller index (≥ 4 vs. <4), bar number (1-3), bar orientation (oblique vs. horizontal), bar flipping within 3 months, and preoperative tCA (≥ 10° vs. <10°). Compared to the preoperative mean tCA, the tCA increased significantly at 1 month postoperatively (5.4 ± 4.2° vs. 5.9 ± 4.4°, p < 0.001). It then decreased significantly by 1day before BR (5.4 ± 4.2° vs. 4.9 ± 3.9°, p < 0.001) and further at 1 week after BR (5.4 ± 4.2° vs. 4.4 ± 4.0°, p < 0.001). All subgroup analyses demonstrated a significant reduction in the tCA following BR. The Nuss procedure induced a temporary increase in tCA at 1 month postoperatively, followed by gradual improvement during the bar maintenance period and a net reduction below the preoperative level after bar removal. Notably, patients with mild thoracic scoliosis also experienced a reduction in tCA after complete PE correction. While this reduction was not clinically meaningful, it still indicates that the procedure does not worsen thoracic spinal alignment and may offer some improvement.

Does social deprivation influence timely presentation of adolescent idiopathic scoliosis: a retrospective study.

Lumbar vertebral body tethering: 2-year multicenter radiographic and reoperation outcomes.

Longitudinal patient-reported outcomes after spinal fusion for adolescent idiopathic scoliosis: recovery trajectories and insights into surgical timing.

Asymmetry of muscle changes is most pronounced at the apex of degenerative lumbar scoliosis: a retrospective cross-sectional analysis of older adults.

Adolescent Idiopathic Scoliosis (AIS) impacts both trunk morphology and body image. While the Cobb angle and photogrammetric metrics (ATSI, POTSI) objectively measure physical deformity, they may not reflect the patient's subjective perception. This study investigated the correlation between these objective indices and self-perceived appearance using the Spinal Appearance Questionnaire (SAQ). A retrospective observational study included 30 female adolescents with AIS (mean age 14.47 ± 1.90 years; Cobb >10°). Trunk asymmetry was objectively evaluated via photogrammetric calculation of ATSI and POTSI scores. Subjective perception was assessed using the Greek version of SAQ. Spearman's rank correlations were used to analyze relationships between the objective indices and SAQ scores. Participants had a mean Cobb angle of 30.77°± 9.51°and a mean SAQ Total score of 52.07 ± 7.98. The analysis revealed no statistically significant correlations between the total SAQ score and ATSI (r = -0.014, p = 0.943), POTSI (r = 0.113, p = 0.552), or the Cobb angle (r = 0.049, p = 0.796). Objective measures of trunk deformity, both radiographic and photogrammetric, do not correlate with self-perceived spinal appearance in adolescents with AIS. This highlights that body image is a multidimensional construct distinct from physical severity, necessitating the routine clinical use of Patient-Reported Outcome Measures (PROMs) alongside objective parameters.

Bracing is the primary conservative treatment for Adolescent Idiopathic Scoliosis (AIS), aiming to arrest curve progression. Therapeutic success relies on initial in-brace correction and patient compliance. This study compares the symmetric Boston brace and the asymmetric 3D Scoliosis Brace (SB) regarding immediate correction, compliance, and one-year outcomes in Cobb and Raimondi angles. A retrospective observational study involved 135 adolescents (Boston: n=54, SB: n=81) with AIS (Cobb 20-45°). Outcomes included percentage of in-brace correction, compliance (wear time %), and changes in Cobb and Raimondi angles at 1-year follow-up. The SB group achieved significantly higher initial in-brace correction (47.8% ± 14.4) compared to the Boston group (39.0% ± 13.5, p<0.001). Compliance was also significantly higher in the SB group (89.6%) versus the Boston group (72.9%, p<0.001). At one year, both groups improved significantly, but the SB group showed superior Cobb angle reduction (from 27.06°to 22.44°) compared to the Boston group (from 26.17°to 24.02°, p=0.007). Both braces effectively maintained rotational stability, preventing clinically significant progression. The Scoliosis Brace demonstrated superior immediate correction and higher patient compliance, contributing to better Cobb angle reduction at one year. Both designs successfully stabilized the rotational component. These findings support the efficacy of asymmetric 3D CAD/CAM designs in optimizing AIS treatment outcomes.

Effectiveness and safety of vertebral distraction techniques in early-onset scoliosis: a systematic review and meta-analysis.

Distribution of curve flexibility in AIS: a multicenter study of 5,267 patients.