Self-healing polymers offer softness and conformability for skin-interfaced electronics. However, their flowable nature often causes gradual shape deformation, limiting their use in circuit-integrated devices. Here, we report a shape-stable self-healing polymer (SS-SHP) featuring a branched polymer network reinforced with reversible imine and hydrogen bonds. The SS-SHP maintained its original shape for 20 days with less than 5% reduction in storage modulus and exhibited a skin-like Young's modulus of 576 kPa, enabling conformal contact with microtextured skin. To achieve conductive circuits, incorporation of Ag flakes into the SS-SHP matrix yielded a self-healing conductor with stable surface resistance over time, avoiding the conductivity degradation typically observed in hydrogen-bonded SHPs. Using the SS-SHP as both substrate and electrode, we fabricated a wireless arterial pressure sensor with optical signal transmission that conforms to the wrist without external contact pressure and enables continuous pulse monitoring, including discrimination of non-pregnant and pregnant pulse waveforms.

​ Gradual correction of genu varum using circular external fixators is well-established. Although the External Fixation Index (EFI) is widely used in linear bone lengthening, no standardized, time-normalized metric exists for angular deformity correction. This study introduces the angular External Fixation Index (aEFI) as a descriptive tool and evaluates internal consistency within a clinical cohort treated with oblique proximal tibial corticotomy (OPTC). ​ A prospective cohort study included 22 patients (30 knees) who underwent gradual genu varum correction using OPTC and circular external fixation. The aEFI was calculated as total duration of external fixation (weeks) divided by achieved angular correction (degrees). Radiographic evaluation included medial proximal tibial angle (MPTA) and hip-knee-ankle angle measured preoperatively and at final follow-up. Functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, and the Stanmore Limb Reconstruction Score. At a mean follow-up of 16.5 ± 3.25 months, coronal alignment was restored in all knees. Mean fixation duration was 27.4 ± 6.2 weeks, with a mean aEFI of 1.89 ± 0.41 weeks/degree. An inverse association was observed between correction magnitude and aEFI (r = -0.88, p < 0.001), reflecting the reduced proportional effect of fixed treatment phases with larger corrections. Functional scores improved, and minor pin-tract infections occurred in 20% of knees and resolved conservatively. ​ The proposed aEFI serves as a standardized, descriptive, time-normalized metric for reporting treatment duration relative to angular correction. External validation across different constructs and deformity patterns is warranted.

In this study, the buckling stability of flat composite shells with a thickness of 5 cm and individual element dimensions of 40 × 200 cm, arranged in an interconnected mesh and subjected to combined loads (axial, lateral, and external pressure), was investigated. Using the First-Order Shear Deformation Theory (FSDT) and numerical implementation in Abaqus, two environmental reinforcement strategies—temperature-dependent and external pressure-dependent functions—were integrated as controllable variables into the model. Nonlinear static analysis revealed that, without environmental reinforcement, the shells experienced sudden collapse at displacements of 7–11 cm. In contrast, temperature-based environmental reinforcement increased the yield load by up to 68%, and after surpassing the linear buckling threshold, the structure exhibited ductile behavior with significantly enhanced energy absorption attributed to the release of residual stresses and more uniform stress distribution across laminates. In the external pressure-based reinforcement model, although the yield load decreased, overall displacement was reduced by 10% and the maximum von Mises stress dropped by 82%, indicating effective mitigation of bending-induced stresses and improved post-buckling stability. Despite their distinct mechanisms, both reinforcement methods induced a qualitative shift in structural behavior—from abrupt, localized failure to controlled, gradual deformation. This study is the first to introduce and validate “environmental reinforcement” in composite shell literature as an active, equipment-free design strategy that transforms ambient conditions from destabilizing factors into performance-enhancing tools. The findings lay a foundation for the development of intelligent roofs, aerospace structures, and resilient systems in civil, aerospace, and defense engineering under complex loading scenarios.

Single-point incremental forming (SPIF) is a method of forming sheet metal components in a variety of industries. SPIF involves the gradual deformation of the sheet metal using a pin tool. In this article, SPIF was used to form a Zn-Cu-Ti alloy square pyramid drawpieces with a wall angle of 60°. Zn-Cu-Ti alloy sheets are characterised by strong anisotropy associated with the hexagonal close-packed structure. The aim of the study was to determine the effect of SPIF process parameters on the strength properties of the drawpieces. Analysis of variance was used to statistically analyse the effect of SPIF process parameters on the yield strength, ultimate tensile strength and elongation of workpiece material after forming. Based on the analysis of variance, it was found that statistically significant parameters influencing SPIF-induced properties of drawpiece material (yield strength, ultimate tensile strength and elongation) were workpiece orientation, orientation of samples taken for testing in relation to the sheet rolling direction and tool rotational speed. Step size significantly affects the yield strength and ultimate tensile strength of drawpiece material.

Modern energy and electronic systems comprise a large number of nonlinear elements operating in dynamic modes. Accurate modeling of such systems requires proper consideration of nonlinear current-voltage characteristics (CVC) and transient processes, which is especially important when designing rectifiers, inverters, control systems and other power electronics devices. Existing electrical circuit simulators do not always provide users with the necessary flexibility, scalability, or compatibility with enterprise safety standards, and may have legal restrictions. Custom effective modeling methods for such systems allow for creating specialized software solutions to analyze dynamic modes of electrical circuits, free from the limitations of commercial simulators and tailored to specific engineering and scientific tasks. The purpose of the work is to develop a method for numerical modeling of dynamic modes of electrical circuits comprising semiconductor diodes or other elements with nonlinear CVC, described by nodal equations. The scientific novelty lies in the development of a homotopy approach to overcoming high condition number of the Jacobian matrix when solving nonlinear differential-algebraic equations (DAEs) of electrical circuits, based on deformation of CVC with adaptation of the deformation parameter depending on the residual norm and condition number of the matrix; in the development of a method for extracting linearly independent differential equations from DAEs of electrical circuits without preliminary analysis of their topology; in the development of a universal stamp of a nonlinear element, based on linearization of the functional in the vicinity of the current approximation, allowing for integration of diode models with various CVCs into nodal equations. Materials and methods. Theoretical electrical engineering methods were used in the work, including the modified nodal potential method. The proposed numerical modeling method involves integration of elements with nonlinear CVC into nodal equations; extraction of differential and algebraic parts from DAEs, based on singular value decomposition of the matrix standing before the derivative vector; transformation of DAEs into a nonlinear system of algebraic equations using backward differentiation formulas (BDF) with variable time step. Initial points for BDF were determined by the diagonally implicit Runge–Kutta method of second order accuracy. Numerical solution of the obtained nonlinear equations was performed by the damped Newton–Raphson method. To reduce the condition number of the Jacobian matrix in transient modes, when the spread of differential conductivities reaches 12 orders and higher, a homotopy approach was proposed, consisting of gradual deformation of the diode CVC from a smoothed to the original curve during convergence, while maintaining a given value of the condition number. Results. To demonstrate the proposed solutions, computer simulation of a bridge rectifier operating on an active-inductive load with two types of diode CVC was performed: piecewise-linear and smooth, corresponding to the Shockley equation with series resistance. The deformation parameter and damping coefficient were adaptively changed depending on the residual norm of the functional and the condition number of the Jacobian matrix. Comparison of simulation results with different methods of specifying diode CVC showed that differences appear predominantly in transient processes of switching diode operation modes. It has been found that to ensure convergence of numerical solution in diode switching modes, characterized by high condition number of the Jacobian matrix, the homotopy approach is more effective than diagonal regularization. The proposed method for numerical modeling of dynamic modes of electrical circuits with nonlinear elements has a natural algorithmic structure, allowing for simple software implementation. Conclusions. 1. The most universal diode stamp, obtained on the basis of linearization of the functional derived from the CVC equation in the vicinity of the current approximation, has been identified. 2. A method for extracting linearly independent differential equations from DAEs of electrical circuits without preliminary analysis of circuit topology has been proposed. 3. A method for calculating the Jacobian matrix for solving nonlinear DAE has been proposed. 4. To ensure convergence of numerical solution with high condition number of the Jacobian matrix, it is preferable to apply the homotopy approach.

Expanded polystyrene (EPS) concrete presents considerable promise as a sustainable construction material, providing both structural and ecological advantages. In terms of structural integrity, EPS core sandwich wall panels (SWP) demonstrate impressive mechanical properties, as evidenced by load testing on samples. The initial crack loads were recorded between 11.5 and 13.5 kN, while the ultimate failure loads ranged from 41 to 44 kN. The panels exhibited an initial stiffness of 4.00 to 4.82 kN/mm, which decreased to 1.32 to 1.72 kN/mm after cracking, indicating a stiffness reduction of 57 to 69%. Furthermore, energy absorption significantly increased, achieving values between 401.00 and 430.72 kN·mm at ultimate loads, which reflects the panels' capacity for gradual deformation and resilience. The deflections at failure were noted to be between 21.0 and 23.0mm, with ductility ratios ranging from 7.00 to 8.33, underscoring the panels' ability to absorb energy and support loads even after cracking. On the environmental front, EPS concrete contributes to lower carbon emissions through lightweight construction, which reduces the need for raw materials, enhances energy efficiency, and utilizes recycled EPS waste, thereby aligning with circular economy objectives. EPS-based products contribute to pollution reduction and sustainable building practices by enhancing insulation, reducing transportation emissions, and managing plastic waste. By reducing landfill waste and improving indoor air quality, EPS helps to mitigate environmental effects. However, further research into life cycle assessments, synergistic applications with materials like rice husk ash, and potential environmental risks is necessary to maximize its structural and environmental efficiency.

Electronic skin has increasingly diverse applications in health monitoring, disease diagnosis, rehabilitation therapy, and human-machine interaction. However, most electronic skin devices struggle to maintain stable performance and adhesion under complex conditions involving high body acceleration and sweat. To address these issues, we present a dynamic conformal electrode based on liquid metal, fabricated by coating the semi-liquid metal (SLM) with high conductivity of 9.0 × 10&lt;sup&gt;6&lt;/sup&gt; S/m and low fluidity onto polyborosiloxane (PBS) exhibiting frequency-responsive rheological properties. The gradual deformation of PBS enables SLM to compress into microscopic skin wrinkles while avoiding hair interference. This dynamic conformal electrode can withstand significant deformation exceeding 1,000%, while also increasing the skin contact area, leading to a lower skin contact impedance of 0.1 MΩ at 1,000 Hz and improved interfacial adhesion, maintaining robust skin adhesion for over 7 days. This study demonstrates the capability of the conformal electrode to conduct long-term monitoring of electrocardiogram, electromyogram, and electroencephalogram signals in areas with rough textures, large skin deformation, and dense hair, enabling continuous dynamic monitoring of human health information. The findings highlight its broad potential for applications in health detection, disease diagnosis, rehabilitation therapy, and human-machine interaction.

Background: The Ilizarov technique, developed by Gavril Ilizarov in the 1950s, revolutionized orthopedic surgery through distraction osteogenesis, allowing gradual bone lengthening and deformity correction while preserving function. It remains relevant in treating congenital deformities, post-traumatic shortening, and infected nonunions, despite advances in internal fixation and magnetic lengthening systems.Aim of the study: This review evaluates the current use, effectiveness, and limitations of the Ilizarov technique and compares it to modern orthopedic methods.Material and methods: A literature review was conducted using PubMed, Embase and VHL. From 176 initial articles, 40 met inclusion criteria based on relevance to the Ilizarov method and were analyzed.Results: The Ilizarov technique is highly effective in complex cases, offering high bone union rates (up to 100%), early weight-bearing, and the ability to simultaneously correct bone and soft tissue issues. However, it is associated with complications such as pin-site infections, joint stiffness, and prolonged treatment duration. Compared to newer methods, it remains cost-effective but demands patient compliance and specialist experience.Conclusions: The Ilizarov technique continues to play a vital role in modern orthopedics. With careful patient selection, team-based care, and technological improvements, its use can be optimized for improved outcomes.

Gradual mechanical deformation discernible devices based on flexible self-powered Ⅲ-nitride pin photoelectrochemical piezo-phototronics

The Campi Flegrei caldera (CFc), Italy, exhibits distinct unrest patterns, including shallow seismicity following substantial strain accumulation, all within a densely populated area. Previous geophysical studies typically analyzed individual episodes, but by comparing two distinct unrest periods we identified recurring manifestations and VP/VS anomalies linked to a confined reservoir at 2- to 4-kilometer depth. Integrating rock physics experiments under hydrothermal conditions, 24 years of rainfall data, and subsurface hydrodynamics, we found increasing rainfall rates, which indicate reservoir recharge and pressurization. We show that hydrothermal water promotes caprock sealing through the formation of a fibrous microstructure. Our experiments further demonstrate that fluid accumulation rates directly influence deformation rates. Together, these processes drive gradual deformation, natural seismicity, and deepening earthquake foci. Recognizing these recurring patterns is crucial for understanding the caldera's unrest-driving mechanism, enabling us to offer actionable insights for hazard assessment and engineering solutions, such as intercepting water upstream to prevent drainage toward Pozzuoli.

This study investigates the impact of salts on the microstructure of natural soft soil under water soaking and seepage conditions over specific periods, comparing results to the natural soil in dry state. The soil sample was taken from a study area in central Iraq, south of Babylon Governorate. The research utilizes scanning electron microscopy (SEM) to analyze soil structure changes. The findings reveal that soaking has a slow effect on salt dissolution, gradually altering the soil’s chemical composition and reducing its cohesion. In contrast, seepage accelerates salt removal, with dissolution beginning around 7 days and nearing completion by 30 days. Seepage also has a more evident effect on soil cohesion and bearing capacity compared to soaking, suggesting that improved drainage systems are crucial to prevent rapid soil degradation. SEM results further show that soaking weakens soil structure, increases porosity, and causes general degradation. Seepage causes an irregular cohesion and gradual deformation, which significantly affects soil stability under varying loads. This study provides novel insights into the effects of salt dissolution on soil behavior under different conditions, pointing out the need for better soil management in areas with saline soils. Doi: 10.28991/CEJ-2025-011-05-04 Full Text: PDF

The parameter information of subsurface media can be categorized into large- and small-scale components, which are crucial for accurate reservoir prediction and characterization. The accuracy and efficiency of geostatistical inversion are highly dependent on the prior model used, as the quality of the prior model directly impacts the inversion results. To enhance the information contained in the prior model, provide reliable geostatistical prior information for inversion, and achieve accurate and realistic inversion outcomes, a mixed prior model that incorporates large- and small-scale information can be constructed based on random media theory. The large-scale prior information is derived using the kriging interpolation method, whereas the small-scale information is generated from random media perturbations, constructed based on the statistical parameters of the media. Subsequently, the large- and small-scale prior information are merged to form a mixed prior model that reflects the overall background variation and the small-scale random perturbations. Finally, a geostatistical inversion approach is developed by combining the mixed prior information with the gradual deformation method. Model tests and field data applications validate the feasibility and effectiveness of this approach.

Predictions of primary fixation in total knee arthroplasty (TKA) can aid in implant design, optimizing long-term survival. Finite element (FE) simulations are commonly used to assess micromotions at the bone-implant interface during daily activities, requiring accurate computational models. A key factor is the material model used to simulate bone properties. This study evaluated two plastic material models-Isotropic Crushable Foam (ICF) and softening Von-Mises (sVM)-for predicting primary fixation in femoral TKA components. Mechanical tests on human femoral trabecular bone samples under cyclic loading were replicated using FE simulations with ICF and sVM models. These models were then applied to FE simulations of three femoral TKA reconstructions, representing patients aged 57, 73, and 90 years. The ICF model replicated the gradual plastic deformation observed in experiments, unlike the sVM model, and more closely matched the permanent deformation of bone samples. In primary fixation simulations, micromotions at the bone-implant interface averaged 27 µm with ICF and 17 µm with sVM. While both predictions fall within acceptable ranges, the ICF model, as a pressure-dependent material model, more accurately replicates experimental energy dissipation and plastic deformation patterns, closely mirroring human bone's plastic behavior. This makes it better suited for simulating implant-bone interface micromotions in primary TKA fixation.

Raising of negative-index medium has been going hand-by-hand with the exploration of quasiplanar subwavelength resonators. Now they are widely used in modern microwave, terahertz, and infrared devices, as well as in advanced physics research. Effects of stacking of the arrays of subwavelength resonators in one few-layer metasurface is connected with the key problems of modern electrical engineering, applied physics, and beyond. Recently, the interest to subwavelength resonators has been growing due to the progress in topological photonics and non-Hermitian photonics. In this paper, the selected effects of arrays coupling in a few-layer metasurface are revisited with yet uncommon focus, i.e., survival and (dis)appearance of subwavelength resonances at the gradual deformation of the resonators at a given lattice period. Microwave frequency range has been chosen to illustrate the concept. The case when the metasurfaces comprise two periodically placed U-shaped resonator arrays is considered. The sizes of the resonators are either varied simultaneously for both front-side and back-side arrays or for the back-side array only. The main purpose of this study is to explore the basic scenarios of resonance evolution in the space of geometrical parameters. It is shown that different resonances may be sensitive to the variations in geometrical parameters and to the dissimilarity between the front-side and back-side arrays to a different extent. The obtained results point to the existence of the bands, resonances, polarization-conversion and related asymmetric transmission regimes that are robust to the deformations. They can serve as the starting point in understanding the functional capability of the physical features while adjusting the size for a much wider variety of the types of subwavelength resonators. Their unveiling promises a wide avenue towards the realization of new frequency-domain and angle-domain filters, ultrathin polarization-plane convertors, asymmetric transmission devices and advanced microwave antennas.

Abstract Sandwich structures have gained considerable attention in engineering due to their lightweight nature and excellent mechanical properties. However, their impact resistance has been a critical limitation. This research addresses this challenge by enhancing the impact resistance of sandwich structures through the integration of fused deposition modeling (FDM) with glass fiber‐reinforced polylactic acid (PLA + GF) composites. Three core geometries trihexagonal, hexagonal, and triangular are 3D printed using FDM technology, while the facing sheets, made of unidirectional Kevlar fiber and an aluminum layer, provide superior impact resistance, energy absorption, and corrosion resistance. The complete sandwich structures are fabricated using a hand layup process and subjected to low‐velocity drop impact tests for evaluation. The study aims to develop lightweight yet high‐strength materials, particularly for bumper applications, by analyzing the mechanical properties of these sandwich structures. Among the tested designs, the trihexagonal core demonstrated the highest peak force, approximately 4000 N at a height of 600 mm and 4500 N at 1100 mm, highlighting its exceptional stiffness and efficient energy dissipation due to uniform impact load distribution. Additionally, the contact time analysis revealed contrasting behaviors: the triangular core reached its peak force the fastest, at 0.514 ms at 600 mm, indicating a brittle and rapid response, while the hexagonal core had the longest contact time of 2.14 ms, showcasing gradual deformation and superior energy absorption. The findings contribute valuable insights for advancing high‐performance materials in various engineering applications, where both strength and lightweight characteristics are crucial. Highlights GF‐reinforced PLA composites were used as a core for sandwich structure. FDM was equipped to print hexagonal, trihexagonal and triangular core. Aluminum facing sheet and Kevlar fiber aids in improving impact resistance. Trihexagonal core shows the optimal balance of recovery under dynamic loading.

In technology, a very common helical surface is a straight closed helicoid, known as a screw. Its formation takes place by the spiral movement of the horizontal segment upwards in such a way that one of its ends crosses a vertical straight line - the axis of the auger. For an open helicoid, the formation of its surface is similar. The difference is that the segment is transient in relation to the axis and is at a constant distance from it. The smaller this distance, the smaller the difference between the surfaces. In both cases, rectilinear generators are perpendicular to the axis. It is known from differential geometry that any helical surface can be bent into a surface of revolution. It is this fact that is taken as the basis for the calculation of a flat blank for the manufacture of an open helicoid coil. Its surface is non-expanded, so the workpiece must be found in such a way as to minimize plastic deformations when forming the surface from a flat workpiece. The article presents parametric equations that describe the continuous bending of the turn of an open helicoid into the compartment of a single-cavity hyperboloid of rotation. Continuous bending can be imagined as a gradual deformation of a helicoid turn by decreasing its pitch. The surface is deformed, remaining helical and ultimately turning into a hyperboloid. Its meridian is the corresponding section of the hyperbola. It is proposed to approximate the section of the hyperboloid by a truncated cone. This approximation will be more accurate in the section of the hyperbola where it asymptotically approaches the line segment. After choosing a cone, its dimensions are determined and its exact sweep is built, since the cone is a sweep surface. The sweep is built in the form of a flat ring with a cut sector and will be a flat blank for forming an open helicoid turn from it. The surface of the turn of an open helicoid can be most accurately obtained by stamping the resulting blank. For low-volume production of the helical surface of an open helicoid, flat rings can be welded together and stretched along the shaft with simultaneous twisting around its axis. The accuracy of the obtained surface will depend on the accuracy of the approximation of the section of the hyperboloid of rotation by a truncated cone.

Geostatistical Facies Simulation based on Training Image Using Generative Networks and Gradual Deformation

As a crucial component of the transportation infrastructure, the health of bridge plays a direct role in the traffic safety. Over time, gradual structural deformation can compromise a bridge's stability and safety. Therefore, accurately predicting bridge deformation is essential for analyzing its causes and detecting potential safety hazards in a timely manner. Satellite-based synthetic aperture radar interferometry (InSAR) technology, which detects deformation at millimeter-scale precision over large areas, offers significant advantages in monitoring bridge deformation. However, most existing time-series deformation prediction methods based on InSAR data primarily focus on land subsidence. Given that bridge is complex, singular structures with unique spatial-temporal characteristics, existing methods designed for land subsidence are not directly applicable to bridge deformation prediction. To address this challenge, we propose a novel K-shape and complete linkage hierarchical cluster long short-term memory (KCC-LSTM) approach for predicting bridge deformation based on time-series InSAR data. The approach initially combines two machine learning based clustering algorithms, K-Shape for better capturing shape features of time series and complete linkage hierarchical clustering combined with spatial geographic location captures the spatial characteristics of time series to derive clusters with unique spatiotemporal deformation behavior, improving clustering accuracy and spatiotemporal correlation. Clustering results generated from this unsupervised machine learning approach are later used as training labels to develop long short-term memory (LSTM) networks. We validate the proposed approach using time-series data from 100 X-band TerraSAR-X images, acquired from 13 April 2010 to 13 December 2019. Our results demonstrate that compared to standard LSTM, the proposed approach reduces root mean square error of Bridge 1 from 3.6 to 0.5 mm and Bridge 2 from 3.6 to 1.3 mm, improving prediction accuracy. The results underscore the effectiveness of the KCC-LSTM model in predicting deformation in complex infrastructure, such as bridge.

The Alagou Reservoir was officially closed for water storage in November 2014. Since September 2016, gradual slope collapse and deformation have been observed at elevations ranging from 600 to 1050 m upstream of the left bank of the Alagou Reservoir dam site. The increasing annual deformation raises significant concerns about a potential landslide, which could lead to surge waves, posing a threat to both the dam and the surrounding environment. Owing to difficult access and worsening conditions, thorough exploration of the site was challenging. Consequently, after emptying the reservoir, we conducted on-site investigations using satellite D-InSAR analysis, numerical modelling and post-event monitoring. This multidisciplinary approach aimed to investigate the relationship between deformation behaviour, triggering conditions and reservoir water-level changes. Our study provides valuable insights into the complex geological processes involved in slope deformation and failure mechanisms induced by water-level fluctuations. We elucidated the interplay between deformation behaviour and triggering conditions, which is essential for designing effective reinforcement treatments for deformed slopes. Although InSAR has proven to be a cost-effective tool for monitoring surface deformation, it offers limited insights alone. Therefore, we recommend a multi-technique approach incorporating geophysical, geotechnical and remote sensing data for a comprehensive understanding of slope stability.

Patients with multiple myeloma (MM) are commonly managed by multidisciplinary oncology teams in concordance with the neurological, oncological, mechanical, and systematic decision framework. Surgery is indicated for mechanical instability and/or neurological deficits. In neurologically intact and mechanically stable patients, chemo- and radiotherapy alone are often the mainstay treatment. A 66-year-old male patient presented with a kyphotic chin-on-chest deformity due to undiagnosed spinal MM. He experienced progressive neck pain and difficulty with activities of daily living (ADLs). Imaging revealed systematic bony element destruction and burst deformities at T1-2 with cervicothoracic central canal stenosis. Due to his disease burden and neurological preservation, spinal alignment was initially achieved via halo traction and immobilization, allowing him to begin systemic therapy almost immediately after diagnosis and improving vertebral bone density and construct integrity prior to surgery. He underwent C2-T10 decompression and instrumented fusion with cement augmentation. At 12 months postoperatively, the patient reported improvement in symptomology and ADLs without radiographic evidence of hardware failure or spinal instability. Spinal MM with instability can be successfully managed with gradual deformity realignment and external orthosis before surgery in a neurologically intact patient with a significant disease burden. https://thejns.org/doi/10.3171/CASE2441.