Correction Of Spinal Deformity Research Articles

Intravenous tranexamic acid and reduction in blood loss and perioperative transfusion requirements in adult spinal deformity: a multicenter propensity-scored observational study.

Intraoperative antifibrinolytic therapy with tranexamic acid (TXA) is a focus of interest for blood loss reduction in multilevel adult spinal deformity (ASD) correction surgery. There is considerable heterogeneity in the reported findings regarding the safety and efficacy of this therapy. In the present study, the authors aimed to rigorously investigate the safety and efficacy of TXA in multilevel ASD correction surgery and to explore secondary perioperative outcomes. This retrospective cohort study used data from the authors' institutional spine deformity database, including records of surgeries performed between January 1, 2013, and December 13, 2021, with a minimum follow-up of 2 years. Adult patients undergoing elective thoracolumbosacral posterior spinal fusion involving 6 or more vertebrae were included. The primary outcome was the safety and efficacy of TXA, with secondary outcomes including postoperative complications and overall outcomes. Propensity-scored stabilized inverse probability of treatment weighting was used to adjust for confounding factors. Subsequent weighted analysis of the treatment effect was performed using regression models for hypothesis testing, with 95% confidence intervals calculated based on weighted means, variances, and standard errors. The p values of primary outcomes and subgroup analyses were adjusted for multiplicity testing with the Benjamini-Hochberg correction at a false discovery rate of 0.05. The conduct and reporting of this study were supported by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The study included 598 patients, with 257 receiving TXA and 341 controls. Weighted analysis revealed that TXA administration was associated with significant reductions in estimated blood loss (p = 0.007), percentage of estimated blood volume lost (p = 0.035), intraoperative total red blood cell transfusion volume (p = 0.035), and postoperative packed red blood cells transfusion volume (p = 0.035). No significant differences were observed in postoperative thromboembolic events (p = 0.397). TXA was significantly associated with reduced blood loss and transfusion requirements in multilevel ASD correction surgery without increasing the risk of thromboembolic complications.

Association between deformity angular distance ratio and neurological risk in patients undergoing three-column osteotomy.

Postoperative neurological deficits are a significant concern for surgeons during spinal deformity correction surgery. Preoperative identification of high-risk patients can help ensure that appropriate measures are taken to minimize the risk of neurological deficits during these procedures. Previous studies have shown that patients with large Cobb angles or deformity angular ratios (DARs) are at higher risk for postoperative neurological deficits. However, some curves with similar Cobb angles and DARs may exhibit significantly different risks of neurological deficits during surgery. Existing methods for evaluating the degree of deformity cannot fully or accurately reflect the degree of spinal deformity. The aim of this study was to determine whether the deformity angular distance ratio (DADR) can reliably assess the neurological risks of patients undergoing three-column osteotomy (3CO). A consecutive series of 266 patients with a deformity apex at T1-L1 who underwent 3CO at a single academic center from December 2010 to January 2024 were included in the study. Preoperative radiograph measurements were used to calculate DAR and DADR. Binary logistic regression was used to model the relationship between DADR and postoperative neurological deficits. Receiver operating characteristic analysis and the area under the curve (AUC) were used to assess the performance of the model. The 266 patients had a median (IQR) age of 48.0 (30.0-60.0) years, with 128 (48.1%) females and 138 (51.9%) males. The incidence of postoperative neurological deficits was 11.3% in this series of patients. Among patients undergoing 3CO, sagittal DADR (OR 1.086, 95% CI 1.045-1.129; p < 0.001) and total DADR (OR 1.080, 95% CI 1.046-1.116; p < 0.001) were associated with an increased incidence of postoperative neurological deficits. A total DADR > 30.4 or a sagittal DADR > 26.4 were associated with a 30% incidence of postoperative neurological deficits, which increased to 50% when the total DADR reached 41.4 or the sagittal DADR exceeded 36.6. The overall predictive performances of sagittal DADR (AUC 0.781) and total DADR (AUC 0.799) for postoperative neurological deficits were comparable and considered to be good. In patients undergoing 3CO for severe spinal deformities, the DADR can be used to quantify the severity of the deformity, which is strongly correlated with the risk of postoperative neurological deficits. Patients with a total DADR > 30.4 or a sagittal DADR > 26.4 are at much higher risk for developing new neurological deficits after surgery.

Respiratory and Postoperative Outcomes in Early-onset Scoliosis Patients Treated With Vertical Expandable Prosthetic Titanium Rib: Single-center Experience of 20 Years.

This study examines the long-term effectiveness and safety of the vertical expandable prosthetic titanium rib (VEPTR) device, developed in 1989 to treat early-onset scoliosis (EOS) and thoracic insufficiency syndrome (TIS). Specifically, it assesses VEPTR outcomes over 20 years in a single center, focusing on spine deformity correction, pulmonary function, weight percentile changes, and complication rates. A retrospective analysis was conducted on 36 patients from the EOS clinic who underwent VEPTR implantation without prior spine surgery, with at least 2 years of follow-up. Data collected included age, sex, weight, height, BMI, weight percentiles, comorbidities, radiographic parameters, pulmonary function tests, and complications. Weight percentile (WP) was calculated as preoperative WP and last follow-up WP. Coronal and sagittal deformities were measured preoperatively, immediately postimplantation, and at the last follow-up. Pulmonary function tests included forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) and were correlated with weight percentile changes. Complications were classified using established criteria. The mean age at VEPTR implantation was 86±34 months, with most cases attributed to neuromuscular scoliosis (56%). The initial coronal Cobb angle improved from 59±18 to 32±14 degrees postimplantation but increased to 60±25 at the final follow-up. Sagittal angles showed similar trends. Pulmonary function tests indicated a decline in FVC and FEV1 over time. There was no correlation between weight percentile changes and pulmonary function changes. Complication rates were high, affecting 63% of patients, which included hardware prominence, device migration, and infections as the most common. Although VEPTR devices initially corrected spinal deformities, their long-term benefits are limited as the correction becomes less pronounced over time. Expected improvement in pulmonary function is not observed. A different approach to treating EOS and TIS is necessary, as the significant complication rates challenge the implants' effectiveness. Level III.

Use of Preoperative Spinal Angiography in Severe Spinal Deformity Patients Who Require Thoracic 3 Column Osteotomy: A Case Series and Review of the Literature.

Three-column osteotomy (3CO) offers substantial spinal deformity correction. Thoracic neurovascular bundle sacrifice is often required, and anterior spinal artery (ASA) perfusion can be compromised. Spinal angiography allows localization of variable ASA vascular contribution. This study's objective was to describe a series of patients who underwent preoperative spinal angiography and discuss the impact on surgical planning and execution of thoracic 3CO for deformity correction. Patients who underwent preoperative spinal angiograms and thoracic 3CO for deformity correction were reviewed. Preoperative, angiographic, and postoperative information was recorded. A literature review on preoperative spinal angiography in deformity surgery was performed. Eight patients were identified: single-level pedicle subtraction osteotomies (1), single-level vertebral column resections (2), and multilevel vertebral column resections (5). The average age was 40.0 years, and 75.0% were female. Thoracic scoliosis ranged from 0 to 105° preoperatively and 0 to 45.1° postoperatively. Thoracic kyphosis ranged from 29° to 120° preoperatively and 20.6° to 54.9° postoperatively. Twelve ASA supply vessels were identified bilaterally in 6 patients. Four patients had nontraditional ASA supply at T4 (1), T6 (1), and L2 (2), and 4 had multiple ASA feeders. Based on angiographic results, osteotomy site was changed (1), and neurovascular bundles were spared (2), a 37.5% rate of surgical plan alteration. There were no permanent neuromonitoring changes or postoperative neurologic deficits. No articles reported on using spinal angiography specifically for deformity surgery. Spinal angiography is low risk and provides critical information regarding ASA supply to potentially mitigate ischemic risk during neurovascular bundle takedown during thoracic 3CO. Further case series are warranted to evaluate the benefits in larger populations, but its clinical applications appear practical.

Biomechanical Principles of Spinal Deformity Correction in the Thoracolumbar Spine.

Thoracolumbar spinal deformities are a pervasive condition affecting the adolescent and adult patient population. These deformities represent three-dimensional alterations in the coronal, sagittal, and transverse planes with implication on the local, regional, and global alignment. With continued studies, the importance of the overall correction on long-term outcomes has been established. Surgical techniques for correcting deformities aim to restore coronal and sagittal alignment of the spine, as well as manage the rotational components in the transverse plane. Through a proper understanding of spinal biomechanics and spinal instrumentation, we can gain better understanding of how to harness the biomechanical properties of the spinal anatomy through the application of deformity correction techniques to optimize the three-dimensional correction of spinal deformities.

Long-term Postural Stability Changes After Correction of Spinal Deformity: A prospective, controlled pilot study.

Prospective cohort study. This study aimed to investigate the durability of postural stability after ASD correction surgery and its' association with clinical outcomes. The prevalence of symptomatic adult spinal deformity (ASD) necessitates surgical intervention, aiming to correct global spinal balance and spinopelvic parameters. Short-term studies have shown improvements in postural control following surgery, but the long-term impact remains unclear. This single-center prospective cohort study included adult patients undergoing long-segment fusion surgery between November 2019 and July 2021. Preoperative and postoperative balance assessments, radiographic analyses, and patient-reported outcome measures (PROMs) were conducted. Statistical analyses evaluated changes in postural stability and clinical outcomes. Fifteen ASD patients were analyzed. Significant improvements were observed in the early postoperative period in coronal center of pressure (COP) sway (P=0.048) and amplitude (P=0.027), total COP sway (P=0.042), coronal center of gravity (COG) amplitude (P=0.013), total COG sway (P=0.044), and head sway in the coronal plane (P=0.025). These improvements were maintained at the final postoperative visit for all measurements except coronal COG amplitude (early vs. last postoperative visit, P=0.040). Radiographic parameters, including pelvic incidence - lumbar lordosis mismatch (P=0.041) and sagittal vertical axis (P=0.032), also significantly improved postoperatively. PROMs revealed significant enhancements in VAS back pain (P=0.045), RAND SF-36 pain (P=0.016), RAND SF-36 physical functioning (P=0.008), and PROMIS pain interference (P=0.032) scores at the last follow-up. These results demonstrate that the postural stability improvements seen after ASD correction are durable and correlate with enhanced clinical outcomes, such as reduced back pain and improved physical functioning. These findings underscore the clinical importance of achieving sagittal alignment in ASD patients. Further research with larger cohorts and extended follow-up periods is warranted to confirm these associations and establish postural stability assessment as a vital parameter in evaluating patients' quality of life postoperatively. Level 3.

The impact of lower thoracic versus upper lumbar upper instrumented vertebra in minimally invasive correction of adult spinal deformity.

The goal of this study was to compare the impact of using a lower thoracic (LT) versus upper lumbar (UL) level as the upper instrumented vertebra (UIV) on clinical and radiographic outcomes following minimally invasive surgery for adult spinal deformity. A multicenter retrospective study design was used. Inclusion criteria were age ≥ 18 years, and one of the following: coronal Cobb angle > 20°, sagittal vertical axis > 50 mm, pelvic tilt > 20°, pelvic incidence-lumbar lordosis mismatch > 10°. Patients were treated with circumferential or hybrid minimally invasive techniques at ≥ 3 spinal levels and had a 2-year minimum follow-up. They were then divided into 2 groups depending on whether the UIV was in the UL region, defined as a UIV location of L1-2, or the LT region, defined as T10-12. A total of 114 of 223 patients met the inclusion criteria (68 LT and 46 UL). The UL group was older (67.5 vs 62.3 years; p = 0.015). Preoperative spinopelvic parameters were similar, except for sacral slope, which was higher in the UL group (30.5° vs 26.5°; p < 0.001). The percentage of patients with fixation crossing the lumbosacral junction was also similar (70.6% vs 67.4%; p = 0.717). Postoperative lumbar lordosis (42.5° vs 35.5°; p = 0.01) and change in coronal Cobb angle (-23.2° vs -9.6°; p < 0.001) were greater in the LT group, but other changes in postoperative spinopelvic parameters and changes in health-related quality-of-life scores were similar between groups. Reoperation rates were lower in the UL group (17.4% vs 36.8%; p = 0.025), largely associated with fewer radiographic failures (UL = 10.9% vs LT = 26.5%; p = 0.042); however, overall complication rates were not significantly different (UL = 43.5% vs LT = 60.3%; p = 0.077). Selecting a UL vertebra for UIV in minimally invasive surgical correction of adult spinal deformity results in lower reoperation rates compared to extending fixation to the LT region. This choice also correlates with shorter operating room times and reduced estimated blood loss. Although extending fixation to the LT region is associated with slightly greater lumbar lordosis and a greater change in the coronal Cobb angle, clinical outcomes were similar between the LT and UL groups for UIV.

Segmental Interbody, Muscle-Preserving, Ligamentotaxis-Enabled Reduction: "SIMPLER" Technique for cMIS Correction of ASD.

Correction of adult spinal deformity (ASD) through minimally invasive techniques is a challenging endeavor and has typically been reserved for experienced surgeons. This publication aims to be the first high-resolution technique guide to demonstrate a reproducible technique for ASD correction utilizing circumferential minimally invasive surgery (cMIS) without an osteotomy. The Segmental Interbody, Muscle-Preserving, Ligamentotaxis-Enabled Reduction (SIMPLER) technique is a novel ligamentotaxis-based scoliosis surgery that represents a paradigm shift from traditional osteotomies toward patient-specific correction. The senior author's (N.A.) cMIS technique for ASD correction without an osteotomy is described using high-resolution photographs, computer-generated imagery (CGI), and a case example. Step-by-step intraoperative photographs document a novel muscle-preserving posterior spinal exposure, spinal robotic safety protocol for instrumentation, dedicated deformity instrumentation system, rod reduction sequence, and minimally invasive fusion technique. CGI assists to reinforce technical considerations described by intraoperative photographs. The SIMPLER technique is documented from incision to closure with high-resolution pictures including CGI to highlight concepts documented in photographs. Technical considerations were detailed for all aspects involved in the planning and execution of an osteotomy-free deformity correction. This represents the first in-depth technical description of ligamentotaxis-based, osteotomy-free, ASD scoliosis correction. The SIMPLER approach is reproducible and minimally invasive and can be done routinely for appropriately selected deformity candidates. This technique serves as a foundation to externally validate previously described cMIS ASD deformity correction outcomes. Circumferential minimally invasive spinal deformity correction is reproducible and can be achieved reliably through the use of the SIMPLER technique, without the use of an osteotomy.

Patient-Specific Rods vs Traditional Rods in Surgical Correction of Adult Spinal Deformities: A Case-Matched Study.

Patient specific pre-contoured rods (PSRs) represent a relatively new technological development aimed at improving surgical outcomes and reducing complications in adult spinal deformity surgery. To date, only a limited number of studies have been published comparing PSRs with traditional spinal rods. In this paper, we compare the surgical, imaging, and clinical outcomes of PSRs and traditional spinal rods in a single-center case-matched study. Thirty cases of adult spinal deformities (ASD) were retrospectively analysed. These included 10 patients who were operated on using UNiD™ (Adaptive Spine Intelligence, MedTronic, Minneapolis, MN, USA) PSRs and 20 operated on using traditional rods from January 2023 to August 2023. Minimum post-surgical follow-up was 6 months. General demographics and standard radiographic parameters, as well as Scoliosis Research Society (SRS)-22, Oswestry Disability Index (ODI) and Short Form Health Survey (SF-12) Scores, were measured at pre-operative examination and at 6-month follow-up. Follow-up imaging data were compared with software-planned correction goals. Intra-operative data and complications were also recorded. Patients in the two groups were matched in terms of age, body mass index (BMI), sex, type and severity of spinal deformity. The magnitude of the coronal deformity (p = 0.812) and preoperative sagittal imbalance (p = 0.845) were similar between the two groups. The number of fused levels (p = 0.439), osteotomies (p = 0.188), implant density (p = 0.880), and surgery duration (p = 0.299) were similar between the two groups. Sagittal correction goals set during preoperative planning were achieved in the PSRs group, with the exception of pelvic tilt (PT) (p = 0.042). In contrast, PT (p = 0.040), L1-S1 lordosis (p = 0.032) and global tilt (GT) (p = 0.001) remained significantly undercorrected in the control group at 6-month follow-up. Clinical outcomes (ODI and SF-12 Scores) and complication rates were similar between the two groups. The use of PSRs improves the achievement of better post-operative spinopelvic alignment in adult spinal deformity surgery. Moreover, no significant differences were noted in terms of complications, operative times, and clinical outcomes compared to traditional spinal rods at 6-month follow-up.

Efficacy and Risks of Posterior Vertebral Column Resection in the Treatment of Severe Pediatric Spinal Deformities: A Case Series.

Background/Objectives: Surgery for adolescent idiopathic deformities is often aimed at improving aesthetic appearance, striving for the best possible correction. However, severe and rigid scoliotic curves not only present aesthetic issues but can also compromise cardiopulmonary health and cause early neurological impairment due to spinal cord compression, posing significant risks of morbidity and mortality if untreated. Conservative treatments are ineffective for severe curves, defined by scoliotic angles over 70° and flexibility below 30% on lateral bending X-rays. Treatment often requires invasive interventions, such as osteotomies and vertebral resections. In particular, posterior vertebral column resection (PVCR) has shown effectiveness in realigning vertebral structures in complex cases. This study describes the efficacy and risks of PVCR through a series of cases treated at our institution. Methods: This case series was conducted at the Rizzoli Orthopedic Institute in Bologna, involving eight pediatric patients with severe, rigid spinal deformities, operated upon between 2018 and 2023. The underlying pathologies included idiopathic kyphoscoliosis, neurofibromatosis type 1, Pott's disease, and other congenital anomalies. Preoperative assessment included standard radiographs, magnetic resonance imaging, and computed tomography. During PVCR, motor and sensory evoked potentials were monitored to minimize neurological injury risk. Postoperative management included blood transfusions, antibiotic support, and early physiotherapy. Results: PVCR resulted in an average reduction in the Cobb angle from 86.3° preoperatively to 22.4° postoperatively, with a mean correction of 64%. The mean duration of the procedures was 337.4 min. Three patients had an uneventful postoperative course, while five developed complications, including infections and temporary neurological deficits, which were successfully managed. One patient developed an epidural hemorrhage that required emergency surgery for hematoma evacuation, with partial recovery. This study demonstrates the potential of PVCR for correcting rigid spinal deformities, highlighting the importance of postoperative management to minimize the associated risks. Conclusions: Posterior vertebral resection techniques offer significant promise in the correction of pediatric spinal deformities. Although ours is a small case series, it can provide important data for such treatment. Long-term monitoring is needed to fully understand the impact of these procedures and to further refine surgical techniques.

Radiographic Severity of Knee Osteoarthritis in Adult Spinal Deformity: the Effect on Rod Fracture after Long Spinal Fusion in Deformity Correction.

Instrumentation failure, notably rod fracture (RF), may occur even after ideal spinal deformity correction in adult spinal deformity (ASD). As RF is the major reason behind a revision surgery, various risk factors of RF are reported in literature, including pedicle subtraction osteotomy (PSO) technique itself. However, whether hip and knee joint diseases serve as another risk factor for RF remains unexplored. To investigate the effects of lower-extremity joint diseases on RF in ASD patients who underwent deformity correction through long-segment fixation with PSO. Retrospective study PATIENT SAMPLE: 96 consecutive ASD patients (mean age, 71.2 years) who underwent deformity correction through PSO and long-segment fixation from T10 to S1 between 2008 and 2019 were included. Those with radiographic data less than 2 years were excluded. RF was confirmed on radiograph, computed tomography (CT) and bone scan or SPECT images. Coronal and sagittal spinopelvic parameters, lower-extremity osteoarthritis (OA) parameters and clinical outcomes (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS]) were analyzed. Radiographic measurements were performed at preoperative, postoperative, and last follow-up visits. Patients were divided into two groups: non-RF (n = 60) and RF (n = 36). Radiographic factors were assessed, correlations between parameters were examined, and multivariate logistic regression analysis was performed to evaluate risk factors for RF. Structural and functional leg length discrepancies (LLDs), pelvic obliquity (PO), and the differences of mechanical axis (MAD) between both extremities had significantly differed between the groups (P < 0.05). The between-knee differences in the extent of OA, clinically significant MAD and PO, and the incidences of both structural and functional LLD were significantly greater in the RF group than in the non-RF group (P<0.05). On correlation analysis, PO was not correlated with coronal radiographic parameters but was correlated with structural and functional LLDs and MAD (P<0.05). Logistic analysis revealed that the difference in OA grade between the knee joints, functional LLD, and preoperative lower extremity surgery were significantly associated with RF (P<0.05). ASD in the elderly often presents alongside degenerative changes in the lower-extremities, and even with ideal spinal deformity correction, RF may still occur if pre-existing joint pathologies are not resolved. In the deformity correction of ASD, it is essential that we not only pursue the restoration of spinopelvic harmony, but also apply perioperative measures for lower-extremity degenerative joint diseases.

Anterior Vertebral Body Tethering (AVBT) in the Treatment of Adolescent Idiopathic Scoliosis: A Retrospective Study.

Background/Objectives: Anterior Vertebral Body Tethering (AVBT) is a relatively novel minimally invasive surgical technique for the treatment of adolescent idiopathic scoliosis (AIS) that enables deformity correction of the spine diminishing vertebral motion reduction caused by the standard posterior spinal fusion approach. This paper reports the introduction of a new technical variant of AVBT, with the aim of evaluating its effectiveness on the correction of both axial and coronal spinal deformity. Methods: A single-centre single-surgeon retrospective cohort study was conducted. AVBTs were performed between 2020 and 2024. Radiographical values, surgical details, and complications of 67 patients affected by AIS were compared before surgery, immediately after surgery, and at the most recent follow-up. Results: Postoperative results have revealed a statistically significant coronal curve correction of 29.85% in the main thoracic (MT) curves (from mean preoperative width of 54.81 ± 11.86° to 38.45 ± 10.19°) and of 26.93% in the thoracolumbar (TL/L) curves (from 35.15 ± 11.83° to 25.69 ± 10.50°) in line with that obtained by the standard technique. Coronal correction at the most recent follow-up was maintained. Postoperative axial rotation reduction was found to be statistically significant in the main thoracic (MT) curves (from mean Nash-Moe value of 1.84 ± 0.71 to 1.36 ± 0.73), with a further decrease at the most recent follow-up compared with preoperative values. Improvement in other radiographical measures did not reach statistical significance and the complication rate was comparable to the standard technique. Conclusions: The extent of coronal correction in patients treated with the proposed modified AVBT technique is satisfactory and in line with results from studies testing the standard AVBT technique. The findings of this study seem to suggest that this technical variant of AVBT is effective in the correction of both axial and coronal deformity, with a surgical complication rate comparable to the standard technique.

Can Intra-Operative Cell Salvage Reduce the Rate of Allogeneic Transfusion in Pediatric Spinal Deformity Surgery?

Retrospective cohort study. The objective of this study was to characterize the association between cell-salvage and allogeneic transfusion rate in pediatric patients undergoing posterior arthrodesis for scoliosis. NSQIP Pediatric database years 2016-2022 was used. Patients under the age of 18 who received posterior arthrodesis with 7 or more surgical levels for spinal deformity correction were included. Rates of cell-salvage and allogeneic transfusion were determined. We assessed the impact of cell-salvage on the rate of allogeneic transfusion using chi-square test and multivariable logistic regression. There were 34,241 patients in this study. The rate of allogeneic transfusion was 21.6% (n = 7407). The allogeneic transfusion rates for idiopathic, neuromuscular, and congenital/syndromic scoliosis were 12.3%, 50.8%, and 25.9%, respectively. Cell-salvage was used in 71.1% of patients (n = 24,344). In the multivariable regression analysis, longer operative time (P < .001), non-idiopathic scoliosis (P < .001), hematocrit less than 35 (P < .001), and ≥13 surgical levels (P < .001) were associated with higher odds of allogeneic transfusion. Use of cell-salvage (P < .001), increasing age (P < .001), and increasing patient weight (P < .001) were associated with significantly lower odds of allogeneic transfusion. In a subanalysis, use of cell-salvage was associated with reduced rate of allogeneic transfusion in patients with idiopathic scoliosis. Cell-salvage was not associated with reduced rates of allogeneic transfusion in neuromuscular and congenital/syndromic scoliosis. This is the largest study investigating the impact of cell-salvage on rate of allogeneic transfusion in pediatric spinal deformity surgery. Use of cell-salvage is associated with reduced allogeneic transfusion rates in idiopathic scoliosis surgery.

Defining a Critical Partition Zone for Sagittal Alignment in Lumbar Spine Fusion Surgery: A Systematic Review.

Sagittal alignment in the lumbar spine is essential for spinal stability and functionality, with significant implications in surgical planning for spinal deformity correction. However, standardized lumbar partitioning, particularly identifying a critical sagittal alignment zone, remains underdefined. This study aims to establish a reliable lumbar partition to guide surgical decisions and optimize clinical outcomes. A systematic review of four major biomedical databases yielded 32 studies, of which 4 met the inclusion criteria. Studies on asymptomatic adults with segmental lordosis data stratified by pelvic incidence were analyzed. Lumbar lordosis values were converted to percentages, allowing for cross-study comparison. Sensitivity analysis and bias assessment were performed to ensure methodological rigor. The findings identified the L3-L5 interval, especially around the L4 vertebra, as a critical biomechanical zone across various populations and pelvic incidence groups. Individuals with higher pelvic incidence had concentrated lordosis in lower segments, while those with lower pelvic incidence had greater lordosis in upper segments, underscoring the L3-L5 region's stability as a surgical reference. The L3-L5 interval serves as a key partition zone for sagittal alignment, providing a stable reference for lumbar spine fusion. These findings offer a foundational clinical reference, potentially improving alignment outcomes and reducing postoperative complications.

Recent Developments in Surgical Treatment of Spinal Deformity in Pediatric Patients: Experience from a Single-Center Series of 42 Neurofibromatosis Type 1 Patients.

The management of spinal deformities in patients with NF-1 is challenging. The study aimed to assess the outcomes of the surgical treatment of spine deformities in children with neurofibromatosis type 1 with our treatment approach. A retrospective single-center study on pediatric patients with spinal deformities associated with NF-1 who received surgical treatment between 2006 and 2024. The study group comprised 42 patients with a mean age at surgery of 9.8 years. Twenty-five patients (60%) were treated by means of growth-preserving techniques and 17 patients (40%) by means of definitive fusion. Preoperative halo-gravity traction was used in 14 (33%) cases. In the group treated with a growth-preserving technique, a 54.1% mean curve correction was observed at the latest follow-up, and growth of the thoracic spine was maintained at a physiological rate; however, 25 unplanned revision surgeries (mostly due to mechanical complications) were necessary. In the group treated by definitive fusion, a 66% curve correction was achieved at initial surgery, which remained unchanged at latest follow-up, and revision surgery was performed in three cases for augmentation of the fusion mass. There was one neurological complication (2%). Another patient developed a deep wound infection (2%). Good and sustainable surgical correction of spinal deformities can be achieved in pediatric patients with NF-1. Due to the bony dystrophic changes, surgical treatment is challenging and the complication rate is higher than in spinal deformities of other etiologies.

Change in standing acetabular orientation 2 years postoperatively after surgical correction of adult spinal deformity.

Although sagittal alignment is known to influence pelvic position, few studies accurately identify the relationship between sagittal alignment and acetabular orientation. We hypothesized that postoperative PT should be correlated with acetabular change in native hips after surgical correction of adult spinal deformity. The objective of this study was therefore to describe the correlation between the change in pelvic tilt and the change in acetabular orientation two years after surgical correction of adult spinal deformity. Based on a retrospective study of a prospective mono center database, 127 acetabuli out of sixty-nine patients were analyzed preoperatively and at two years postoperatively of surgical management of sagittal imbalance by posterior arthrodesis extended to the pelvis. The analysis was based on bi-planar EOS radiographs with 3D reconstructions of the pelvis and spine using SterEOS 3D software. The following specific parameters were analyzed: sacral slope, pelvic tilt, lumbar lordosis, SVA, acetabulum tilt (AT), anteversion (AA) (orientation of the acetabulum in the axial plane), abduction (AAbd) (orientation of the acetabulum in the frontal plane), inclination (AI) (orientation of the acetabulum in the sagittal plane), and anterior acetabulum coverage (ACA). A Pearson correlation was performed between the pre-and postoperative change in acetabular parameters (right and left) and pelvic parameters. Linear regressions were performed to identify the most relevant pelvic and spinal parameters. A subgroup analysis was performed to identify a difference between distal sacral and distal ilium fixations. All measured acetabular parameters were significantly different two years after surgery. Changes in AT (p = 0.03), AI (p = 0.03) and ACA (p = 0.05) were significantly greater in the ilium fixation group. Postoperative PT reduction was strongly correlated with the decrease of AT and AA ( = 0.61 and = 0.57, p < 0.001), it was also correlated with the increase of AI and ACA and the decrease of AAbd. The entire cohort linear regression analysis revealed that a 1 ° decrease in PT resulted in a 0.4 ° decrease in AA and a 0.6 ° decrease in AT (R2 = 0.45 and = 0.38). Our study highlights the significant influence of the change in sagittal alignment on acetabular orientation in standing position. This correlation explains the increased risk of anterior hip impingement, the change in acetabular load distribution that might lead to early hip osteoarthritis, and the overall change in the subjects' gait pattern. IV.

Surgical treatment of scoliosis in patients with osteogenesis imperfecta: a single institution case series.

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by skeletal deformities, bone fragility, and spinal complications. Various studies' insights underscored the impact of scoliosis on pulmonary function, positive outcomes with spinal fusion, and improved functional abilities post-surgery. However, partial loss of correction remains inevitable. This study examines six surgically treated OI patients with scoliosis. Surgical intervention using a posterior approach with pedicle screws and hooks aimed to correct spinal deformities. Preoperative, postoperative, and follow-up radiological assessments were conducted, revealing significant reductions in scoliotic angles post-surgery. Complications included infections and proximal junctional kyphosis requiring revision surgeries. Despite the challenges posed by poor bone quality and implant stability, no implant failures occurred in this series. Ponte osteotomies at the apex of deformity aided in corrective maneuvers. Surgical treatment of scoliosis in patients affected by OI is challenging and may be associated with perioperative and postoperative complications. Ponte osteotomy may improve the correction and reduce necessary force at the time of correction.

The association between locomotive function and incidence of proximal junctional kyphosis following adult spine deformity surgery

Background and objectivesThis retrospective review study aimed to determine whether functional mobility test (FMT) results are related to the incidence of proximal junctional kyphosis (PJK) after surgical correction of adult spinal deformity (ASD).MethodsA total of 157 patients who underwent reconstructive spinal surgery for ASD between July 2019 and December 2021 were included in this study. Three types of FMTs were performed preoperatively: timed-up-and-go (TUG) test, five times sit-to-stand (STS) test, and alternate step (AS) test. The primary outcome measure was the occurrence of PJK at 1 year after surgery. Oswestry disability index (ODI) and EuroQOL-5-dimension (EQ-5D) scores were surveyed as patient-reported outcome measures of the surgery.ResultsThe occurrence of PJK was observed in 41 of the 157 patients (26.1%) at 1 year after surgery. Among the three functional mobility tests, STS test results were significantly higher in the patients who developed PJK. The receiver operating characteristics curve drawn with the STS test had an area under the curve of 0.69 and the optimal cutoff value was suggested as 22 seconds. Multivariate logistic regression analysis identified the STS test along with age and preoperative ODI score as the significant predictors of PJK (p = 0.026, 0.005 and 0.001, respectively).ConclusionsA longer test time on the STS test result was associated with a higher occurrence of postoperative PJK. A cutoff value of 22 s can be suggested. Preoperative surveillance of these patients and providing additional efforts and surgical procedures for the prevention of PJK are anticipated to improve the surgical outcome of ASD correction.

Electrical stimulation methods for scoliosis in children: a literature review

Introduction. Scoliosis is one of the most common orthopedic diseases of childhood and adolescence, leading to disability and reducing the child’s quality of life. The prevalence of scoliosis in the structure of pediatric orthopedic pathology reaches 30 %. In 50 % of cases, the disease is characterized by a severe progressive course, especially during puberty. Aim. Studying the effectiveness of electrical stimulation methods for scoliosis in children to develop recommendations for their practical use based on the analysis of systematic reviews and randomized controlled trials. Materials and methods. The search was carried out using the database of evidence-based physiotherapy PubMed, Cyberleninka and eLIBRARY using the keywords: «electrical stimulation», «pulse currents», «scoliosis», «children» for the period from 2008–2024.Exclusion criteria: articles published on this topic before 2008. Main content. The main methods of physiotherapy used in the treatment of scoliosis in children are electrotherapy methods, among which electrical stimulation plays a leading role. The advantage of electrical stimulation for scoliosis in children is to provide training in the strength and tone of the back muscles on the side of the deformity. Electrical stimulation is indicated for scoliosis of I and II degrees. The greatest effect in the correction of scoliotic spinal deformity in children is observed with the combined use of electrical stimulation and exercise therapy. This review provides data on the relevance of medical rehabilitation of scoliosis in children, the mechanism of action of electrical stimulation, data on the effectiveness of using electrical stimulation methods for scoliosis in children: sinusoidal modulated currents, diadynamic therapy, transcutaneous electrical neurostimulation, interference therapy, fluctuarization and functional programmable electrical stimulation. Conclusion. Currently, a wide range of electrical stimulation technologies has been developed for the medical rehabilitation of children with scoliosis, among which sinusoidally modulated currents and diadynamic currents are most often used. Transcutaneous electrical neurostimulation, having a predominantly antinociceptive effect, also has an effect on muscle contractions. Functional programmable electrical stimulation of muscles is a promising technology for medical rehabilitation of children with scoliosis, requiring further study and scientific justification.

Reposterior individualized three-column osteotomy for tuberculous spinal angular kyphosis deformity

To investigate the efficacy of posterior three-columns osteotomy in the treatment of severe tuberculous angular kyphosis. Total of 33 patients with severe tuberculous angular kyphosis were treated with posterior three-columns osteotomy from January 2006 to January 2019 including 24 males and 9 females with an average age of (40.6±23.3) years old ranging from 15 to 62 years old and an average disease duration of (23.5±15.5) years ranging from 4 to 40 years. The Cobb's angle of kyphosis was (118.65±28.82)°. Interradicular bone-disc-bone osteotomy(BDBO), posterior-only vertebral column resection (PVCR) and posterior multilevel vertebral osteotomy (PMVO) were performed to correct spinal deformity individually. The visual analogue scale (VAS), Oswestry disability index (ODI), sagittal vertical axis (SVA), ASIA spinal cord functional classification and motor function score, and deformity correction rate were measured and statistically analyzed before, after and at the final follow-up. Total of 33 patients were followed up from 15 to 96 months with an average of (38.00±6.38) months. The last follow-up of kyphosis Cobb angle (23.88±5.45)° showed no significant loss from postoperative 12 months (20.40±9.13)°, P>0.05. The SVA, VAS, ODI and ASIA spinal cord functional classification and motor function score were significantly improved at 1 year and last follow-up after operation(P<0.01). The fusion time of the osteotomy site was (18.50±5.16) months. The ASIA classification of 15 patients with spinal cord injury were improved by at least 2 grades after operation, and their daily life and work ability were various levels of restored. Postoperative complications of spinal cord injury occurred in 3 cases. Posterior three-columns osteotomy is the most effective method for the treatment of angular kyphosis of spinal tuberculosis.Careful preoperative design and individualized osteotomy can not only correct the deformity, but also a successful decompression to the spinal cord and promote the recovery of spinal cord function.