Adult spinal deformity (ASD) is a heterogeneous, three-dimensional condition. In coronal malalignment, the lumbosacral fractional curve has been recognized as an essential driver of both pathology and cosmetic deformity. While various factors have been identified in association with postoperative complications, it remains unclear whether the magnitude of the fractional curve is an independent predictor of the risk of mechanical failure. The two objectives of this study were (1) to determine whether the magnitude of the fractional curve independently predicts mechanical failure, and (2) to determine whether the magnitude of the fractional curve influences lower lumbar lordosis correction. We conducted a single-center retrospective study of patients who underwent ASD surgery between 2016 and 2025 (mean follow-up: 21.0 ± 12.5 months). The primary outcomes were radiographic parameters, mechanical complications, and patient-reported outcome measures. Bone mineral density and preoperative comorbidity burden were also assessed as potential predictors of surgical outcomes. Of the 210 patients who underwent ASD correction surgery, the mean age was 66.9 ± 8.9 years, 140 (66.7
To describe registry-observed trends in preoperative halo gravity traction (HGT) utilization across a multicenter pediatric spine database. This retrospective study used the Pediatric Spine Study Group (PSSG) registry to identify patients treated with preoperative HGT between 2009 and 2024. Patients with cervical pathology or intraoperative-only traction were excluded. Variables included demographics, diagnosis, age at HGT initiation, pre-halo coronal curvature, and sagittal kyphosis. Utilization trends were assessed using binomial logistic regression; coronal curve severity trends were evaluated using linear regression; and etiologic composition was assessed using one-vs-rest binomial logistic regression. The cohort had a mean age of 7.5 ± 3.6 years at HGT initiation, with 56.1
To determine whether changes in intraoperative neuromonitoring with saphenous nerve somatosensory evoked potential (SSEP) stimulation, preoperative assessment of lumbar plexus location, and screw placement, are associated with thigh paresthesia development following an anterior-to-the-psoas (ATP) approach for vertebral body tethering (VBT) in adolescent idiopathic scoliosis (AIS) patients. 39 patients who underwent a thoracoabdominal ATP approach for VBT with a minimum 2-year follow-up were included. Neurologic monitoring variables, including saphenous nerve SSEPs and quadriceps motor evoked potentials (MEPs), psoas location, an indicator of lumbar plexus location, and screw placement were compared between patients with and without postoperative thigh paresthesia. Demographics and outcomes were analyzed using the Mann–Whitney U test and Fisher’s exact test as appropriate, with statistical significance set at p < 0.05. 41
AIS is a 3D deformity characterized by vertebral body rotation, often quantified by the angle of trunk rotation (ATR). However, there is not necessarily a linear relationship between ATR and Cobb angle. We aimed to examine demographic factors that affect this association. Initially, univariate and multiple linear regression compared ATR and Cobb angle in 4329 AIS patients. Given marked differences between Black patients and other racial groups in the thoracic region, we repeated our analysis after dichotomizing patients. Males and females were also compared in the thoracic and lumbar regions. For BMI and age, we repeated these analyses, including BMI and age as interaction terms in each regression. A sample of 4329 AIS patients had mean age 12.7 ± 2.3 years (1–21 years) for patients with available data. Mean age at the time of Cobb angle and ATR measurements was 15.0 ± 2.2 years (9.6–26.5 years) for 4326 patients with available data for date of birth and visit date. Among 4262 patients with available thoracic scoliometer measurements of 35 degrees or less, the mean thoracic Cobb angle was 54.0 ± 15.0 degrees (0–127 degrees), and the mean thoracic rib hump angle was 13.8 ± 5.8 degrees (0–33 degrees). Among 4054 patients with available lumbar scoliometer measurements of 35 degrees or less, the mean lumbar Cobb angle was 40.9 ± 13.8 degrees (4–110 degrees) and the mean lumbar rib hump angle was 8.3 ± 5.7 degrees (0–30 degrees). The mean BMI was 21.5 ± 4.4 (10.6–39.8) for 3890 patients with available data. After dichotomizing patients, black patients’ slope was 0.3 and 0.2 less than other groups when using univariate (p = 0.01) and multiple linear regression (p = 0.04), respectively. Females demonstrated a significantly greater slope than males in the thoracic region and significantly lesser slope in the lumbar region when using both univariate and multiple linear regression. With each point increase in BMI, thoracic slope decreased by 0.03 for both univariate (p = 0.001) and multiple (p = 0.002) linear regression. The relationship between ATR and coronal curvature varies significantly by race, sex, and BMI. In particular, Black patients demonstrate lower thoracic curves for the same ATR measurements. Females demonstrate greater curves at lower ATR measures in the thoracic region, and males demonstrate greater curves in the lumbar regions. As BMI increases, the slope between thoracic ATR and Cobb angle decreases.
Surgical goals for congenital spinal deformity (CSD) include correction of deformity and prevention of progression without affecting neurological function. CSD has a higher incidence of intraoperative neuromonitoring (IONM) alerts than other scoliosis types and a potential for risk of postoperative neurological deficit. This study investigates incidence, risk factors, and outcomes associated with IONM alerts in surgically treated CSD. A prospectively collected pediatric database was queried for surgically managed patients with CSD. Demographic, surgical, and IONM details were analyzed and neurological outcomes were tracked. One hundred patients were included. Diagnoses were scoliosis, kyphosis, and kyphoscoliosis. Mean dominant-plane curvature was 64°. Hemivertebrae were present in 51 patients. IONM alerts occurred in 19
To evaluate the impact of L4 tilt and coronal lumbopelvic alignment on in-brace correction (IBC) in adolescent idiopathic scoliosis (AIS). Seventy-four AIS patients treated with CAD/CAM braces between January 2021 and January 2024 were retrospectively analyzed. Pre-brace and 1-month in-brace radiographs were assessed. Cobb angle, L4 tilt, pelvic obliquity (PO), and IBC percentages were measured. IBC was calculated as the percentage reduction in Cobb angle. Patients were grouped according to L4 tilt (≤ 10° vs. >10°). Correlation and stepwise regression analyses were performed to determine predictors of IBC. L4 tilt showed a significant negative correlation with both lumbar (r = −0.318, p = 0.012) and thoracic IBC (r = −0.538, p = 0.001). PO was also negatively correlated with lumbar (r = −0.348, p = 0.006) and thoracic IBC (r = −0.569, p = 0.001). Patients with L4 tilt ≤10° demonstrated significantly higher lumbar (66.2
We evaluated whether the type of cerebral palsy (CP) (spastic vs. ataxic-hypotonic) affected outcomes in patients who underwent posterior spinal fusion (PSF). We queried CP patients from 2008-2020 with GFMCS grade IV or V who underwent PSF with at least 2 years’ follow-up. Demographic, radiographic, operative and CPCHILD scores were compared. We performed a matched comparison of patients with spasticity (SP) versus patients with ataxia-hypotonia (AH) by age and coronal curve angle. From 390 CP patients, 309 (79
Retrospective study. The aim of this study is to evaluate the predictive ability of pre-operative Scoliosis Research Society-22 revised questionnaire (SRS-22r) domains for achieving Minimum clinically important difference (MCID) at 2 years after adolescent idiopathic scoliosis (AIS) surgery. Understanding which AIS will achieve clinically meaningful postoperative benefit remains challenging, particularly when counseling families about expected changes in health-related quality of life. MCID thresholds for SRS-22r domains have been described, but it is unclear how baseline profiles can be leveraged to anticipate meaningful improvement at 2 years after surgery. A retrospective analysis of AIS patients undergoing posterior spinal fusion was performed. Pre-operative, 1-year, and 2-year SRS-22r domain scores (Function, Pain, Self-Image, Mental Health), VAS pain, and ODI were collected. MCID was defined as a ≥ 1-point improvement from baseline to 2 years. Univariate and multivariable logistic regression models were constructed, and model performance was assessed using ROC–AUC and calibration curves. ROC-based threshold optimization using Youden’s J statistic, and fivefold cross-validation was used to derive clinically interpretable pre-operative cut-points. In total, 189 patients were analyzed for the study. All SRS-22r domains improved significantly at 2 years, with the greatest absolute gain in Self-Image 64.9
Osteoblastoma is a rare bone-forming tumor with a predilection for the spine. Typically affecting adolescents and young adults, it presents with localized pain and neurologic deficits if spinal lesions extend into, or indeed predominantly involve, the epidural space. Its imaging appearance can mimic infection or other neoplasms, making diagnosis challenging. We report on a 14-year-old boy with scoliosis and progressive thoracic back pain found to have a left T11 epidural mass. The lesion caused bony remodeling of the T11 posterior elements and spinal cord compression on MRI. Initial CT-guided and open biopsies were nondiagnostic, but definitive excisional surgery via T11 laminectomy confirmed osteoblastoma. Histopathology demonstrated tumor within both adjacent bone and perilesional soft tissue. The patient’s pain resolved after resection, measures of scoliosis improved, and he remained neurologically intact. After nearly 5 years of follow-up, there has been no evidence of recurrence. Painful scoliosis in a child warrants evaluation for underlying pathology. Small biopsies may be inconclusive; excision may be required for diagnosis and treatment. Histopathology in this case showed both osseous and perilesional soft-tissue involvement despite predominantly extraosseous growth, supporting complete resection when feasible. Recurrence-free status after prolonged follow-up is reassuring, but continued surveillance remains warranted.
To investigate the association between trunk extensor endurance time and dynamic alignment changes during walking in older patients with adult spinal deformity (ASD). This cross-sectional study targeted patients with ASD who were dissatisfied with their posture and pain during walking. Trunk extensor endurance was defined as the maximum endurance time (ET) for maintaining the upper body posture, measured using the Ito-Shirado test. Dynamic spinal alignment changes during walking were evaluated by calculating the change in sagittal trunk shift (STS), measured before and after a 3-min walk using a three-dimensional motion analysis system, referred to as ΔSTS. To examine the association between ET and ΔSTS, multivariable linear regression analysis was performed, adjusting for potential confounders to calculate standardized partial regression coefficients (β) and 95
Purpose Surgical corrections for adult spinal deformity (ASD) often extend from T4-pelvis. Certain patients may require fusion from C2-pelvis. Comparisons are necessary to guide surgical decision-making, particularly for frailer patients with multiple comorbidities. This study analyzed the additional morbidity incurred by proceeding with fusion to the upper cervical spine (i.e., C2) versus to T4. Methods This was a retrospective analysis comparing C2-pelvis versus T4-pelvis fusions for ASD. Patients were propensity-matched in a 1:4 ratio based on age, sex, ASA score, BMI, smoking, diabetes, and use of 3-column osteotomy. Outcomes included postoperative complications, hospital/ICU length-of-stay (LOS), time-to-ambulation, 30- and 90-day readmission rates, reoperations, and overall survival (OS). Results 80 patients (16 C2-pelvis, 64 T4-pelvis) were analyzed. All patients had ASA scores >= 3. C2-pelvis yielded higher complication rates (100% C2-pelvis vs. 68.7% T4-pelvis; p = 0.008) and number of complications per patient (3.2 +/- 2.2 C2-pelvis vs. 1.3 +/- 1.6 T4-pelvis; p = 0.004). For specific complications, C2-pelvis more often yielded prolonged hypotension requiring vasopressors (p < 0.001), psychiatric complications (p = 0.04), and delirium (p = 0.04). Hospital LOS was similar between cohorts (p = 0.33), but ICU LOS (p = 0.02) and time-to-ambulation (p = 0.046) were longer after C2-pelvis. C2-pelvis had higher readmission rates within 30 (p = 0.001) and 90 (p = 0.001) days. OS was shorter after C2-pelvis (24.4 +/- 2.8 months vs. 68.5 +/- 4.2 months for T4-pelvis; p < 0.001). Conclusions C2-pelvis fusions for ASD yield significantly higher rates/numbers of complications, longer ICU LOS, longer time-to-ambulation, higher readmission rates, and shorter OS than T4-pelvis fusions, even among patients of similar age and systemic disease/comorbidities. Greater follow-up and numbers of C2-pelvis patients are required for more definitive outcome comparisons.
