To identify variables associated with good (improved or stable) outcomes in pulmonary function tests (PFT) at least 2 years after initial surgical intervention for early onset scoliosis (EOS). This was a multi-site retrospective review of EOS patients with PFTs preoperative and minimum 2 years postoperative. Clinical, radiographic, and PFT data were collected. Treatment types included definitive fusion (DF) and growth-friendly (GF). Forced vital capacity (FVC) ≥ 80
To describe the incidence and recovery of motor weakness after pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance and determine whether early postoperative weakness is associated with patient-reported outcomes (PROs) at latest available follow-up. We retrospectively reviewed consecutive adults undergoing revision posterior fusion with PSO (Schwab grade 3–4) for fixed sagittal imbalance from December 2015 to June 2022. Lower-extremity strength was graded 0–5, and weakness was defined as 3/5 or less in any distribution. PROs (SRS-22r, ODI, VAS back, and leg pain) were collected preoperatively through latest follow-up. Latest outcomes were compared by weakness status on postoperative day 5, 6 weeks, and 3 months. Forty-nine patients (67
The optimal surgical management of paediatric high-grade spondylolisthesis (HGS) remains controversial. Instrumented fusion in situ (IFIS) is considered low risk for neurological complications at the expense of limited correction of spinopelvic imbalance. This study evaluated radiographic outcomes of IFIS using a modified Jackson technique, with a focus on sagittal alignment and the evolution of spinopelvic balance over time. A retrospective review of 19 patients (< 18 years, mean age 13.7) with ≥ grade 3 HGS treated with IFIS using a modified Jackson technique between 2006 and 2022. Radiographic parameters including slip percentage, pelvic incidence, sacral slope, pelvic tilt, lumbosacral angle, and balance classification were analysed at baseline, 6 months, and 2 years post-operatively. Subgroup analysis was performed for patients with vertical versus non-vertical sacrum morphology. Mixed-measures ANOVA determined changes across time points. Improvements in sagittal parameters were progressive, with more substantial changes observed at 2 years than at 6 months, suggesting gradual improvement over time. Significant improvements were observed in slip percentage (p < 0.001), sacral slope (p = 0.005), pelvic tilt (p = 0.016), lumbosacral angle (p < 0.001), and L5 incidence (p = 0.019). Patients presenting with a vertical sacrum showed greater increases in sacral slope and reduction in pelvic retroversion. The results of IFIS using a modified Jackson technique for paediatric HGS suggests significant partial improvements in key sagittal alignment parameters, including SS, PT, and LSA at 2-year follow-up. Whilst pelvic balance often remained incomplete at 2 years, ongoing radiographic improvement suggests a potential for further adaptation with longer follow-up. Level IV.
Implant migration is an incompletely characterised complication of growth-friendly treatment for early-onset scoliosis (EOS), with inconsistent terminology across the literature. This systematic review aimed to characterise reported patterns, study-specific frequency, associated factors, detection, and clinical consequences of implant migration and migration-related fixation failure in growth-friendly EOS constructs. PubMed, Embase, and CINAHL were searched from database inception to 27th November 2025 in accordance with PRISMA guidelines. Studies reporting implant migration or migration-related fixation failure in children with EOS treated with growth-friendly constructs were included. Findings were synthesised descriptively because migration definitions, constructs, outcome ascertainment, and reporting were heterogeneous. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools, and certainty of evidence was evaluated using GRADE. Nineteen studies were included, predominantly retrospective cohorts and case series. Migration terminology was inconsistent and frequently overlapped with pull-out, dislodgement, loosening, and loss of fixation. For descriptive synthesis, reported events were organised into three recurring anatomical patterns: apical/ventral rod migration, proximal anchor migration/fixation failure, and distal or pelvic anchor migration/fixation failure. Ventral rod migration was represented by two publications, including one cohort in which CT-defined migration occurred in 3/90 patients (3.3
Previous studies have emphasized the importance of thoracic kyphosis (TK) restoration and sagittal alignment for long-term outcomes following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Although various equations have been introduced to predict the ideal regional alignment of the thoracic or lumbar spine, no study has validated these equations or investigated the influence of achieving these patient-specific ideal regional parameters on patient-reported health-related quality of life (HRQoL) outcomes following PSF for AIS. A retrospective cohort study of a multicenter AIS database identifying patients with PSF with 5-year follow-up was performed. Patients with Lenke 1 curves with complete radiographic records, focusing on sagittal alignment parameters for lumbar lordosis (LL), TK (T2-12), sagittal vertical alignment (SVA), and patient-reported outcomes scores (SRS-22) at preoperative and 5-year follow-up timepoints were included for analysis. “Ideal” TK was calculated using pelvic incidence (PI) and “ideal” lumbar alignment was defined using two criteria. Patients were then subdivided based on whether ideal regional alignment was achieved at 5 years follow-up. SRS-22 total scores were subdivided into quintiles with the lowest 40
