PURPOSE:Rigo Chêneau-style orthoses (RCSOs) have gained popularity for treating adolescent idiopathic scoliosis (AIS) due to their emphasis on 3-dimensional correction. However, previous studies lack objective measures of brace wear compliance and have not described in-brace correction (IBC) thresholds associated with treatment success. This study evaluated the relationship between IBC, brace wear, and treatment outcomes in AIS patients treated with RCSOs. METHODS:A retrospective review at a single academic institution included skeletally immature patients aged 10 to 18 years with AIS and a major curve of 20 to 40 degrees, who underwent full-time RCSO treatment with thermal wear-time sensors. Patients were followed until skeletal maturity or progression to surgery. Treatment success was defined as a change of ≤5 degrees in the major curve at the latest follow-up. Multivariable logistic regression identified predictors of treatment success. RESULTS:Fifty patients (45 females, 90%) were included, with 36 (72%) classified as Sanders stage 3 and a mean age at brace initiation of 12.4±1.2 years (range: 10.1 to 15.5). The mean baseline major curve was 31±5 degrees with an IBC of 55±20%. The mean brace wear was 11.7±3.6 hours per day. At a mean follow-up of 3.0±0.9 years (range: 1.1 to 5.3), 43 patients (86%) avoided surgery and 36 (72%) met criteria for treatment success, with a mean major curve of 32±12 degrees. Greater IBC (60% vs. 40%, P<0.001) and brace wear (12.4 vs. 10.0 h, P=0.034) were associated with treatment success in univariate analysis, with IBC remaining an independent predictor in multivariable analysis (P=0.013). An IBC ≥45% was associated with treatment success (AUC=0.79). Patients achieving ≥45% IBC (n=33) demonstrated significantly higher success rates (88% vs. 41%, P<0.001) and lower rates of progression to surgery (6% vs. 29%, P=0.037). CONCLUSIONS:In this study, which included objective compliance data, 3-dimensional RCSO bracing in AIS was associated with high rates of treatment success. Greater IBC and brace wear were associated with improved outcomes, with IBC emerging as the primary independent predictor of success. An IBC of 45% was associated with improved outcomes and may represent a clinically meaningful target in modern 3-dimensional bracing. LEVEL OF EVIDENCE:Level IV.

This study examines trends in surgical management and outcomes in patients with myelomeningocele (MMC) undergoing spine surgery, focusing on complications and radiographic outcomes. A retrospective review of a multicenter registry was conducted. Demographics, surgery type, ambulatory status, and radiographic parameters were collected. Complications occurring within five years post-index surgery were recorded and classified by the Modified Clavien-Dindo-Sink (MCDS) scale. Patients were divided into “early vs. late” groups based on the median time point, and by ambulatory status. Complication rates were evaluated over five-year intervals. Statistical analyses included t-tests, Mann–Whitney U, chi-square, and Cochran-Armitage trend tests. The cohort included 187 MMC patients, with 161 undergoing growth-friendly (GF) procedures and 26 index fusions. 119 patients (63

The purpose of this study was to compare perioperative outcomes between adolescents and young adults undergoing posterior spinal fusion for idiopathic scoliosis using a large clinical registry. This was a retrospective cohort study using data from the NSQIP and NSQIP-Pediatric databases from 2016 to 2024. Patients aged 10–40 years who underwent posterior spinal fusion for idiopathic scoliosis were included. Two study cohorts were defined: (1) adolescent idiopathic scoliosis (AIS) (10–17 years) and (2) young adult idiopathic scoliosis (YADIS) (18–40 years). Outcomes included operative time, length of stay (LOS), allogeneic transfusion, any adverse event, 30-day readmission, 30-day reoperation, and non-home discharge. Groups were compared using chi-square test and Student’s t-test. Multivariable regression analyses were performed controlling for sex, ASA, and number of fusion levels. There were 31,120 AIS patients (mean age 14.5 years) and 439 YADIS patients (mean age 21.9 years). Compared with the AIS cohort, YADIS had significantly longer operative times (AIS: 276.4 min vs YADIS: 353.7 min; p < 0.001) and longer LOS (AIS: 3.4 days vs YADIS: 5.1 days; p < 0.001). The YADIS cohort had higher rates of allogeneic transfusion (AIS: 10.9

STUDY DESIGN:Multicenter retrospective cohort. OBJECTIVE:To compare complications, patient-reported outcomes, and radiographic measures between patients treated for early-onset scoliosis (EOS) with magnetically controlled growing rods (MCGRs) according to whether they had definitive fusion, retention of implants, or implant removal alone. BACKGROUND DATA:For patients with EOS, MCGRs enable noninvasive spinal distraction until skeletal maturity, when most undergo definitive fusion. Because MCGR expansions are more frequent than with traditional growing rods, the incidence of autofusion may differ. The long-term safety and effectiveness of implant retention is unknown. METHODS:We included 240 patients with EOS (mean age at index surgery, 8.8 y) who completed treatment with MCGRs and had ≥2-year follow-up after definitive management. Patients were grouped by definitive management: fusion (n=225), implant retention without fusion (n=12), or implant removal alone (n=3). Demographics, radiographic parameters, Early Onset Scoliosis Questionnaire (EOSQ-24) scores, and complication rates were analyzed. P<.05 was considered significant. RESULTS:Two years after definitive treatment, mean Cobb angle improved in the fusion group (54° to 42°, P<.0001), remained stable in the retention group (60°, P=.89), and worsened in the removal group (61° to 78°, P=.03). At 5 y after definitive treatment, 6 patients with retained implants maintained Cobb angle (54°) and spinal height (338 mm). At 2 years, mean T1-S1 height did not differ between fusion and retention groups (P=.61). Two years after "graduation," EOSQ-24 scores were similar across groups, except pulmonary function, which was highest in the fusion group. Chronic pain was most frequent in the removal group (2 of 3, P=.005). No patients with retained implants experienced implant-related complications. CONCLUSIONS:Retention of MCGRs may be considered in some high-risk patients with acceptable alignment who are poor candidates for fusion. Although short-term outcomes were promising, retention should be regarded as an exception. Long-term risks warrant further study. LEVEL OF EVIDENCE:III.

BACKGROUND:Orthopaedic management of spinal deformity in patients with early onset scoliosis (EOS) often prioritizes objective radiographic correction; radiographic improvement alone does not fully capture the treatment's meaningful benefits from the patient's perspective. The Early Onset Scoliosis Questionnaire (EOSQ-24) has been previously developed and validated to measure health-related quality of life (HRQoL) in patients with EOS. To date, the traditionally accepted assumption has been that a 10% difference in scores is clinically different. However, an evidence-based estimate for the minimal clinically important difference (MCID) in EOSQ-24 scores is needed. OBJECTIVES:To determine the MCID for the EOSQ-24 questionnaire and establish a clinically relevant threshold to assess changes in patient HRQoL. METHODS:This is a prospective, multicenter study of EOS patients. Eighty-five patients with EOS and/or their parents completed the EOSQ-24 before and after treatment, and the mean change in EOSQ-24 score was calculated. A global assessment survey using a Likert-based scale then evaluated if patients experienced a change (worsening or improvement) after the intervention, and if so, whether it was important to their HRQoL. An anchor-based MCID was determined using a receiver operating characteristic curve to find the threshold score change that optimally identified those with important change. A secondary, 1 standard error of measurement (1 SEM) distribution-based approach was then calculated using the standard deviation of pre-intervention EOSQ-24 scores and a reliability coefficient of 0.92, based on prior validation studies. These 2 methods were compared with determine the MCID. RESULTS:The mean change in EOSQ-24 score for all patients was 8.5 points (SD = 8.1). The anchor-based MCID was 5.2 with an area under the curve (AUC) of 0.600, indicating a limited discriminative ability of the EOSQ-24 score change. The data distribution-based MCID was 4.6, representing the minimum change to reflect a true difference beyond measurement error. CONCLUSIONS:The final MCID for EOSQ-24 scores in EOS patients is a 5-point change and was derived from 2 methods that were highly consistent, supporting the robustness of this threshold for meaningful change in EOSQ scores. Accurate clinician recognition of important HRQoL changes in this population is important to improve clinical care. LEVEL OF EVIDENCE:Level II.

Intraoperative neuromonitoring (IONM) improves safety during pediatric spinal deformity surgery by providing real-time neurophysiological assessment, enabling the earlier detection of neural compromise and the potential prevention of permanent injury. However, current IONM interpretation is subject to variability and relies on human expertise. This study evaluates a machine learning (ML) algorithm designed to identify subtle changes in motor evoked potentials (MEPs) that may precede neurological injury. IONM data from 84 pediatric spine surgeries at a single high-volume academic center were retrospectively analyzed. Fourteen patients experienced intraoperative MEP signal loss, with six developing postoperative deficits. An ML model was trained on baseline muscle specific MEPs from each patient to identify signal changes during surgery. The model continuously analyzed real-time MEP data, generating a similarity score relative to baseline. A “red flag” alert was triggered if signal deviation exceeded 10

Current methods for assessing spinal flexibility in adolescent idiopathic scoliosis (AIS) typically rely on multiple side-bending radiographs to determine the structural nature of minor curves. However, these methods are subject to inherent variability due to differences in radiographic technique and patient effort, limiting their reproducibility. To address this limitation, we aimed to evaluate the effectiveness of a single supine full-spine anteroposterior (AP) radiograph as an alternative to side-bending radiographs for the identification of minor structural curves in AIS. Preoperative full spine standing, bending and supine AP radiographs of 123 surgical patients with AIS were evaluated. Coronal Cobb angles and sagittal parameters were measured classified according to the Lenke classification. Patients were grouped by the location of the major curve. Group one included Lenke Types 1 to 4. Group two included Lenke Types 5 and 6. Supine Percent Correction (SPC) was calculated for each curve. Sensitivity and specificity for our proposed supine structural criteria, Pearson’s correlation coefficient between the supine and side-bending films, and area under the receiver operator characteristic (ROC) curve was calculated. Both groups demonstrated a statistically significant strong positive correlation between supine and side-bending radiographs across all curve regions. Receiver operating characteristic (ROC) analysis identified a residual Supine Cobb angle ≥ 30° and Supine Percent Correction (SPC) ≤ 30

The current classification of idiopathic scoliosis relies on chronological age cutoffs to differentiate juvenile (JIS) from adolescent (AIS) subtypes. However, age-based distinctions may not reliably reflect physiological maturity, a critical factor for predicting curve progression and guiding treatment. This study investigates skeletal maturity differences across the traditional JIS-AIS age threshold using the Sanders maturity scale (SMS). A retrospective review was conducted using a multicenter pediatric spine registry. Patients aged 7–13 years with idiopathic scoliosis and documented SMS scores were included. SMS distributions were analyzed across age bands surrounding the JIS-AIS cutoff (9–10 vs. 10–11 years). Demographic and anthropometric data evaluated factors associated with skeletal maturity variation. Among 637 patients (86

To assess the complementary value of transverse plane descriptors (orientation of the regional planes of deformation (ORPD) and local apical vertebral rotations (AVR)) integrated into the new modular three-tiered, four-modifier SRS-Lenke-Aubin 3D classification, relative to conventional 2D radiographic parameters and current Lenke 2D classification in adolescent idiopathic scoliosis (AIS). Transverse plane deformities of 285 surgically treated AIS cases reconstructed in 3D were quantified using ORPD and AVR, independently assessed for the proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TL/L) regions. Correlation analyses evaluated relationships between standard 2D parameters (Cobb angles, thoracic kyphosis (TK), lumbar lordosis (LL)) and transverse plane indices (ORPD, AVR). The distribution of ORPD and AVR subclasses was examined, as well as the associations between conventional Lenke lumbar and thoracic sagittal profile modifiers, and their corresponding 3D transverse plane modifiers. Complementary analyses also included 3D displacement of the apex relative to the end-vertebrae line (DAEVL). Nearly all ORPD–AVR subclass combinations were observed across regions, confirming the system’s ability to capture diverse deformity patterns. ORPD and AVR were independent in PT and MT but correlated in TL/L (r = 0.69). Cobb angle correlated moderately with ORPD in MT (r = 0.43) and strongly in TL/L (r = 0.67), while correlations with AVR were moderate in MT (r = 0.50) and TL/L (r = 0.59). TK correlated negatively with MT ORPD (r = –0.58), whereas LL showed no association with TL/L ORPD. DAEVL correlated strongly with Cobb across all regions but only weakly to moderately with ORPD. Associations between Lenke 2D modifiers and ORPD were strong in TL/L (V = 0.59) and moderate in MT (V = 0.37). Multivariate models showed that Cobb and TK explained 44

To investigate how the transverse-plane descriptors and modifiers of the SRS-Lenke-Aubin 3D classification—orientation of the regional plane of deformation (ORPD), apical vertebral rotation (AVR), and apical displacement (3D distance from the apex to the end-vertebrae line, DAEVL)—characterize Lenke 1 thoracic curves and complement conventional 2D Lenke modifiers and radiographic measures. One hundred sixty-two Lenke 1 adolescent idiopathic scoliosis patients underwent 3D reconstruction from preoperative biplanar radiographs. Associations between transverse-plane descriptors (ORPD, AVR, DAEVL) and standard coronal and sagittal radiographic measures (Cobb angles, thoracic kyphosis [TK], lumbar lordosis [LL]) were analyzed across proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TL/L) regions. Relationships between classical Lenke modifiers and transverse-plane modifiers derived from the SRS-Lenke-Aubin 3D classification were evaluated using contingency tables, chi-square tests or Fisher-Freeman-Halton exact tests as appropriate, and Cramér’s V. Pearson correlations and multivariate linear regression were used to assess regional coupling and the independent contributions of coronal and sagittal parameters to ORPD. Subgroup analyses compared Lenke 1A, 1B, and 1C patterns. Across analyses, substantial inter-patient variability was observed, with wide dispersion of transverse-plane descriptors for similar 2D measurements. Relationships between coronal severity and transverse-plane geometry were region-dependent. ORPD showed no statistically significant association with Cobb magnitude in the PT and MT regions (p > 0.05), whereas a moderate and statistically significant association was observed in the TL/L region (r = 0.4792, p < 0.001). Associations between AVR and Cobb magnitude were weak in PT (r = 0.1688, p = 0.0317) and moderate in both MT (r = 0.4424, p < 0.001) and TL/L (r = 0.4085, p < 0.001). ORPD and AVR were not significantly associated in PT, showed a weak inverse association in MT (r = −0.2177, p = 0.0054), and were moderately associated in compensatory TL/L (r = 0.5342, p < 0.001). TK demonstrated a moderate-to-strong inverse association with MT ORPD (r = −0.6344, p < 0.001), while LL showed no significant association with TL/L ORPD (r = 0.1177, p = 0.1357). DAEVL showed moderate associations with Cobb magnitude across regions and selective coupling with ORPD and AVR. Strong associations were observed between the Lenke lumbar modifier and TL/L ORPD, and between the thoracic sagittal profile modifier and MT ORPD (both p < 0.001), indicating partial overlap but suggesting complementarity between 2D and 3D descriptors. Multivariate regression confirmed region-specific behavior, with MT ORPD primarily influenced by sagittal profile and TL/L ORPD predominantly driven by coronal magnitude. Subgroup analyses revealed distinct 3D signatures across Lenke 1A, 1B, and 1C, but the 1C subgroup should be interpreted as exploratory. In Lenke 1 thoracic curves, given the weak to moderate associations found, ORPD, AVR, and DAEVL thus provide additional, complementary, region-specific information that is not fully explained by conventional 2D parameters. The predominance of weak-to-moderate associations reflects meaningful independence rather than lack of relationship, reinforcing the value of integrating transverse-plane descriptors to enhance 3D characterization of AIS.

Curve flexibility plays an important role in the treatment of adolescent idiopathic scoliosis (AIS). This study aimed to describe the patterns and variability of curve flexibility in a large patient cohort. Five thousand two hundred sixty-seven surgical patients from an international AIS registry were analyzed. Curve flexibility was calculated as percent change from the major Cobb angle on bending radiographs. Associations between curve flexibility and demographic, clinical, and radiographic parameters were assessed using non-parametric tests and linear correlations. Thoracic curves were less flexible than lumbar curves (35.5

BACKGROUND:Hypotension is a critical, modifiable risk factor for neurological deficit in spine surgery. Patients with intraoperative neurophysiological monitoring (IONM) changes are particularly vulnerable, as their spinal cord has already demonstrated sensitivity to correction, and hypotension may exacerbate areas of inadequate perfusion. These patients are admitted postoperatively to the ICU for close neurological and hemodynamic monitoring. This study evaluated adherence to patient-specific mean arterial pressure (MAP) goals in the first 24 hours following IONM changes. METHODS:A retrospective review of patients undergoing spinal surgery with IONM changes between 2023 and 2025 at a single institution was conducted. Demographic and radiographic data were documented. Individual 24-hour postoperative "Target MAP" goals were established. Arterial line MAP values were collected. Hypotension was defined as MAP <5th percentile for age-based norms. RESULTS:Twenty-one patients [12 female, 9 male; mean age 14.3±2.6 y (range: 7.7 to 19.0)] with IONM changes during pediatric deformity surgery were included. Etiologies included 8 idiopathic, 6 neuromuscular, 5 congenital, and 2 syndromic patients. Of those with major coronal deformities (n=19), mean preoperative and postoperative major curves were 79±22 degrees (range: 40 to 120 degrees) and 38±16 degrees (range: 18 to 75 degrees), respectively, with an average correction of 56%±11% (range: 41% to 71%) in completed cases. Four surgeries were aborted. Six patients (29%) had persistent neurological deficits beyond the first postoperative day. The median MAP goal was >80 mm Hg (range: >60 to >100). Twenty patients (95%) did not continuously meet their MAP goal, defined as ≥1 instance of MAP beneath target. Seven patients' (33%) 24-hour average MAPs were below target. On average, patients spent 27% of the time (6.4 h) beneath their target MAP. Four patients (19%) had a documented period of hypotension. CONCLUSIONS:Despite ICU-level care and established MAP goals in critical patients with prior IONM loss or within warning criteria, postoperative blood pressure management often failed to meet MAP goals. This is the first study to highlight this crucial gap between management goals and postoperative hemodynamic adherence. LEVELS OF EVIDENCE:Level IV.

This study evaluates radiographic outcomes and reoperations in patients undergoing anterior vertebral body tethering (VBT) of the lumbar spine. A retrospective review of an EOS database identified pediatric patients who underwent lumbar VBT. Demographic and surgical data were collected, as well as radiographic and clinical outcomes including complications, reoperations, and conversion to posterior spinal fusion (PSIF). Analyses included paired t-tests, Wilcoxon signed-rank tests and chi-square. Thirty-two patients with idiopathic scoliosis who underwent thoracolumbar VBT with 2-year follow-up were included. Mean age at surgery was 13.7 ± 1.8 years (mean follow-up 2.0 ± 0.2 years); median Sanders score was 3 (50

Selective thoracic fusion (STF) in adolescent idiopathic scoliosis (AIS) corrects the primary thoracic curve while achieving spontaneous lumbar curve correction (SLCC) and preserving flexibility. This study introduces a novel preoperative radiographic parameter defined as the ratio of the tilt of the upper and lower end vertebrae of the lumbar curve to the corresponding lumbar Cobb angle as a predictor of SLCC. A multicenter retrospective review identified Lenke 1–4 patients with lumbar modifiers B or C undergoing STF. Radiographic parameters through 2-year follow-up included lumbar Cobb angle, UEV/LEV tilt, lumbar flexibility, and apical translation. LEV:Cobb and UEV:Cobb ratios were calculated by dividing vertebral tilt by preoperative lumbar Cobb. Univariate and multivariate regression assessed predictors of SLCC. Subgroup analyses were performed by lumbar modifier and fusion level relative to the stable vertebra. 193 patients met inclusions criteria (mean age at time of surgery 15.0 ± 2.0 years, 86

BACKGROUND:Bracing is the primary non-operative treatment for adolescent idiopathic scoliosis (AIS), with in-brace correction (IBC) being a key predictor of long-term success. Although BMI has been linked to bracing outcomes, it fails to capture important aspects of body habitus, such as fat distribution and torso shape, that influence brace fit and force transmission. This study aims to evaluate a novel radiographic measure, the lateral waist-to-height (WH) ratio, as a more accurate predictor of IBC in AIS patients. METHODS:A retrospective review of AIS patients treated with Rigo-style braces between 2014 and 2024 at a single institution was conducted. Thoracolumbar (TL) height and waist width at the iliac crest were measured on AP and lateral radiographs to calculate WH ratios. Linear regression evaluated associations between IBC and BMI, WH ratios, and TL height change. Multivariate regression adjusted for major curve angle and curve apex. RESULTS:The study included 209 females (mean age 11.4±2.1 y, BMI 17.7±2.8). Mean pre-brace major curve angle was 28.2±7.3 degrees, with average IBC of 64.8%±31.6%. Lateral WH ratio correlated positively with IBC ( R =0.21, P =0.014), representing a weak but statistically significant correlation. By contrast, BMI and AP ratio did not demonstrate significant associations with IBC. In multivariate analysis, both major curve angle ( P <0.001) and lateral WH ratio ( P =0.009) were independent predictors of IBC. CONCLUSIONS:Lateral WH ratio offers a more holistic representation of body habitus than BMI and is independently associated with in-brace correction. These findings suggest that the lateral WH ratio may provide additional insight into brace fit and initial correction, warranting further study to determine its potential role in predicting long-term bracing outcomes in AIS. LEVEL OF EVIDENCE:Level III.