Neurospine最新文献

{"title":"Bridging the Great Discordance: Ontological Intelligence as the New Paradigm in Spine Surgery.","authors":"Jin-Sung Kim","doi":"10.14245/ns.26520556.0278","DOIUrl":"10.14245/ns.26520556.0278","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"519-521"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinopelvic Parameters, Degree of Correction, and Proximal Junctional Complications After Adult Spinal Deformity Surgery: A Systematic Review and Meta-analysis.","authors":"HyungSub Jin, Kyung-Soo Suk, Byung Ho Lee, Si Young Park, Hak-Sun Kim, Seong-Hwan Moon, Sub-Ri Park, Namhoo Kim, Jae Won Shin, Ji-Won Kwon","doi":"10.14245/ns.26520938.0469","DOIUrl":"10.14245/ns.26520938.0469","url":null,"abstract":"<p><strong>Objective: </strong>Proximal junctional kyphosis (PJK) is a frequent postoperative complication following adult spinal deformity (ASD) surgery, whereas proximal junctional failure (PJF) is a less common but clinically more severe complication. Spinopelvic radiographic parameters have been associated with the development of these complications, yet existing studies have reported inconsistent results. This study aimed to investigate the association between spinopelvic parameters and proximal junctional complications (PJK/PJF), including analysis based on age-adjusted pelvic incidence (PI)-lumbar lordosis (LL) mismatch categories.</p><p><strong>Methods: </strong>This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2020 guidelines. PubMed, Cochrane Library, and Embase were comprehensively searched from inception through March 2025. Adults (>18 years) who underwent surgery for ASD or long-segment (≥4 levels) spinal fusion were included. Studies were independently selected by 2 reviewers based on preset criteria. Random-effects model was used to calculate mean differences/standardized mean differences for continuous variables and odds ratios (ORs) for categorical outcomes.</p><p><strong>Results: </strong>A total of 47 retrospective studies were included in the meta-analysis. Preoperatively, the PJK group had lower LL and sacral slope (SS) but had higher pelvic tilt (PT), T1PA, and C7-sagittal vertical axis than the non-PJK group. Postoperatively, the PJK group showed significantly lower PI-LL mismatch values and SS and higher PT, thoracic kyphosis, thoracolumbar kyphosis, and T1 pelvic angle. When stratified by the age-adjusted PI-LL formula, overcorrection was associated with significantly higher odds of PJK (OR, 2.67; 95% confidence interval [CI], 1.61-4.42), whereas no significant association was observed for PJF. Using age-specific thresholds, overcorrection was significantly associated with higher odds of PJF (OR, 1.67; 95% CI, 1.10-2.52).</p><p><strong>Conclusion: </strong>Preoperative sagittal imbalance and postoperative spinopelvic differences were associated with proximal junctional complications, whereas associations for PJF were more limited. Age-adjusted overcorrection showed outcome-specific associations with proximal junctional complications, suggesting that age-tailored alignment may be clinically relevant. Given the retrospective aggregate evidence and limited age-adjusted data, future prospective studies with standardized radiographic timing and separate outcome assessment for PJK and PJF are needed to validate these findings.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"720-739"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Domain-Adapted Foundation Models for Single-Click Surgical Instrument Segmentation in Spinal Endoscopy.","authors":"Bong-Su Mun, Zhi Zhao, Sang-Min Park, Jiwon Park, Hyun-Jin Park, Hyung Rae Lee, Ho-Joong Kim, Jin S Yeom","doi":"10.14245/ns.26520632.0316","DOIUrl":"10.14245/ns.26520632.0316","url":null,"abstract":"<p><strong>Objective: </strong>Accurate segmentation of surgical instruments in endoscopic images is essential for developing computer-assisted surgical systems, yet creating annotated training datasets remains labor-intensive. This study aimed to evaluate the efficiency of point-based interactive segmentation using foundation models for surgical instrument annotation in spinal endoscopy.</p><p><strong>Methods: </strong>We conducted a retrospective study comparing point-based segmentation performance between Segment Anything Model (SAM) 2.0, SAM 2.1, and domain-adapted MedSAM 2.1 for surgical instrument segmentation in spinal endoscopy. A test set of 308 images from 10 patients undergoing full-endoscopic lumbar decompression/discectomy or biportal endoscopic decompression/discectomy was evaluated. Models were assessed using standardized point prompts placed at the ground truth mask centroid. Primary outcomes included Dice similarity coefficient at single-click and success rate (Dice≥0.85). Secondary analysis evaluated click-to-quality metrics across iterative refinement up to 10 clicks.</p><p><strong>Results: </strong>At single-click, MedSAM 2.1 achieved significantly higher Dice scores than SAM 2.1 (0.937±0.074 vs. 0.844±0.222, p<0.001; 95% confidence interval [CI] for difference, 0.070-0.116) and SAM 2.0 (0.937±0.074 vs. 0.824±0.236, p<0.001; 95% CI for difference, 0.088-0.138), with a 3-fold reduction in variability (standard deviation: 0.074 vs. 0.222). External validation on the publicly available Spine Endoscopic Atlas dataset (202 images from 10 patients) confirmed generalizability, with MedSAM 2.1 achieving Dice 0.918±0.083, compared to 0.724±0.281 for SAM 2.1 and 0.708±0.290 for SAM 2.0 (both p<0.001). Interrater agreement between 2 independent annotators demonstrated excellent reliability (intraclass correlation coefficient, 0.991; 95% CI, 0.986-0.994; mean pairwise Dice, 0.953±0.051). The MedSAM 2.1-assisted workflow reduced annotation time by 75.8% compared to manual polygon annotation (7.7±13.3 seconds vs. 31.8±18.2 seconds per image; p<0.001; 4.1-fold speedup). SAM 2.1 improved progressively with additional clicks (Dice 0.844 to 0.943 at 10 clicks), while MedSAM 2.1 showed nonmonotonic progression (0.937 to 0.947), indicating near-optimal first-click predictions.</p><p><strong>Conclusion: </strong>Domain-adapted MedSAM 2.1 improved single-click annotation accuracy and efficiency for surgical instruments in spinal endoscopy, suggesting that low-resource domain adaptation may facilitate institutional dataset construction for surgical artificial intelligence research.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"633-643"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Decision Making and Outcomes of Sagittal Vertebral Resection: A Head-to-Head Comparison With Total Vertebral Resection.","authors":"Panpan Hu, Peilin Hua, Hua Zhou, Ben Wang, Yanchao Tang, Feng Wei, Zhongjun Liu","doi":"10.14245/ns.26520256.0128","DOIUrl":"10.14245/ns.26520256.0128","url":null,"abstract":"<p><strong>Objective: </strong>To compare perioperative burden, hardware outcomes, and oncologic control between sagittal vertebral resection (SVR) and total vertebral resection (TVR) for thoracolumbar tumors, and to propose a practical framework for SVR surgical decision making.</p><p><strong>Methods: </strong>Clinical data, operative parameters, and follow-up outcomes were retrospectively analyzed. To address baseline imbalances in tumor volume and preoperative embolization, a 1:1 propensity score matching was performed based on 5 critical covariates, resulting in a matched cohort of 78 patients (39 per group). Groups were compared using Student t-test or Mann-Whitney U-test for continuous variables and chi-square/Fisher exact test for categorical variables.</p><p><strong>Results: </strong>In the total cohort (39 SVR vs. 84 TVR), SVR significantly reduced blood loss (median 1,200 mL vs. 1,500 mL, p=0.016), transfusion (800 mL vs. 1,200 mL, p<0.001), complication rate (51.3% vs. 77.4%, p=0.004), and hospital stay (13.7 days vs. 19.0 days, p=0.012). Bilateral nerve root sacrifice was less frequent in SVR (41.0% vs. 69.0%, p<0.001). Negative surgical margins (71.8% vs. 73.8%, p=0.814) and local recurrence (12.8% vs. 13.1%, p=0.965) were comparable. Postmatching analysis (n=78) confirmed that even after balancing for tumor volume and embolization, the SVR group maintained significant advantages in blood loss (p=0.035) and operation time (p=0.041). Hardware failure occurred in 3 TVR patients (3.6%) but in none after SVR.</p><p><strong>Conclusion: </strong>SVR significantly reduces perioperative morbidity while maintaining comparable oncologic outcomes relative to TVR. The superiority of SVR remains robust after propensity score adjustment for tumor complexity. By formalizing a type-based surgical decision-making framework, this study provides practical guidance for when and how SVR may be safely adopted as a standardized alternative to TVR in appropriately selected thoracolumbar tumors.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"740-753"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explanatory Factors for Neck-Related Disability, Headache, and Pain After Cervical Decompression Surgery in Individuals With Cervical Radiculopathy and Neck-Related Headache: A National Registry-Based Study With 2-Year Follow-up.","authors":"Jard Svensson, Håkan Löfgren, Anna Hermansen, Peter Zsigmond, Anneli Peolsson","doi":"10.14245/ns.26520658.0329","DOIUrl":"10.14245/ns.26520658.0329","url":null,"abstract":"<p><strong>Objective: </strong>To investigate explanatory factors associated with neck-related disability, headache, and neck and arm pain 2 years after anterior cervical decompression and fusion (ACDF) or posterior cervical foraminotomy (PCF) in individuals with cervical radiculopathy (CR) and neck-related headache.</p><p><strong>Methods: </strong>This registry-based cohort study used prospectively collected data with a 2-year follow-up from the Swedish Spine Registry. Individuals who underwent ACDF (n=1,866) or PCF (n=357) for CR between January 2016 and March 2021 and reported preoperative neck-related headache were included. Standard analysis of covariance models were used to identify explanatory factors for the absolute values of Neck Disability Index (NDI), NDI-headache, Numerical Rating Scale (NRS) neck pain, and NRS arm pain at the 2-year follow-up after ACDF or PCF.</p><p><strong>Results: </strong>Explanatory factors explained 33% and 32% of the neck-related disability, 20% and 35% of the headache, 21% and 13% of the neck pain, and 16% and 24% of the arm pain at 2-year follow-up after ACDF and PCF, respectively, in individuals with CR and neck-related headache. The preoperative value of these outcomes had the greatest impact, except for neck and arm pain after PCF, where neck-related disability had a greater impact.</p><p><strong>Conclusion: </strong>Neck-related disability, headache, and neck and arm pain after ACDF and PCF in individuals with CR and neck-related headache are associated with preoperative levels of these outcomes, as well as demographic, lifestyle, surgical factors and self-reported health, that should be considered before surgery. The models explained 13%-35% of the variance in the outcomes, indicating that a substantial proportion remains unexplained.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"593-604"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Registries in Spine - What Have We Learned So Far, and What Will the Future Bring?","authors":"Paul Gerdhem, Bjorn Knutsson, Olof Wolf, Victor E Staartjes, Adrian Elmi-Terander","doi":"10.14245/ns.26520720.0360","DOIUrl":"10.14245/ns.26520720.0360","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"522-525"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Occipital Condyle Screw Fixation for Craniocervical Instability: Integrating Morphometric Evidence, Anatomical Parameters, and Experience From Surgical Series.","authors":"Mateo Tomas Fariña Nuñez, Sven Theiler, Inka Berglar, Massimo Barbagallo, Massimo Bottini, Victor Gabriel El-Hajj, Stefanos Voglis, Nicolai Maldaner, Tamas F Fekete, Daniel Haschtmann, Markus Loibl, Dezsö J Jeszenszky, Maria L Gandía-González, Menno R Germans, David Bellut, Carlo Serra, Luca Regli, Erik Edström, Adrian Elmi-Terander, Victor E Staartjes","doi":"10.14245/ns.26520732.0366","DOIUrl":"10.14245/ns.26520732.0366","url":null,"abstract":"<p><p>Instability of the craniocervical junction is a potentially life-threatening condition requiring surgical stabilization. Traditional occipital plate fixation carries risks of construct loosening and intracranial complications due to variable skull thickness, particularly after posterior fossa decompression where plate fixation is challenging. Occipital condyle screws (OCS) provide direct fixation into the occipital condyles (OCs). However, comprehensive outcome data remains sparse. This systematic review and meta-analysis evaluated anatomical parameters, technical aspects, and surgical outcomes of OCS fixation in craniocervical stabilization. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, PubMed/MEDLINE, Embase, and Scopus were searched for studies reporting techniques and outcomes of occipitocervical fixation using OCS. Two reviewers independently extracted data, and study quality was assessed using the Newcastle-Ottawa Scale, when possible. Random-effects meta-analysis was performed. The primary endpoint was to characterize the technical aspects of craniocervical fixation using OCS and to ascertain its overall feasibility, defined by morphometric suitability, technical success rates, and complication rates. Thirty studies met inclusion: 12 cadaveric (618 specimens), 10 imaging (1,604 participants), and 8 surgical (284 patients). Morphometry consistently showed larger OC in male populations. Bicortical screw placement achieved 100% technical success. Standard 3.5-mm screws (18-24 mm) were commonly used. Recommended trajectories varied (sagittal with 18°-28° angulation; axial with 22°-37° angulation). No major symptomatic vascular or permanent neurological complications occurred. Meta-analytic data revealed significant differences in morphometric measurements of the OC and differences in the OCS length and angulation parameters. OCS fixation appears to be an anatomically feasible and technically promising fixation strategy in selected patients when anatomy and technique are carefully evaluated. Population-specific morphometric variability mandates individualized preoperative assessment. Future comparative studies should define long-term outcomes, fusion rates, and optimize region-specific surgical parameters.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"703-719"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Commentary on \"Rates of Subsequent Lumbar Surgery Following Spinal Fusion in Patients With Parkinson Disease: A Propensity-Score Matched Nationwide Cohort Analysis\".","authors":"Yusuke Nishimura","doi":"10.14245/ns.26521310.0655","DOIUrl":"10.14245/ns.26521310.0655","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"547-548"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Independent Risk Factors of Spinal Infection After Vertebral Augmentation: A Multicenter Propensity-Matched Case-Control Study.","authors":"Rongbin Chen, Jianquan Chen, Tianhang Xuan, Xuefeng Feng, Lijin Yang, Handi Yang, Xinyi Li, Shunping Li, Xingwei Fang, Mingze Yuan, Canjing Peng, Maoshui Chen, Yong Li","doi":"10.14245/ns.26520616.0308","DOIUrl":"10.14245/ns.26520616.0308","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the incidence of spinal infection after vertebral augmentation (SIAVA) and identify its independent risk factors.</p><p><strong>Methods: </strong>This multicenter, retrospective case-control study included patients who underwent percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fractures at 4 centers between January 2015 and December 2021. Each SIAVA case was matched with 3 controls using propensity score matching based on demographic and clinical variables. LASSO (least absolute shrinkage and selection operator) regression was used for variable selection, followed by multivariable conditional logistic regression to identify risk factors for SIAVA.</p><p><strong>Results: </strong>Among 7,797 PVA procedures, 42 SIAVA cases were identified, yielding an incidence of 0.54%. The median time from PVA to SIAVA diagnosis was 4.3 (interquartile range, 2.8-11.7) weeks. After 1:3 matching (42 cases vs. 126 controls), multivariable analysis identified 4 independent risk factors: preoperative pulmonary infection (odds ratio [OR], 3.64; 95% confidence interval [CI], 1.21-11.0; p=0.022), intravertebral fluid sign on magnetic resonance imaging (MRI) (OR, 6.17; 95% CI, 1.92-19.9; p=0.002), type D (intradiscal) cement leakage (OR, 2.93; 95% CI, 1.10-7.85; p=0.032), and serum albumin ≤35 g/L (OR, 3.29; 95% CI, 1.15-9.45; p=0.027). Within the infection cohort, 25 patients (59.5%) underwent revision surgery, and 2 deaths (4.8%) occurred during follow-up.</p><p><strong>Conclusion: </strong>The incidence of SIAVA was 0.54%. Preoperative pulmonary infection, intravertebral fluid sign on MRI, type D cement leakage, and serum albumin ≤35 g/L were identified as independent risk factors. These findings may help clinicians implement preoperative risk-reduction strategies.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"690-702"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Minimally Invasive Scoliosis Surgery in Adolescent Idiopathic Scoliosis Exceeding 80° of Curve Magnitude.","authors":"Hong Jin Kim, Jungwook Lim, Dong Yun Kim, Joung Woo Shin, Jae Hyuk Yang, Seung Woo Suh","doi":"10.14245/ns.26520810.0405","DOIUrl":"10.14245/ns.26520810.0405","url":null,"abstract":"<p><strong>Objective: </strong>To investigate feasibility and effectiveness of minimally invasive scoliosis surgery (MISS) via posterior approach in patients with adolescent idiopathic scoliosis (AIS) presenting with very severe curve exceeding 80°.</p><p><strong>Methods: </strong>A total of 257 flexible AIS patients who underwent deformity correction using posterior MISS were retrospectively categorized into 3 groups based on the curve magnitude: moderate (M group, main Cobb angle <60°, n=142), severe (S group, 60°-80°, n=91), and very severe (VS group, ≥80°, n=24). Radiological parameters, perioperative outcomes, and complication rates were compared among the 3 groups.</p><p><strong>Results: </strong>The VS group required significantly longer operative times (p<0.001), more fused segments (p<0.001), and a greater number of rib resections during thoracoplasty (p=0.032) compared to the other groups. Despite these surgical demands, there were no statistical differences in the correction rate (p=0.954) and last follow-up thoracic kyphosis (p=0.830) among the 3 groups. Regarding complications, while the overall complication rate showed no statistical difference, the VS group required significantly more invasive management for pleural effusions (p=0.012).</p><p><strong>Conclusion: </strong>Posterior MISS demonstrated acceptable radiological and perioperative outcomes even in flexible AIS with Cobb angles ≥80°. These findings suggest the posterior MISS can be a feasible surgical option for selected very severe AIS patients with sufficient flexibility.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 3","pages":"567-576"},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}