Spine deformity最新文献

{"title":"Google and ChatGPT responses to common patient questions about scoliosis: Comment.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1007/s43390-025-01179-9","DOIUrl":"https://doi.org/10.1007/s43390-025-01179-9","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding \"Impact of a novel patient-specific, patient-matched Bezier parametric curve rod platform on proximal junction biomechanics in an in silico thoracolumbar instrumented fusion model\".","authors":"Leela Kumaran, Sheifali Gupta","doi":"10.1007/s43390-025-01170-4","DOIUrl":"https://doi.org/10.1007/s43390-025-01170-4","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sex on S2-alar-iliac pelvic screw position and lumbosacral rod alignment in adult spine deformity.","authors":"Ramone M Brown, Wasil Ahmed, Matthew S Miyasaka, Daniel Berman, Jeremy Steinberger, Samuel K Cho, Jun S Kim, James D Lin","doi":"10.1007/s43390-025-01178-w","DOIUrl":"https://doi.org/10.1007/s43390-025-01178-w","url":null,"abstract":"<p><strong>Background: </strong>S2 Alar-Iliac (S2AI) screw placement is a common method to achieve stable lumbosacral fixation in the setting of multilevel fusion constructs. Differences in pelvic morphology between males and females can result in a more medial screw starting point in males. This can affect the ability to easily connect the pelvic screw to the rest of the construct. The purpose of this study is to assess the impact of sex and pelvic anatomy on the location of S2AI screw placement and lumbosacral rod alignment in the coronal plane.</p><p><strong>Methods: </strong>Consecutive cases with S2AI screw placement were identified. Radiographic measurements included the distance between the posterior superior iliac spine (PSIS) on preoperative computed tomography (CT) imaging, distance between S2AI screw heads, and rod-to-rod angles.</p><p><strong>Results: </strong>Females exhibited significantly greater distance between PSIS compared to males, reflecting sex-based anatomical differences in pelvic structure (p < 0.01). Average rod-to-rod angles were significantly more convergent distally in males than in females (p < 0.05). No significant differences were observed between freehand and stereotactic navigation techniques for rod-to-rod angles or screw distances. PSIS distance was a strong predictor of both rod-to-rod angle (β = 3.3, p < 0.01) and screw distances (β = 0.3, p < 0.01). When evaluating sex and technique as predictors, only sex was significant for PSIS distance (p < 0.01) and rod-to-rod angle (p < 0.05).</p><p><strong>Conclusions: </strong>The placement of S2AI screws demonstrate sex-based anatomical differences in the location of S2AI screw placement. These anatomical differences should be taken into account in preoperative planning.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three novel orbito-cervical parameters: highly repeatable and simple measurements of horizontal gaze.","authors":"Féthi Laouissat, Sonia Ramos-Pascual, Jean-Charles Le Huec, Danilo Casasola, Ankitha Kumble, Mo Saffarini, Pierre Roussouly","doi":"10.1007/s43390-025-01186-w","DOIUrl":"https://doi.org/10.1007/s43390-025-01186-w","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this single centre radiographic study on healthy volunteers was to evaluate three novel orbito-cervical parameters in a population of healthy volunteers and calculate the observer agreements and errors for these parameters.</p><p><strong>Methods: </strong>The cohort comprised 126 healthy adult volunteers, 88 females and 38 males, aged 33.6 ± 12.0, with full-spine sagittal radiographs and no history of back and/or neck pain, spine and/or lower limb pathologies, or spine and/or hip surgeries. The following were measured on radiographs: C1-slope (C1S), orbito-cervical tilt (OCT), orbito-cervical incidence (OCI), chin-brow vertical angle (CBVA), McGregor's slope (McGS), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Pearson's correlation coefficients were calculated between all radiographic measurements.</p><p><strong>Results: </strong>C1S was 9.8 ± 6.6°(range, 0.1-29.1), OCT was 66.7 ± 6.9°(range, 48.7-82.0), and OCI was 75.9 ± 7.2°(range, 52.5-89.8). All measurements had excellent observer agreements (ICC > 0.900) and low observer errors (MAE < 2.5). OCI strongly correlated with C1S + OCT (r = 0.95, p < 0.001). OCT strongly correlated with McGregor's slope (r = - 0.78, p < 0.001), moderately correlated with CBVA (r = 0.64, p < 0.001), but weakly correlated with OCI (r = 0.46, p < 0.001). C1S moderately correlated with OCT (r = - 0.51, p < 0.001), OCI (r = 0.5, p < 0.001), CBVA (r = - 0.52, p < 0.001), and McGregor's slope (r = 0.64, p < 0.001).</p><p><strong>Conclusion: </strong>OCI is strongly correlated with C1S + OCT and these orbito-cervical parameters are to some extent correlated with existing sagittal cervical parameters. Furthermore, they have excellent observer agreements (ICC > 0.900) and low inter- and intra- observer errors (MAE < 2.5). The authors recommend the use of these orbito-cervical parameters in clinical practice to provide a better understanding of horizontal gaze, leading to improved preoperative planning for spinal fusion.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing stable vertebra on push-prone traction radiographs for the determination of the lowest instrumented vertebra: a novel approach for AIS patients with Lenke type 3C and 6C.","authors":"Tinnakorn Pluemvitayaporn, Suttinont Surapuchong, Nuttavut Chavalparit, Piyabuth Kittithamvongs, Warot Ratanakoosakul, Kitjapat Tiracharnvut, Chaiwat Piyasakulkaew, Sombat Kunakornsawat","doi":"10.1007/s43390-025-01188-8","DOIUrl":"https://doi.org/10.1007/s43390-025-01188-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess whether using stable vertebra on push-prone traction radiographs for selecting the lowest instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) patients with Lenke types 3C and 6C undergoing posterior spinal surgery can preserve more lumbar motion segments while still achieving satisfactory surgical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;AIS patients requiring surgical treatment typically present with progressive curves exceeding 40° and are skeletally immature. This study specifically focuses on AIS patients exhibiting Lenke curve types 3C and 6C, which include structural thoracic as well as thoracolumbar and lumbar curves. The selection of the LIV remains a contentious issue due to concerns about distal adding-on and the potential for spinal imbalance postoperatively. Existing literature suggests that longer fusion constructs and positioning the LIV below L3 can lead to significant functional limitations and accelerated disc degeneration. While Lenke advocated for identifying the stable vertebra (SV) as the LIV, our recent study indicates that push-prone traction radiographs provide superior predictability for correcting postoperative spinal alignment. This study aims to evaluate the effectiveness of using the stable vertebra identified through push-prone traction radiographs as the LIV in preserving segmental motion during posterior spinal surgery for managing Lenke type 3C and 6C curves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;AIS patients with Lenke type 3C and 6C who underwent posterior spinal surgery between 2021 and 2024 were enrolled in the study. Preoperative 36-inch whole spine radiographs, including push-prone traction view, were obtained for curve flexibility assessment. The lowest instrumented vertebra (LIV) was determined by identifying the stable vertebra (SV) on push-prone traction radiographs. Demographic data, including sex, age, BMI, Lenke's curve type, and pre- and postoperative major coronal Cobb angle, thoracic kyphosis, lumbar lordosis, and C7 to central sacral vertical line (C7-CSVL), were collected. Statistical analysis was conducted to assess the differences in curve magnitudes between pre- and postoperative measurements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-six AIS patients (33 female and 3 male) with a mean age of 13.9 ± 2.2 years were included in this study, with a mean follow-up period of 28.4 months. Preoperatively, the cohort presented with Lenke type 3C (24 out of 36) and Lenke type 6C (12 out of 36). The preoperative thoracic curve was corrected to an average of 5.7°, demonstrating an average correction rate of 89%. Similarly, the preoperative lumbar curve was corrected to an average of 5° with a correction rate of 90%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Push-prone traction radiographs may serve as an alternative method for determining the optimal LIV level in patients with Lenke type 3C and 6C. Identifying stable vertebra on push-prone traction radiographs","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinopelvic alignment and sagittal gait kinematics of adult patients with cerebral palsy.","authors":"Patrick P Nian, Vishnu Deep Chandran, Colson Zucker, Peter Cirrincione, Zhenkun Gu, Silvia Zanini, Jennifer Jezequel, Bridget Assip, Sherry Backus, Dara Jones, David Scher, Paulo Selber","doi":"10.1007/s43390-025-01190-0","DOIUrl":"https://doi.org/10.1007/s43390-025-01190-0","url":null,"abstract":"<p><strong>Purpose: </strong>Sagittal spinopelvic alignment (SPA) is originally calculated by the algebraic expression pelvic incidence-lumbar lordosis (PI-LL), heralded numerous clinically relevant radiographic measures of spine alignment, e.g., T4-L1-pelvic angle. SPA malalignment compromises spine fusion outcomes and quality of life of typically aging persons. This study investigated gait and SPA of patients with cerebral palsy (CP) using multiple sagittal radiographic measures.</p><p><strong>Methods: </strong>Twenty-three patients, mean age 35 years with CP at GMFCS I-II were included. Radiographic measures included C2PA, T4PA, L1PA. PI-LL and T4-L1PA mismatch were defined as > 10°/ < - 10° and > 4°/ < - 4°, respectively. Trunk, pelvis, hips, and knees kinematics were obtained. Statistical parameter mapping (SPM) assessed kinematic differences throughout the gait cycle. Multivariable linear regression assessed the relationship between gait and radiographic parameters.</p><p><strong>Results: </strong>Fourteen and eleven patients (60.9% and 47.8%) presented with PI-LL and T4-L1PA mismatch, respectively. PI-LL mismatched patients demonstrated significantly lower knee flexion during gait. T4-L1PA mismatched patients demonstrated increased anterior pelvic tilt, hip flexion, and decreased knee flexion during gait, which was consistent with SPM analysis. Multivariable linear regression showed T4-L1PA, C2PA, and anterior pelvic tilt were associated with knee flexion.</p><p><strong>Conclusion: </strong>This is the first study to evaluate SPA parameters and gait kinematics in patients with CP. This observational and preliminary data suggested that SPA and knee flexion in gait may be associated. Whether the variations in gait patterns are coping mechanisms or the cause for SPA malalignment requires clarification. The implications of SPA malalignment on the quality of life of this population warrant further investigations.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining anatomical landmarks for simulated juxtapedicular screw placement for posterior spinal fusion in adolescent patients with scoliosis.","authors":"Adam A Jamnik, Sarah Pirkle, Dennis P Devito, Joshua S Murphy, Brandon A Ramo, Nicholas D Fletcher","doi":"10.1007/s43390-025-01160-6","DOIUrl":"https://doi.org/10.1007/s43390-025-01160-6","url":null,"abstract":"<p><strong>Purpose: </strong>To define anatomical landmarks on the vertebrae at each spinal level for surgeons to use intraoperatively as a guide for the placement of juxtapedicular screws in the setting of hypoplastic or absent pedicles.</p><p><strong>Methods: </strong>Preoperative computed tomography (CT) of patients with adolescent idiopathic scoliosis (AIS) was analyzed for thoracic pedicles ≤ 3 mm wide, measured between the outer cortices at the isthmus, as these may require a juxtapedicular screw for safe placement. For these pedicles, a simulated juxtapedicular screw was placed into the vertebrae using image reconstruction software. The distance from the screw's insertion point was measured in the axial plane to the medial and lateral borders of the superior articular process (SAP) and to the posterior tip of the transverse process (TP), and in the sagittal plane to the junction of the SAP and TP. Screw trajectory angle was measured between the longitudinal axis of the screw and the sagittal and axial planes.</p><p><strong>Results: </strong>Of 6324 pedicles, a total of 378 pedicles (6.0%) met inclusion. The average distance to the medial and lateral borders of the SAP was 14.7 ± 3.4 mm and 10.7 ± 5.4 mm, respectively; to the tip of the TP was 9.0 ± 3.9 mm, and to the TP/SAP junction 2.8 ± 1.6 mm. The average angle in the axial plane was 21.1 ± 4.4° and in the sagittal plane it was - 4.2 ± 3.6°.</p><p><strong>Conclusions: </strong>Preoperative CT scans were used to map a safe starting point and trajectory for juxtapedicular screw placement in thoracic vertebrae. These findings can assist surgeons with thoracic pedicle screw placement.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting shoulder balance using novel intraoperative radiographic measures in adolescent idiopathic scoliosis.","authors":"Lane H McCoy, Kirsten Brouillet, Scott J Luhmann","doi":"10.1007/s43390-025-01185-x","DOIUrl":"https://doi.org/10.1007/s43390-025-01185-x","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case-series OBJECTIVE: The purpose of this study is to validate novel radiographic measures, specifically Rib-2 height (R2H) and T1-Rib-2 Change (T1R2C), as predictors of postoperative shoulder balance following adolescent idiopathic scoliosis (AIS) surgery. Shoulder balance following posterior spinal fusion (PSF) in AIS continues to be important for optimal aesthetic outcomes and patient satisfaction. Using currently accepted radiographic measures intraoperatively (e.g., T1-tilt) for the achievement of shoulder balance remains a challenge. Power analysis determined 28 patients were needed to achieve 80% power with an effect size Pearson's r = 0.5.</p><p><strong>Methods: </strong>AIS patients who underwent PSFs were retrospectively identified when no further deformity correction was completed after the last intraoperative long-cassette radiograph. Traditional radiographic measures were completed. For intra-op patients, a reference vertical was used for all measurements. All measures were Pearson correlated with radiographic shoulder height (RSH) 6 weeks post-op (6wk) and 2y.</p><p><strong>Results: </strong>There were 29 patients (26 female, 90%) whose mean age at surgery was 14.1 years. The mean RSH changed from -14.9mm pre-op to 5.4mm 2y post-op (p =1.9e-6). T1R2C and R2H demonstrated strong positive correlations pre-op (T1R2C r=0.7, p =0.0001) / (R2H r=0.6, p =0.001) to post-op (T1R2C r=0.8, p =2.23e-7) / (R2H r=0.6, p =2e-4). All radiographic variables showed significant correlations with RSH pre-op to post-op (p<0.001). Intraoperative R2H had intermediate associations with RSH at 6wks (r=0.48, p=0.018) and 2y post-op (r=0.4, p =0.04). Intra-op T1R2C and remaining coronal measurements showed no correlation with RSH. Linear regression models show a significant predictive relationship between RSH at 2y and intra-op R2H. The model was not improved when corroborated with intra-op T1R2C.</p><p><strong>Conclusion: </strong>R2H was a significant predictor of RSH pre-op to post-op and intra-op to post-op, performing better than T1R2C and other radiographic measures. R2H could be used as an objective radiographic measurement tool to plan surgery and during surgery to optimize shoulder balance following PSF including T1-Rib-2 Change.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling shoulder balance in scoliosis: a clinical and radiological analysis.","authors":"Nikhil Goyal, Siddharth S Sethy, Pratibha Bhatia, Vishal Verma, Saptarshi Barman, Bhaskar Sarkar, Pankaj Kandwal","doi":"10.1007/s43390-025-01177-x","DOIUrl":"https://doi.org/10.1007/s43390-025-01177-x","url":null,"abstract":"<p><strong>Purpose: </strong>Shoulder balance is an important parameter while assessing the scoliosis deformity from a patient as well as clinician's perspective following the treatment. While there is uniform consensus about the importance of shoulder balance in scoliosis patients, what constitutes shoulder symmetry is still debatable. The aim of the study was to evaluate radiographic and clinical parameters both for medial and lateral components of shoulder balance.</p><p><strong>Methods: </strong>A prospective database of scoliosis was reviewed. Patient demographics and radiological parameters, including radiographic shoulder height, clavicle angle, T1 tilt, first-rib angle, coracoid height difference, and clavicle rib intersection distance, were recorded. Shoulder angle, axillary angle, neck trapezius angle, lateral and medial shoulder height, axillary height, and neck height were recorded for clinical parameters by two independent observers. SRS-22r score was used for patient-reported outcome measure.</p><p><strong>Results: </strong>57 patients (AIS = 31, EOS = 26) were recruited. Intra-observer and inter-observer reliability was excellent for both radiographic and clinical parameters. Most of the radiological parameter had poor-to-moderate correlation with clinical parameters except Radiological Shoulder Height with Lateral Shoulder Height (r = 0.6, p < 0.05) and First Rib Angle with Medial Shoulder Height (r = 0.6, p < 0.05) having strong corelations. On comparing EOS and AIS patients for radiographic and clinical parameters correlation, no significant difference was found between two groups. First rib angle, neck trapezial angle, and neck height were significantly higher in medial shoulder imbalance group, while coracoid angle, radiological shoulder height, coracoid height difference, and shoulder angle were significantly higher in lateral shoulder imbalance group.</p><p><strong>Conclusions: </strong>The results indicated that radiographic parameters could only partially reflect the clinical appearance of shoulders. In surgical planning of deformity correction, both medial and lateral components of shoulder balance should be taken into consideration for both radiological and clinical parameters. Level of Evidence Diagnostic study, Level III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and in-brace Cobb angle predict brace failure in adolescent idiopathic scoliosis.","authors":"Shinji Sasao, Hiroki Oba, Shota Ikegami, Masashi Uehara, Terue Hatakenaka, Daisuke Kurogochi, Takuma Fukuzawa, Keisuke Shigenobu, Fumiaki Makiyama, Michihiko Koseki, Jun Takahashi","doi":"10.1007/s43390-025-01163-3","DOIUrl":"https://doi.org/10.1007/s43390-025-01163-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify independent risk factors for brace treatment failure, examine the correlation between initial in-brace Cobb angle and curve progression, and assess the relationships among age, curve type, initial in-brace Cobb angle, and treatment success.</p><p><strong>Methods: </strong>Eighty consecutive patients (76 girls and 4 boys; mean age: 12.0 ± 1.2 years) commenced treatment with an underarm brace and were followed for a minimum of 2 years after brace initiation. Brace treatment failure was defined as a final Cobb angle of ≥ 50°, surgery, or curve progression ≥ 6°. A spinal surgeon evaluated standing long-cassette antero-posterior radiographs the pre-treatment, initial in-brace, and final follow-up time points. Multivariate analysis was conducted to classify patients into the bracing success and failure groups. We employed receiving operator characteristic analysis to determine cut-off values based on age and initial in-brace Cobb angle.</p><p><strong>Results: </strong>The cohort of 80 patients were followed for a mean of 3.1 ± 1.2 years. Overall success rate was 62%, with 19 patients requiring surgery and 30 experiencing bracing failure. Bracing success cases exhibited significantly lower pre-treatment Cobb angle (29.1° vs. 31.7°; P = 0.038), lower initial in-brace Cobb angle (15.5° vs. 21.0°; P < 0.001), and higher in-brace correction rate (48.6% vs. 32.9%; P < 0.001). Multivariate analysis identified younger age (+ 1 year, odds ratio 0.44; P = 0.006) and higher initial in-brace Cobb angle (+ 10°, odds ratio 5.0; P = 0.009) as independent predictors of treatment failure, with cut-off values of 12 years and 16°, respectively.</p><p><strong>Conclusion: </strong>For patients aged ≥ 12 years, controlling Cobb angle to < 16° at the initial underarm brace fitting may prevent significant curve progression and reduce the likelihood of surgery.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}