Spine deformity最新文献

{"title":"Radiographic predictors of proximal junctional kyphosis after adult spinal deformity surgery: a systematic review and meta-analysis.","authors":"Eslam Abourisha, Tanmay Talavia, Gaurav Jha, Sheweidin Aziz","doi":"10.1007/s43390-026-01563-z","DOIUrl":"https://doi.org/10.1007/s43390-026-01563-z","url":null,"abstract":"<p><strong>Background: </strong>Proximal junctional kyphosis and failure are common complications after adult spinal deformity correction, often leading to reoperation. While global sagittal alignment has been studied extensively, the role of proportional radiographic parameters remains unclear.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and the Cochrane Library were searched (2000-2025). Eligible studies included adults undergoing ASD fusion of four or more levels with reported PJK incidence and key sagittal parameters including LDI, lumbar lordosis, TK, sagittal vertical axis, PI, and pelvic tilt. Risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled weighted mean differences with 95% confidence intervals were calculated using fixed-effects models.</p><p><strong>Results: </strong>Of 1046 records screened, 27 studies were included qualitatively and five studies (802 patients; follow-up 24-72 months) in quantitative synthesis. PJK incidence ranged from 22 to 38%. Patients who developed PJK demonstrated significantly greater postoperative TK (WMD = + 4.9°, p < 0.00001), lower preoperative and postoperative LL (WMD = - 4.5°, p = 0.0002; WMD = - 3.9°, p < 0.0001), higher preoperative SVA (WMD = + 17.2 mm, p < 0.0001), and unexpectedly lower PI (WMD = - 2.4°, p = 0.009). Differences in absolute LDI values, PT, and postoperative SVA were not statistically significant.</p><p><strong>Conclusions: </strong>Greater postoperative TK, reduced LL, elevated preoperative SVA, and lower PI were consistently associated with the development of PJK. These findings underscore the importance of pelvic incidence-based alignment strategies, appropriate restoration and distribution of lumbar lordosis, morphology-aware thoracic contouring, and mechanical transition techniques to mitigate junctional failure following adult spinal deformity correction.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075835","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":"Best Practice Guidelines for the Execution of Intraoperative Neuromonitoring in Spine Deformity Surgery.","authors":"Jason B Anari, Alexander M Park, Michael W Brown, Mehdi M Elfilali, Katerina M Kourpas, Benjamin B Bruins, Alier Franco, Anil Mendiratta, Teeda Pinyavat, Jonathan Umina, Samuel Strantzas, Rajiv Sethi, Stephen Lewis, Rajiv R Iyer, Richard Menger, Daniel J Sucato, Kenneth D Illingworth, Amer F Samdani, Lawrence G Lenke, Michael G Vitale","doi":"10.1007/s43390-026-01559-9","DOIUrl":"https://doi.org/10.1007/s43390-026-01559-9","url":null,"abstract":"<p><p>To develop expert consensus-based guidelines for the execution of intraoperative neuromonitoring (IONM) in routine adolescent idiopathic scoliosis (AIS) and high-risk spinal deformity cases, with the goal to reduce variability in monitoring practices, optimize patient safety and care, and provide a clear framework for operative teams to reference. A modified Delphi process was used to establish expert consensus on best practices for IONM execution. Three consecutive rounds, each including an online survey and a virtual meeting, were conducted among 16 multidisciplinary experts (pediatric and adult orthopedic and neurosurgical spine surgeons, anesthesiologists, neurologists, and neurophysiologists), followed by a fourth online survey to finalize consensus. An 80% agreement threshold for proposed consensus items was set throughout the process. Items that did not reach consensus were refined based on feedback and redistributed in subsequent rounds. Items that met consensus across all the rounds were incorporated into the final best practice guidelines. Across the three rounds, 14 (87.5%), 13 (81.6%), and 14 (87.5%) experts completed the questionnaires and 12 (75.0%), 11 (68.8%), and 13 (81.6%) experts attended the virtual meetings. All 16 (100%) experts completed the final survey. The expert panel reached consensus on 27 items in the AIS cohort and 25 items in the high-risk cohort; final consensus items were organized into IONM Timeline Checklists for the AIS and high-risk cohorts. Multidisciplinary expert consensus-based guidelines for IONM practices were successfully established intended to standardize neuromonitoring practices, reduce variability in care, and facilitate efforts to improve neurologic safety for AIS and high-risk patients undergoing spinal deformity surgery.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075847","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":"Tissue expanders in complex pediatric spine deformity.","authors":"Amareesa Robinson, Scott Oishi, Megan Johnson, David Thornberg, Karl Rathjen","doi":"10.1007/s43390-026-01548-y","DOIUrl":"https://doi.org/10.1007/s43390-026-01548-y","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the use of tissue expansion (TE) as an adjunct for management of tenuous soft tissue envelopes in children with complex spine deformities.</p><p><strong>Methods: </strong>Single institution, retrospective review of patients (minimum 2-year follow-up) who had TE for management of spinal deformity prior to posterior spinal fusion (PSF) between 1997 and 2021. Demographics, clinical, and radiographic data were reviewed. Complications were classified using the Clavien-Dindo system (Grade 3 defined as requiring unplanned return to the operating room [UPROR]) and noted if related to the TE or PSF.</p><p><strong>Results: </strong>Twenty patients were included. Fifteen of the 20 patients had a diagnosis of myelomeningocele (MM), and 7 of the 20 patients (all who had MM) had an open wound at the time of TE placement. Six of the 7 patients (86%) with an open wound and 5 of 13 patients (38%) without an open wound experienced a Grade 3 complication (p=0.07). Of the 11 patients with Grade 3 complication, 1 patient had UPROR related only to TE, 9 patients had an UPROR related to PSF, and 1 patient had UPRORs related to TE and PSF.</p><p><strong>Conclusion: </strong>Tissue expansion can be a useful adjunct in the management of complex spine deformities associated with poor soft tissue envelopes. Patients should be counseled of the high probability of UPROR.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031368","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":"Risk factors for PJK and DJF in operatively corrected adult patients with congenital hemivertebra.","authors":"Yilin Lu, Zekun Li, Xiang Zhang, Junyu Li, Yongqiang Wang, Weishi Li, Miao Yu","doi":"10.1007/s43390-026-01564-y","DOIUrl":"https://doi.org/10.1007/s43390-026-01564-y","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital hemivertebra (HV) is a morphological defect that occurs during embryonic development. This study investigates the risk factors for developing proximal junctional kyphosis (PJK) and distal junctional failure (DJF) after surgery for adults.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 72 consecutive HV patients undergoing surgical treatment at a single center with a minimum 2-year follow-up. Patients' baseline data, clinical features, surgical details, and radiographic parameters were retrospectively analysed. Univariate and multivariate analyses were conducted to explore risk factors affecting the occurrence of PJK and DJF postoperatively.</p><p><strong>Results: </strong>A study of 72 patients found that at final follow-up, 14 (19.4%) developed PJK and 12 (16.7%) developed DJF. PJK patients showed significant differences in multiple hemivertebrae (MHV) and postoperative sagittal parameters (Sacral slope (SS): 34.1 vs 25.6; lumbar lordosis (LL): 42.9 vs 33.7) compared to non-PJK patients. DJF patients differed significantly in BMI, intraoperative transfusions, lumbar disc herniation (LDH) prevalence, and pre/postoperative parameters (preop Pelvic Tilt (PT): 15.7 vs 23.3; postop LL: 34.9 vs 50.5). Patients with PJK (p = 0.008) and DJF (p = 0.041) demonstrated greater preoperative kyphosis. The DJF group had a significantly higher rate of LDH at the distal or adjacent junctional area (83.3% vs 26.7%, p<0.001) and of significant disc degeneration at lower instrumented vertebra+1 (LIV+1) (83.3% vs 38.3%, p = 0.004). While preoperative quality of life scores were similar, the DJF group had worse final Health Related Quality of Life (HRQoL) (p≤0.016). Logistic regression analysis showed that multiple hemivertebrae and smaller postoperative SS (the cut-off value was 32.4°) were risk factors for PJK at the last follow-up. A larger postoperative LL (with a cut-off value of 36.9°) and the presence of lumbar disc herniation were identified as risk factors for DJF.</p><p><strong>Conclusion: </strong>Multiple hemivertebrae and postoperative SS <32.4° are risk factors for PJK, while postoperative LL > 36.9° and LDH are risk factors for DJF.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031435","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":"Who are the best candidates? Factors predicting success and failure of vertebral body tethering.","authors":"Dustin Kress, Eddie Geagea, Taghi Ramazanian, Mona Doshi, Kevin M Neal","doi":"10.1007/s43390-026-01554-0","DOIUrl":"https://doi.org/10.1007/s43390-026-01554-0","url":null,"abstract":"<p><strong>Purpose: </strong>Vertebral body tethering (VBT) is a fusionless alternative for adolescent idiopathic scoliosis (AIS), but predictors of long-term success remain unclear. We aimed to report outcomes 2-8 years following VBT and identify factors associated with revision surgery.</p><p><strong>Methods: </strong>Single institution retrospective review of a prospectively collected AIS database.</p><p><strong>Inclusion criteria: </strong>VBT between 2015-2022, skeletal maturity (Risser 5 or Risser 4 with Sanders 7) at follow-up, and minimum 2-year follow-up or revision surgery. Patients were classified as not requiring revision surgery (NRS) or requiring revision surgery (RS).</p><p><strong>Results: </strong>Forty-one patients were included: 21 (51%) NRS and 20 (49%) RS. Mean follow-up was 4.3 years (NRS) and 3.6 years (RS). Compared with RS, NRS patients had lower preoperative curve magnitude (46° vs. 52°, p = 0.03) and higher Sanders stage (3.4 vs. 2.4, p = 0.01). Sanders <3 (OR = 9.2, 95% CI 1.3-67.3, p = 0.03) and preoperative curve magnitude (OR = 2.7 per 10°, 95% CI 1.1-6.8, p = 0.04) were independent predictors of revision surgery. Double curves had higher revision rates (86% vs. 41%); 30% of RS patients had double curves versus 5% of NRS. Immediate correction to <35° was achieved in 67% (NRS) vs. 25% (RS) (p = 0.01). Final Cobb angle was 25° (NRS) vs. 34° (RS) (p = 0.003).</p><p><strong>Conclusions: </strong>VBT patients not requiring revision surgery had preoperative curves <50° and more advanced skeletal maturity (Sanders 3.4 vs. 2.4). These patients were more likely to achieve immediate correction to <35° and maintain correction at follow-up. These factors should be considered when selecting patients for fusionless techniques and inform preoperative counseling regarding revision risk.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031440","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":"Clinical and radiographic outcomes of robotic-assisted direct pars repairs for spondylolysis.","authors":"Samantha Snyder, Vivien Chan, James Caruso, Elaine Butterworth, Paal Nilssen, Kenneth D Illingworth, Corey T Walker, David L Skaggs","doi":"10.1007/s43390-026-01560-2","DOIUrl":"https://doi.org/10.1007/s43390-026-01560-2","url":null,"abstract":"<p><strong>Background: </strong>Spondylolysis is one of the most common identifiable causes of low back pain in young athletes. Direct pars repair offers a motion-preserving surgical option, and robotic-assisted minimally invasive surgery may reduce invasiveness and improve precision compared to traditional open techniques.</p><p><strong>Methods: </strong>We performed a single-center retrospective review of patients with symptomatic spondylolysis who underwent robotic-assisted direct pars repair from 2023 to 2025. A reference array was placed on the spinous process of the affected vertebrae through a < 2 cm midline incision, and screws were placed through a separate < 2 cm midline incision. Hydroxyapatite screws were planned using pre- or intraoperative CT or synthetic CT. Screw position was confirmed with fluoroscopy and EMG.</p><p><strong>Results: </strong>The study included 32 consecutive patients (mean 16 years, range 10-23) with 63 pars fractures (92% bilateral). Four patients (12%) had Grade 1 spondylolisthesis. Mean spondylolysis gap size was 1.5 mm (range 0.0-7.7 mm). Mean bilateral repair operative time was 118 min, and 27 patients (84%) were discharged same-day. Fourteen fractures had bone grafting at index surgery, and three patients (STIR negative) underwent bone grafting later for non-union. Four cases (13%) had minor perioperative complications with full resolution (anterior thigh pain/tightness, bilateral lower extremity paresthesia and transient pain that did not limit ambulation, seroma that resolved after bedside aspiration, guidewire breakage). There were no major complications or neurological injuries. At first postoperative follow-up (mean 21 days), 28 (88%) patients had complete resolution of pre-operative pain and 4 (12%) had improved pain. First CT (mean 10 weeks, n = 59 fractures) demonstrated complete union in 25 (42%), partial union in 24 (41%), and no union in 10 (17%). Among patients with delayed fracture healing requiring additional CT scans for surveillance (n = 28 fractures), final CT at a mean postoperative time of 27 weeks demonstrated complete union in 20 (71%), partial union in 3 (11%), and no union in 0 (0%). At final CT, STIR-positive fractures (n = 8) achieved 100% complete union versus 45% in STIR-negative fractures (n = 20). Screw placement matched preoperative planning in 100% of cases. One patient had a subsequent lamina fracture around the screw and will likely need revision. Twenty-nine of 32 patients (90.6%) returned to sport/baseline activity.</p><p><strong>Conclusion: </strong>This is the largest case series of spondylolysis treated with robotic-assisted direct pars repair. 100% of patients with a pre-operative STIR-positive MRI were pain-free and returned to sports.</p><p><strong>Level of evidence: </strong>level III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018068","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":"Is myelomeningocele a distinct subgroup within neuromuscular early-onset scoliosis (M-EOS)? A clinical and radiographic comparison after graduation from growing rod treatment.","authors":"Ataberk Beydemir, Rafik Ramazanov, Mehmet Berktas, Mehmet Ayvaz, Halil Gokhan Demirkiran, Muharrem Yazici","doi":"10.1007/s43390-026-01558-w","DOIUrl":"https://doi.org/10.1007/s43390-026-01558-w","url":null,"abstract":"<p><strong>Purpose: </strong>The aim was to compare clinical and radiographic outcomes between myelomeningocele (MMC) and other neuromuscular early-onset scoliosis (EOS) patients following graduation from growing rod treatment and to evaluate whether MMC should be considered a distinct subgroup within the classification of EOS.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 26 patients with neuromuscular EOS (10 with MMC, 16 with other neuromuscular etiologies) treated with traditional or magnetically controlled growing rods between 2004 and 2023, all of whom achieved graduation and had a minimum of 2-year of post-graduation follow-up. Demographic, clinical, radiographic, and complication data were analyzed. Complication burden was assessed using unplanned return to the operating room (UPROR), modified Clavien-Dindo-Sink grading, and negative binomial regression.</p><p><strong>Results: </strong>Wound-related complications were significantly more frequent in the MMC group (80.0% vs. 6.2%, p = 0.002). The MMC patients had a higher complication burden (mean 3.3 ± 2.3 vs. 0.9 ± 1.4, p = 0.003), more multiple reoperations (≥ 2 UPROR: 70.0% vs. 0.0%, p = 0.007), more severe complications (modified Clavien-Dindo-Sink grade 3b: 70.0% vs. 25.0%, p = 0.016), and a 3.52-fold higher overall complication rate (IRR = 3.52, 95% CI 1.63-10.80). Spinal growth and sagittal alignment were also significantly compromised in the MMC patients.</p><p><strong>Conclusion: </strong>MMC patients demonstrate a markedly distinct complication profile and clinical trajectory compared to other neuromuscular EOS patients, supporting consideration of MMC as a separate subgroup within EOS classification systems to improve risk stratification and guide individualized treatment. Even within the current framework, recognizing MMC through a diagnosis-specific modifier may offer a practical means of improving risk stratification without requiring structural reclassification.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018086","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":"Low bone mineral density in non-ambulatory adolescents relates to lower correction of neuromuscular scoliosis after posterior spinal fusion.","authors":"Konstantinos Tsaknakis, Clara Knieriem, Charlotte Scheulen, Venla Soini, Katja A Lüders, Lena Braunschweig, Luise Metzger, Jan-Henrik Kreuzer, Katharina Jäckle, Heiko M Lorenz, Anna K Hell","doi":"10.1007/s43390-026-01532-6","DOIUrl":"https://doi.org/10.1007/s43390-026-01532-6","url":null,"abstract":"<p><strong>Purpose: </strong>Non-ambulatory adolescents with neuromuscular scoliosis (NMS) often require surgical intervention. The purpose of this study was to examine whether low bone mineral density (BMD) affects the results of posterior spinal fusion.</p><p><strong>Methods: </strong>Volumetric BMD (vBMD) was measured in preoperative computed tomography (CT) scans of scoliotic patients with Duchenne Muscular Dystrophy (DMD), Spinal Muscular Atrophy (SMA), Cerebral Palsy (CP) and Rett syndrome (RTT). CT scans of healthy age-matched adolescents were used to define reference vBMD values and to calculate Z-scores. Scoliosis angles were measured in preoperative and postoperative radiograms to evaluate neuromuscular spinal deformity correction.</p><p><strong>Results: </strong>Initial scoliosis angles of 169 patients with NMS were 83 ± 31°. PSF improved deformities to 33 ± 21° with an overall correction of 60.8 ± 16.4%. All patients (n=169) had significantly lower vBMD values in comparison to age-matched healthy controls (n=87). Patients with DMD (n=55) had lowest vBMD for age values, followed by patients with SMA (n=34), CP (n=52) and RTT (n=28). Significantly lower Z-scores (- 2.5±1.5 versus - 1.7±1.3) were found in adolescents with poor scoliosis correction in comparison to those with good results. A higher initial scoliosis angle had a negative effect on the deformity correction (R²=0.089).</p><p><strong>Conclusion: </strong>All adolescents with NMS had significantly lower vBMD in comparison to age-matched controls. Lower vBMD values were associated with poor spinal deformity correction of 60% and less.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018124","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":"Reply to a letter to the editor regarding \"Does spasticity affect outcomes in patients with cerebral palsy undergoing posterior spinal fusion?\"","authors":"Daniel Cherian, Mitchell Parker, Amer F Samdani, Joshua M Pahys, Terrence G Ishmael, Paul D Sponseller, Peter O Newton, Harms Study Group, Steven W Hwang","doi":"10.1007/s43390-026-01562-0","DOIUrl":"https://doi.org/10.1007/s43390-026-01562-0","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017338","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":"Reoperation and fusion after documented tether breakage following vertebral body tethering: a systematic review and meta-analysis.","authors":"Evren Sönmez, Lokman Ayhan, Melih Kapdan","doi":"10.1007/s43390-026-01561-1","DOIUrl":"https://doi.org/10.1007/s43390-026-01561-1","url":null,"abstract":"<p><strong>Purpose: </strong>Radiographic tether breakage after vertebral body tethering (VBT) is common, but its clinical consequence remains uncertain. After a break is detected, the relevant question is not breakage incidence but the conditional probability of further surgery. We quantified patient-level reoperation and fusion-containing surgery after documented breakage.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched from inception through June 30, 2026. Two reviewers independently screened English-language full-text reports, extracted linked post-breakage outcomes, and adjudicated cohort overlap. The primary outcome was any unplanned reoperation after documented breakage; the principal secondary outcome was fusion-containing surgery. One representative cohort per overlap cluster was selected. Proportions were synthesized using a binomial normal generalized linear mixed model.</p><p><strong>Results: </strong>Five independent cohorts contributed 230 break-positive patients; 41 underwent unplanned reoperation (pooled proportion, 15.7%; 95% CI 6.0-24.4). Four cohorts reported unique fusion-patient counts; 13 of 146 patients underwent fusion-containing surgery (8.9%; 95% CI 3.2-14.2). Thus, 189 of 230 patients (82.2%) had no reported reoperation and 133 of 146 (91.1%) had no reported fusion-containing surgery during source-study follow-up. Certainty was very low for both outcomes.</p><p><strong>Conclusion: </strong>Documented breakage should not be assumed to represent treatment failure or an automatic indication for revision. Most break-positive patients had no reported further surgery during available follow-up in these observational cohorts, although selected patients required tether revision, hybrid salvage, or fusion. Management should be based on interval progression, symptoms, residual deformity, alignment, skeletal maturity, and patient priorities rather than radiographic breakage alone.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018112","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}