Spine deformity最新文献

{"title":"Patient-perceived recovery after posterior spinal fusion: evaluating minimum clinically important difference (MCID) in adolescents with idiopathic scoliosis.","authors":"Leila Mehraban Alvandi, J Nicholas Charla, Zachariah Samuel, Edina Gjonbalaj, Mohamed Said, Jorden Xavier, Carolyn Rachofsky, Morgan Roche, Priya Singh, Yungtai Lo, Jacob Schulz, Jaime A Gomez, Eric D Fornari","doi":"10.1007/s43390-026-01374-2","DOIUrl":"https://doi.org/10.1007/s43390-026-01374-2","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) affects 1-3% of children in the United States, with approximately 38,000 patients undergoing posterior spinal fusion (PSF) annually. The relationship between preoperative patient-reported outcomes, postoperative recovery, and long-term clinical significance remains unclear. This study assesses longitudinal changes in Scoliosis Research Society-22r (SRS-22r) scores. It evaluates clinical significance using the Minimum Clinically Important Difference (MCID) in AIS patients undergoing PSF.</p><p><strong>Study design: </strong>Retrospective study using prospectively collected data.</p><p><strong>Methods: </strong>A retrospective study was conducted using prospectively collected data on AIS patients who underwent PSF at a single academic institution between 2012 and 2022. Patient-reported outcomes were assessed using the SRS-22r questionnaire at preoperative, 6-month, 1-year, and ≥ 2 years postoperative time points. MCID threshold achievements were determined using anchor-based criteria from Bago et al. The percentage of patients achieving MCID and predictors of MCID achievement were analyzed using logistic regression.</p><p><strong>Results: </strong>A total of 161 patients (mean age 15.26 ± 2.15 years; 65.8% female) were included. At 1 year, MCID achievement ranged from 30.1% (Self-Image) to 43.4% (Mental Health). By ≥ 2 years, MCID rates declined in Pain (25.9%) and Self-Image (22.8%) but increased in Function/Activity (44.1%). Lower preoperative SRS-22r scores consistently predicted MCID achievement across all domains. A documented mental-health history reduced the likelihood of Pain MCID at 1 year, and larger postoperative Cobb angles independently decreased the odds of achieving Self-Image MCID at both follow-up points. Neighborhood opportunity (Child Opportunity Index) was not associated with outcomes. Sensitivity analyses demonstrated that complete-case ≥ 2 year MCID rates were consistently bounded by best- and worst-case values and closely approximated LOCF estimates, supporting robustness despite attrition.</p><p><strong>Conclusion: </strong>Meaningful postoperative improvement after PSF varies substantially by SRS-22r domain. Pain and mental-health gains occurred early and stabilized, whereas function demonstrated ongoing recovery, and self-image improved rapidly and remained stable. MCID achievement was most likely in patients with greater preoperative symptom burden, while mental-health history and residual postoperative deformity diminished domain-specific improvements. The stability of MCID patterns across sensitivity analyses reinforces the reliability of long-term findings. These results highlight the importance of incorporating psychological assessment, expectation management, and attention to postoperative alignment into perioperative care for AIS patients.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820559","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":"Identification of predictors for proximal junctional kyphosis and failure following all-posterior surgery for adolescent-onset kyphotic deformities.","authors":"Salih Kaya, Sinan Yılar","doi":"10.1007/s43390-026-01390-2","DOIUrl":"https://doi.org/10.1007/s43390-026-01390-2","url":null,"abstract":"<p><strong>Objective: </strong>To identify independent predictors of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in patients with adolescent-onset kyphotic deformities.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients with kyphotic deformities presenting during adolescence who underwent all-posterior corrective surgery performed by a single experienced spine surgeon between 2015 and 2023. A total of 132 patients met the inclusion criteria. Demographic, radiographic, and surgical variables were collected. Patients were classified as PJK( +) or PJK(-). To address clinical relevance, a secondary analysis further stratified PJK( +) patients into asymptomatic radiographic PJK and a PJF-surrogate group. Group comparisons were performed using Mann-Whitney U and chi-square or Fisher's exact tests. Variables associated with PJK and the PJF-surrogate outcome were entered into multivariable logistic regression models.</p><p><strong>Results: </strong>The median age was 18 years (IQR, 16-22), with 68 females (51.5%) and 64 males (48.5%) and a median follow-up of 52 months (minimum 24 months). PJK developed in 36 of 132 patients (27.2%). Age, immediate postoperative proximal junctional angle (PJA), ΔPJA, and ΔSVA values were significantly higher in the PJK( +) group (all p < 0.05). In multivariable analysis, immediate postoperative PJA and sagittal vertical axis difference (ΔSVA) were independent predictors of PJK, with excellent model discrimination (AUC 0.95). In the secondary analysis, patients meeting PJF-surrogate criteria demonstrated significantly higher immediate postoperative PJA and greater ΔPJA from postoperative to final follow-up (all p < 0.05). Immediate postoperative PJA remained an independent predictor of PJF-surrogate status in multivariable analysis (OR 1.58; p = 0.012).</p><p><strong>Conclusions: </strong>Higher immediate postoperative PJA and ΔSVA were independently associated with the development of PJK. Early postoperative junctional alignment may serve as an indicator of patients at risk for clinically relevant junctional deterioration.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780342","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":"Pregnant adolescent idiopathic scoliosis patients with prior fusion are more often recommended cesarian section delivery, without clear differences in maternal or fetal complications: a retrospective matched-cohort analysis.","authors":"Alexandros F Pappajohn, Anthony E Seddio, Om B Jahagirdar, Wasif Islam, Sahir S Jabbouri, Dominick A Tuason, Mert O Bahtiyar, Jonathan N Grauer","doi":"10.1007/s43390-026-01373-3","DOIUrl":"https://doi.org/10.1007/s43390-026-01373-3","url":null,"abstract":"<p><strong>Purpose: </strong>Women with adolescent idiopathic scoliosis (AIS) who have undergone posterior spinal fusion (PSF) prior to conception may have altered pregnancy courses. The current study aimed to evaluate female AIS patients with, relative to without, prior PSF for rates of cesarian (C)-section and pregnancy-related complications at a national level.</p><p><strong>Methods: </strong>First-time pregnancies in female AIS patients were identified using the 2010 - Q1 2023 PearlDiver M170 database. Patients were stratified by prior PSF status (AIS[-]PSF versus AIS[ +]PSF) and matched 4:1 based on age and comorbidity burden. Pregnancy outcomes including vaginal delivery, C-section, and conversion from vaginal delivery to C-section (unplanned C-section) were compared using multivariate analyses. Additionally, vaginal delivery and C-section patients were stratified and separately matched 4:1 by PSF status and compared for maternal and fetal complications.</p><p><strong>Results: </strong>In matched cohorts (AIS[-]PSF, n = 2,623; AIS[ +]PSF, n = 656), those with prior PSF were more likely to deliver by C-section (OR 1.61, p < 0.001), but not more likely to undergo unplanned C-section. The incidence of all studied maternal or fetal complications during pregnancy and delivery was not statistically different for vaginal delivery or C-section regardless of PSF status (p > 0.05 for all).</p><p><strong>Conclusion: </strong>Among women with AIS, prior posterior spinal fusion is associated with higher rates of cesarean delivery but not with increased maternal or fetal complications, suggesting that vaginal delivery may be safely considered when otherwise clinically appropriate.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780337","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":"Can pelvic incidence be used to analyse the sagittal profile in adolescent idiopathic scoliosis? A retrospective analysis of 100 patients.","authors":"Ajoy Prasad Shetty, Juan Esteban Muñoz Montoya, Karthik Ramachandran, K S Sri Vijay Anand, Rishi Mugesh Kanna, Shanmuganathan Rajasekaran","doi":"10.1007/s43390-026-01383-1","DOIUrl":"https://doi.org/10.1007/s43390-026-01383-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate pelvic incidence (PI) as a reliable parameter for analysing sagittal profiles in patients with adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>This retrospective cohort study included 100 patients with AIS (aged 12-17 years) who underwent posterior spinal deformity correction and had a 2-year follow-up. Radiographic parameters-Pelvic Incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), and T1 pelvic angle (TPA)-were evaluated preoperatively, at 6 months, and at 2 years postoperatively. Sagittal profiles were classified using the theoretical Roussouly system. Statistical analysis used repeated-measures ANOVA with Tukey HSD post hoc testing to assess temporal variability and Pearson correlation coefficients to assess associations between pelvic and spinal parameters.</p><p><strong>Results: </strong>The mean age was 13.3 years, with females comprising 66% of the cohort; Lenke type 5 was the most common curve type. Roussouly type 3 predominated at all time points. Pelvic parameters (PI and SS) remained stable (p > 0.1), whereas spinal parameters showed significant changes in LL (p = 0.000) and TK (p = 0.001). Global alignment shifted in SVA (p = 0.014), while TPA remained unchanged (p > 0.3). PI consistently correlated with PT (r = 0.60), SS (r = 0.64), and LL (r = - 0.55) across intervals.</p><p><strong>Conclusion: </strong>PI showed minimal temporal variability, confirming its reliability as a morphological parameter in AIS. These findings support the role of PI in sagittal alignment assessment and reinforce the applicability of the Roussouly classification in AIS patients.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820570","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":"Comment on \"Outcomes after surgical correction of severe scoliosis in patients with osteogenesis imperfecta: a prospective, 2-year minimum follow-up study with radiographic and patient-reported outcomes\".","authors":"Xin Zhang","doi":"10.1007/s43390-026-01384-0","DOIUrl":"https://doi.org/10.1007/s43390-026-01384-0","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780316","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":"Comment on \"does an increased preoperative body mass index (BMI) affect adolescent idiopathic scoliosis surgery outcomes and complications? a meta-analysis\".","authors":"Mengyue Wang, Junjie Jiang, Meimei Wang","doi":"10.1007/s43390-026-01381-3","DOIUrl":"https://doi.org/10.1007/s43390-026-01381-3","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780273","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":"Response to \"Comment on \"Artificial intelligence automated measurements of spinopelvic parameters in adult spinal deformity-a systematic review\"\".","authors":"Saarang Patel, Anthony Bishara, Tej D Azad","doi":"10.1007/s43390-026-01387-x","DOIUrl":"https://doi.org/10.1007/s43390-026-01387-x","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780297","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":"Traditional growing rod lengthening without intraoperative neuromonitoring: a 20-year institutional analysis demonstrating neurologic safety and cost savings.","authors":"Alex R La Poche, Tyler D Metcalf, Austin V Montgomery, Gregory A Mencio, Jeffrey E Martus, Craig R Louer","doi":"10.1007/s43390-026-01376-0","DOIUrl":"https://doi.org/10.1007/s43390-026-01376-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the neurologic safety and economic implications of performing traditional growing rod (TGR) lengthening procedures for early-onset scoliosis (EOS) without intraoperative neuromonitoring (IONM). Although IONM is widely adopted for deformity correction, its necessity during routine distraction lengthening procedures remains uncertain.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of pediatric EOS patients (< 18 years) who underwent TGR lengthening procedures between 2000 and 2020 at a single tertiary children's hospital. Inclusion required documented neurologic assessments and radiographic follow-up within 6 months of the index surgery. Patients with alternative fixation strategies or incomplete records were excluded. Demographic, operative, and neurologic outcome data were collected from institutional registries and chart review. The use or omission of IONM was confirmed. Procedural cost estimates for IONM were obtained from institutional billing records using CPT-based rates. Descriptive statistics were calculated in SPSS v29.</p><p><strong>Results: </strong>Fifty-nine patients (279 TGR lengthening procedures) met inclusion criteria. The mean age at index surgery was 6.6 ± 2.3 years. IONM was not used for any TGR lengthening procedures during this period. No immediate postoperative or delayed neurologic deficits were identified during the 20-year study period. The mean procedure duration was 45.2 ± 6.1 min. The estimated institutional cost of IONM per 45-min TGR lengthening was $6,500, representing an approximate cumulative savings of $1.81 million across all procedures.</p><p><strong>Conclusion: </strong>Over two decades, no neurologic complications occurred in TGR lengthening procedures performed without IONM, supporting the safety of omitting routine monitoring. Selective IONM use may yield substantial economic benefit without compromising patient outcomes.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779847","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":"Osteoporosis and adult spinal deformity-a review for spinal surgeons by the SRS adult spinal deformity task force on senescence.","authors":"Elizabeth Lord, Matthew Vincent, Corey T Walker, Joseph Osorio, Camilo Molina, Kristen Jones, Miranda van Hooff, Alekos Theologis, Mitsuru Yagi, Laurel Blakemore, Suken Shah, Serena Hu, Marinus de, Kleuver, Javier Pizones, Michael Kelly, Ferran Pellise, Christopher Ames, Robert Eastlack","doi":"10.1007/s43390-026-01342-w","DOIUrl":"https://doi.org/10.1007/s43390-026-01342-w","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the understanding of osteoporosis in the context of adult spinal deformity (ASD) surgery with a focus on diagnosis, surgical risks, non-operative, and operative treatment techniques.</p><p><strong>Methods: </strong>A comprehensive literature search was performed. Articles were identified using the search terms \"osteoporosis,\" \"adult spinal deformity,\" \"scoliosis,\" and \"spine surgery.\" Relevant studies were selected based on their focus on the intersection of these topics with an emphasis on utility in spine surgery.</p><p><strong>Results: </strong>This review discusses osteoporosis diagnosis, surgical risks, and non-operative, and surgical treatments in the context of ASD surgery with a focus on clinical applications. Areas for future growth are highlighted.</p><p><strong>Conclusion: </strong>As adult spinal deformity (ASD) patients increase globally, the Scoliosis Research Society (SRS) formed a task force to improve understanding of osteoporosis and its impact on this vulnerable population. This review brings together the latest research on the topic and highlights this area as one of critical importance and growth in the field.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780278","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":"Comparison of postoperative infection risk with and without topical vancomycin in adult posterior spinal fusion: a propensity-matched cohort study of 126,910 patients.","authors":"Haad A Arif, Devan Devkumar, Hesham Tanbour, Michael J Conklin, Steven M Theiss","doi":"10.1007/s43390-026-01378-y","DOIUrl":"https://doi.org/10.1007/s43390-026-01378-y","url":null,"abstract":"<p><strong>Purpose: </strong>Surgical site infections (SSIs) are the third most common complication following spine surgery. The effect of topical vancomycin in addition to perioperative systemic cefazolin remains uncertain. This study sought to investigate the effect of topical vancomycin administration on 90-day postoperative infection risk following adult posterior spinal fusion (PSF).</p><p><strong>Methods: </strong>The TriNetX Global Collaborative database was queried to identify adult patients undergoing PSF. Patients were stratified into two cohorts based on documented administration of topical vancomycin and systemic cefazolin (topical cohort) versus systemic cefazolin alone (control cohort). Patients underwent 1:1 propensity matching based on demographics and relevant comorbidities. The primary outcomes of interest included 90-day rates of infection-related complications. Subgroup analyses were performed to identify the influence of neuromuscular scoliosis, PSF with osteotomies, pelvic fixation, or fusion of greater than six levels on infection rates. Infectious complication rates were also compared between patients receiving topical vancomycin with and without topical gentamicin or tobramycin.</p><p><strong>Results: </strong>After propensity matching, 63,455 patients were included in each cohort. Patients in the topical cohort demonstrated comparable rates of overall infection (3.0% vs. 3.1%, p = 0.794), superficial surgical site infection (SSI) (0.9% vs. 0.8%, p = 0.151), deep SSI (0.6% vs. 0.6%, p = 0.070) and all other infectious complications when compared to the control cohort. Subgroup analysis revealed decreased rate of deep SSI when using topical gentamicin or tobramycin with vancomycin versus topical vancomycin alone (0.7% vs. 1.7%, p = 0.019). No other between-group differences were observed.</p><p><strong>Conclusion: </strong>This study found no significant difference in 90-day postoperative infectious complications following PSF when topical vancomycin was added to standard systemic cefazolin prophylaxis compared to cefazolin prophylaxis alone. Vancomycin with the addition of gentamicin or tobramycin, however, was associated with decreased rates of deep SSI.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780304","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}