Spine deformity最新文献

{"title":"Research priorities in Spine Deformity: a machine learning-based topic analysis of the journal's first decade (2013-2026).","authors":"Rohan A Phadke, Samer G Salman, Nathan J Lee","doi":"10.1007/s43390-026-01534-4","DOIUrl":"https://doi.org/10.1007/s43390-026-01534-4","url":null,"abstract":"<p><strong>Purpose: </strong>Spine Deformity is the official journal of the Scoliosis Research Society (SRS) and the leading publication dedicated to scoliosis, deformity, and surgical correction. We applied BERTopic, a transformer-based machine learning topic-modeling framework, to characterize the evolution of research priorities in Spine Deformity from 2013 to 2026.</p><p><strong>Methods: </strong>All English-language abstracts published in Spine Deformity from January 2013 through May 2026 (n = 1851 after quality filtering) were embedded using PubMedBERT, and then clustered with uniform manifold approximation and projection plus hierarchical density-based spatial clustering of applications with noise, and annotated via class-based term frequency-inverse document frequency. Temporal trends were tested with ordinary least-squares regression and Benjamini-Hochberg false discovery rate correction (α = 0.05).</p><p><strong>Results: </strong>BERTopic identified 29 distinct research topics (noise = 18.4%). Six topics were emerging: postoperative posterior spinal fusion (PSF) outcomes and upper instrumented vertebra (UIV) selection; database studies of length-of-stay (LOS) and adverse events; frailty and perioperative risk; PSF in cerebral palsy and neuromuscular scoliosis; online patient education using large language models (LLMs); and socioeconomic disparities in deformity care. Two topics were cold: sagittal alignment and spinopelvic parameters in AIS, and biomechanical pedicle screw-rod testing. Although no standalone machine learning (ML) cluster emerged, ML and artificial intelligence (AI) methods appeared in 30 abstracts (1.6%), concentrated in radiographic measurement, risk prediction, and LLM-based patient education.</p><p><strong>Conclusion: </strong>Transformer-based topic modeling provides a data-driven map of Spine Deformity's first decade, revealing rapid growth in PSF outcomes research, frailty-aware perioperative care, registry-based outcomes analysis, and AI/LLM applications, alongside maturation of historical sagittal alignment and biomechanical research.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913354","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 density at the upper instrumented vertebra, not the residual fractional curve, predicts mechanical failure in adult spinal deformity: a ten-year single-center series.","authors":"Kento Yamanouchi, Takeshi Fujii, Aiyush Bansal, Kenneth Nguyen, Renzo Laynes, Mir Amaan Ali, Venu M Nemani, Jean-Christophe Leveque, Philip K Louie","doi":"10.1007/s43390-026-01543-3","DOIUrl":"https://doi.org/10.1007/s43390-026-01543-3","url":null,"abstract":"<p><strong>Background: </strong>Adult spinal deformity (ASD) is a heterogeneous, three-dimensional condition. In coronal malalignment, the lumbosacral fractional curve has been recognized as an essential driver of both pathology and cosmetic deformity. While various factors have been identified in association with postoperative complications, it remains unclear whether the magnitude of the fractional curve is an independent predictor of the risk of mechanical failure. The two objectives of this study were (1) to determine whether the magnitude of the fractional curve independently predicts mechanical failure, and (2) to determine whether the magnitude of the fractional curve influences lower lumbar lordosis correction.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study of patients who underwent ASD surgery between 2016 and 2025 (mean follow-up: 21.0 ± 12.5 months). The primary outcomes were radiographic parameters, mechanical complications, and patient-reported outcome measures. Bone mineral density and preoperative comorbidity burden were also assessed as potential predictors of surgical outcomes.</p><p><strong>Results: </strong>Of the 210 patients who underwent ASD correction surgery, the mean age was 66.9 ± 8.9 years, 140 (66.7%) were female, and mechanical failure was observed in 46 cases (21.9%). A multivariate logistic regression identified preoperative Hounsfield unit at the upper instrumented vertebra (UIV) as an independent predictor of decreased odds of mechanical failure (OR 0.99, 95% CI 0.98-0.99). A greater fractional curve was significantly associated with greater correction of lower lumbar lordosis (β = 0.20, p = 0.008) while it was not a significant predictor of mechanical failure.</p><p><strong>Conclusion: </strong>A greater preoperative fractional curve was associated with increased correction of lower lumbar lordosis and a tendency toward L4-S1 overcorrection, particularly for fractional curves >20°. The magnitude of the fractional curve was not an independent predictor of mechanical failure. Lower preoperative Hounsfield units at the upper instrumented vertebra were independently associated with increased risk of mechanical failure. These findings suggest that the fractional curve should be used to guide the lower lumbar correction strategy rather than mechanical risk stratification, while bone quality at the UIV warrants routine preoperative assessment to reduce the risk of postoperative mechanical failure.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887399","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":"Utilization patterns in preoperative halo gravity traction for pediatric spine patients: are we stretching the indications?","authors":"Kenneth T Nguyen, Jason Fink, Michael J Heffernan, Pediatric Spine Study Group, R Carter Clement","doi":"10.1007/s43390-026-01535-3","DOIUrl":"https://doi.org/10.1007/s43390-026-01535-3","url":null,"abstract":"<p><strong>Purpose: </strong>To describe registry-observed trends in preoperative halo gravity traction (HGT) utilization across a multicenter pediatric spine database.</p><p><strong>Methods: </strong>This retrospective study used the Pediatric Spine Study Group (PSSG) registry to identify patients treated with preoperative HGT between 2009 and 2024. Patients with cervical pathology or intraoperative-only traction were excluded. Variables included demographics, diagnosis, age at HGT initiation, pre-halo coronal curvature, and sagittal kyphosis. Utilization trends were assessed using binomial logistic regression; coronal curve severity trends were evaluated using linear regression; and etiologic composition was assessed using one-vs-rest binomial logistic regression.</p><p><strong>Results: </strong>The cohort had a mean age of 7.5 ± 3.6 years at HGT initiation, with 56.1% female. Age at index surgery increased modestly over the study period (β = 0.18 years/year), driven primarily by growth-friendly procedures. Baseline coronal curve severity increased modestly (+ 0.85°/year; p = 0.003). Mean pre-halo sagittal kyphosis was 80.0 ± 29.5° and remained stable. HGT was increasingly represented among growth-friendly procedures (OR 1.08/year; p < 0.001), while its use preceding definitive fusion remained stable. Etiologic distribution did not change across the study period.</p><p><strong>Conclusion: </strong>Within this large multicenter registry, HGT use increasingly preceded growth-friendly procedures over time, while its application before definitive fusion remained stable. Pre-traction coronal curve severity and age at HGT initiation increased gradually, potentially reflecting a growing willingness to defer surgery in anticipation of HGT's ability to temporize larger curves.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881594","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":"Characterizing neurological complications following anterior-to-the-psoas vertebral body tethering in adolescent idiopathic scoliosis: The role of neuromonitoring, psoas location, and screw placement.","authors":"Juan Rodriguez-Rivera, Abel De Varona-Cocero, Djani Robertson, Nicholas Vollano, Constance Maglaras, Brooke K O'Connell, Anna Shor, Aleksandar Beric, Athena Lolis, Adauri Bueno de Camargo, Zoran Budimlija, Themistocles Protopsaltis, Juan C Rodriguez-Olaverri","doi":"10.1007/s43390-026-01520-w","DOIUrl":"https://doi.org/10.1007/s43390-026-01520-w","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether changes in intraoperative neuromonitoring with saphenous nerve somatosensory evoked potential (SSEP) stimulation, preoperative assessment of  lumbar plexus location, and screw placement, are associated with thigh paresthesia development following an anterior-to-the-psoas (ATP) approach for vertebral body tethering (VBT) in adolescent idiopathic scoliosis (AIS) patients.</p><p><strong>Methods: </strong>39 patients who underwent a thoracoabdominal ATP approach for VBT with a minimum 2-year follow-up were included. Neurologic monitoring variables, including saphenous nerve SSEPs and quadriceps motor evoked potentials (MEPs), psoas location, an indicator of lumbar plexus location, and screw placement were compared between patients with and without postoperative thigh paresthesia. Demographics and outcomes were analyzed using the Mann-Whitney U test and Fisher's exact test as appropriate, with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>41% of patients experienced postoperative thigh paresthesia. Additionally, 10% reported transient thigh numbness. No patients developed motor deficits. Lumbar plexus position and screw distance did not significantly differ between groups, and no neuromonitoring alarms occurred during psoas retraction. Although changes in quadriceps MEPs were not statistically associated with postoperative sensory symptoms, a higher proportion of patients with paresthesia demonstrated MEP changes (50% vs 19%, p = 0.063) and decreased MEP amplitudes (31% vs 13%, p = 0.077), representing a directional difference. All sensory symptoms resolved without intervention at a mean of 5.3 ± 5.6 weeks and a median of 2.5 (IQR 1-10).</p><p><strong>Conclusion: </strong>Changes in intraoperative neuromonitoring with saphenous nerve SSEP stimulation, psoas location, and screw positioning were not statistically associated with postoperative thigh paresthesia following the ATP approach for VBT in AIS patients. However, a directional difference was observed between quadriceps MEP changes and postoperative thigh paresthesia. These findings highlight the complexity of neurologic responses and support further investigation into patient-specific anatomy, surgical technique, and optimization of neuromonitoring strategies.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881597","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":"Curve progression in female adolescent idiopathic scoliosis with Risser grade ≥ 3: incidence, magnitude, and risk factors in a cohort of 915 unbraced female patients.","authors":"Yusuke Setojima, Toshiaki Kotani, Tomoyuki Asada, Shun Okuwaki, Yosuke Ogata, Shuhei Ohyama, Yasushi Iijima, Tsuyoshi Sakuma, Shohei Minami, Seiji Ohtori","doi":"10.1007/s43390-026-01375-1","DOIUrl":"10.1007/s43390-026-01375-1","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the magnitude and incidence of curve progression and identify clinical factors independently associated with late-stage progression in untreated female adolescent idiopathic scoliosis (AIS) patients with Risser grade ≥ 3.</p><p><strong>Methods: </strong>This retrospective cohort study included 915 female AIS patients with Risser grade ≥ 3 and a major Cobb angle ≥ 10° without prior treatment. The primary outcome was change in the major Cobb angle (ΔCobb). Patients were additionally divided into the progressive (ΔCobb ≥ 6°) and the non-progressive groups. Multivariable regression analyses were performed to evaluate independent factors associated with curve progression. Covariates included age, months since menarche, body mass index (BMI), residual height growth, and main curve location.</p><p><strong>Results: </strong>Overall, 111 patients (12.1%) experienced clinically significant progression. Multivariable linear regression analysis revealed that lower BMI, lower Risser grade, greater residual height growth, and smaller baseline Cobb angle were independently associated with a greater magnitude of curve progression.　Curve location was a significant predictor, with thoracolumbar curve showing significantly less progression magnitude compared to proximal thoracic curve. Multivariable logistic regression identified lower BMI, lower Risser grade, and greater residual height growth as independent factors associated with clinically significant progression.</p><p><strong>Conclusion: </strong>Despite late-stage skeletal maturity, a clinically significant risk of curve progression persists in female AIS patients with a Risser grade ≥ 3. The Risser sign is insufficient; lower BMI, residual height growth, and specific curve patterns are independent factors of late-stage progression. They should be integrated with skeletal maturity indicators to improve risk stratification and guide management decisions for traditionally low-risk patients.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1789-1795"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842459","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":"Methodological considerations in interpreting the effect of topical vancomycin in posterior spinal fusion.","authors":"Malaha Ali","doi":"10.1007/s43390-026-01440-9","DOIUrl":"10.1007/s43390-026-01440-9","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1965-1966"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960266","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 \"Sagittal misalignment patterns and pathomechanical hypothesis of adolescent idiopathic scoliosis: a radiographic analysis\".","authors":"S Sundararajan, M Shanmuga Priya, G Santhosh Raj, Archana","doi":"10.1007/s43390-026-01431-w","DOIUrl":"10.1007/s43390-026-01431-w","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1961-1962"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949571","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":"Looking back to move forward: why history matters so much in spine surgery.","authors":"Rene Castelein","doi":"10.1007/s43390-026-01511-x","DOIUrl":"10.1007/s43390-026-01511-x","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1517-1518"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607550","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":"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":"Satoshi Takada, Suken A Shah, Hiroshi Taneichi, Yusuke Hori, Petya K Yorgova, Andrea Elsby, Tyler C McDonald, Richard W Kruse, Jeanne M Franzone","doi":"10.1007/s43390-026-01340-y","DOIUrl":"10.1007/s43390-026-01340-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate both radiographic and patient-reported outcomes after surgical correction of severe scoliosis in osteogenesis imperfecta (OI) patients with minimum 2-year follow-up. The main research question was whether modern multimodal surgical approaches translate into meaningful improvements in both deformity correction and quality of life measures.</p><p><strong>Methods: </strong>This retrospective analysis of prospectively collected data included 35 OI patients (mean age 12.2 ± 3.7 years) who underwent posterior spinal fusion for scoliosis at a single institution between 2013 and 2022. OI type 3 was most common (69%). Radiographic parameters and patient-reported outcomes (SRS-22, CP CHILD, PROMIS) were assessed preoperatively and at latest follow-up (mean 5.5 ± 3.1 years). Surgical technique included navigation-guided pedicle screw placement, cement augmentation at foundation levels, and perioperative bisphosphonate therapy.</p><p><strong>Results: </strong>Major curve improved from 72.3 ± 15° to 32.2 ± 17° (56% correction, p < 0.001) and minor curve from 53.8 ± 14° to 24.1 ± 12° (55% correction, p < 0.001). Other radiographic parameters including apical vertebral translation, lowest instrumented vertebra tilt, pelvic obliquity, and thoracolumbar kyphosis showed significant improvement while maintaining thoracic kyphosis and lumbar lordosis. SRS-22 total score improved from 3.6 to 4.1 (p = 0.002), with function, pain, and self-image domains achieving minimal clinically important differences. CP CHILD total score improved, with significant improvement in the positioning/transferring/mobility domain. PROMIS showed significant improvements in fatigue and pain interference. Two complications (5.7%) occurred without infections or neurological deficits.</p><p><strong>Conclusion: </strong>Modern surgical correction of severe scoliosis in OI patients achieved significant improvements in both radiographic parameters and patient-reported outcomes, demonstrating the effectiveness of current multimodal surgical strategies in this challenging population.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1891-1901"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving surgical strategies in myelomeningocele (MMC): shift toward index fusion with stable complication rates.","authors":"Edwin S Kulubya, Matthew J Weintraub, Omar Taha, Mehdi M Elfilali, Chidebelum O Nnake, Alexander M Park, Michael W Brown, Taemin Oh, John T Smith, Paul D Sponseller, Purnendu Gupta, Lawrence I Karlin, Michael G Vitale","doi":"10.1007/s43390-026-01358-2","DOIUrl":"10.1007/s43390-026-01358-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines trends in surgical management and outcomes in patients with myelomeningocele (MMC) undergoing spine surgery, focusing on complications and radiographic outcomes.</p><p><strong>Methods: </strong>A retrospective review of a multicenter registry was conducted. Demographics, surgery type, ambulatory status, and radiographic parameters were collected. Complications occurring within five years post-index surgery were recorded and classified by the Modified Clavien-Dindo-Sink (MCDS) scale. Patients were divided into \"early vs. late\" groups based on the median time point, and by ambulatory status. Complication rates were evaluated over five-year intervals. Statistical analyses included t-tests, Mann-Whitney U, chi-square, and Cochran-Armitage trend tests.</p><p><strong>Results: </strong>The cohort included 187 MMC patients, with 161 undergoing growth-friendly (GF) procedures and 26 index fusions. 119 patients (63%) experienced major complications (MCDS ≥ III), predominantly wound-related (79). The late group was older at index surgery (6.7 vs. 7.7 years, p = 0.031) and had a higher rate of index fusion (7.5% vs. 20.2%, p = 0.022). Preoperative and postoperative radiographic parameters were similar. Among GF patients, 71 underwent definitive spinal fusion. On average, patients treated with VEPTR/TGR underwent 5 lengthening procedures, while those treated with MCGR underwent 8. Across all GF patients, the average number of unexpected reoperations was 1.6. Overall five-year complication rates did not differ significantly between early and late cohorts (66.7% vs. 60.6%; p > 0.05). A declining trend in complication rates over time was observed (p = 0.082).</p><p><strong>Conclusions: </strong>From 2002-2019, surgical management of MMC evolved toward increased index fusion and older age at index, possibly to reduce repeat surgery risks. Despite this, radiographic outcomes and overall complication rates were similar between early- and late-era cohorts, and a downward trend in complications that approached statistical significance was observed over time.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1851-1861"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147619157","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}