Spine deformity最新文献

{"title":"Role of spinal MRI for pre-operative work up in patients with adolescent idiopathic scoliosis: a retrospective case study and narrative review.","authors":"Sassan Keshavarzi, Griffin Harris, Subaraman Ramchandran, Noah Gabor, Jeffrey Spardy, Thomas Errico, John Ragheb, Stephen George","doi":"10.1007/s43390-024-00991-z","DOIUrl":"10.1007/s43390-024-00991-z","url":null,"abstract":"<p><strong>Introduction: </strong>There remains variability in the acquisition of whole-spine MRI prior to surgical correction in patients with adolescent idiopathic scoliosis (AIS). In this study, we take a retrospective look at the clinical impact of uniformly obtaining spinal MRI on all patients with a diagnosis of AIS.</p><p><strong>Methods: </strong>Three hundred thirty four patients with presumed AIS who underwent surgery between 2017 and 2022 were identified; 283 of these patients who were asymptomatic and had a preoperative MRI in the database were included. We investigated radiographic, demographic, and clinical risk factors for the presence of neural axis anomalies. Radiologists' reports were reviewed to determine the level of the conus medullaris and the presence of any intra-spinal dysraphisms. The utility of known risk factors for neural axis anomalies and the utility of MRI identifying anomalies on clinical decision-making, intra-operative neuromonitoring (IONM) alerts, and postoperative neurologic insult in asymptomatic AIS patients were investigated.</p><p><strong>Results: </strong>There were 283 patients with a mean age of 14.1 years, 67 males (22.6%) and 26 (9.2%) left-sided thoracic curves. MRI identified nine patients with central cord dilations, four patients with low cerebellar tonsils, four patients with Chiari Malformations, five patients with low-lying conus, one patient with a tethered cord, and five patients with arachnoid cysts. Six (2.1%) of the 283 patients underwent a neurosurgical intervention and 3 (50%) of the 6 went on to have IONM alerts. Eighteen (6.4%) of the 283 patients had IONM alerts and 5 (28%) of the 18 had neural axis anomalies. None of the patients with IONM alerts had a permanent neurologic deficit post-operatively.</p><p><strong>Conclusion: </strong>In asymptomatic patients presumed to have AIS, 9.9% had a neuro-axis anomaly, 2.1% needed a neurosurgical intervention, and 6.4% of the patients had an IONM alert. We did not find known risk factors for identifying neural axis anomalies to have statistically significant application in asymptomatic AIS patients. Presence of neuroaxis anomalies increased the chance of having IONM alerts, however, we were unable to demonstrate if neurosurgical interventions in these patients with anomalies were preventative for IONM alerts or have statistically significant protection against clinical complications.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"509-518"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547240","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":"Research trends of biomechanics in scoliosis from 1999 to 2023: a bibliometric analysis.","authors":"Peng Dou, Xuan Li, Haobo Jin, Boning Ma, Ming Jin, Yi Xu","doi":"10.1007/s43390-024-01000-z","DOIUrl":"10.1007/s43390-024-01000-z","url":null,"abstract":"<p><strong>Objective: </strong>Despite the abundance of research on the biomechanics of scoliosis, there is a lack of a comprehensive bibliometric analysis. This study utilizes bibliometric methods to elucidate the research trends and hotspots within this domain.</p><p><strong>Methods: </strong>The data for this study were obtained from the Web of Science Core Collection and then analyzed using the open-source Bibliometrix R package and Citespace.</p><p><strong>Results: </strong>The analysis encompassed 410 publications published from 1999 to 2023. There is a sustained increase in the number of publications within the field. Utilizing citation analysis and keyword analysis, the study identified key research focuses. Burst keyword analysis identified 19 keywords.</p><p><strong>Conclusions: </strong>The period from 1999 to 2023 has witnessed significant research attention on the biomechanics of scoliosis. The demographic shift towards an aging population has recently increased interest in ASD. Proximal biomechanical changes and transitional zones in PJK and PJF are hotspots in research, offering emerging scholars in this discipline valuable opportunities for exploration.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"391-403"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583941","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":"Guidelines for returning to activity after spinal deformity surgery.","authors":"Joel D Turtle, Jwalant S Mehta, Stefan Parent, Grace X Xiong, Jason Py Cheung, Michelle C Welborn, Alex R Vaccaro, Patrick J Cahill, Ferran Pellisé, Serena S Hu","doi":"10.1007/s43390-024-01010-x","DOIUrl":"10.1007/s43390-024-01010-x","url":null,"abstract":"<p><p>Returning to activity after spinal deformity surgery is vital for patient recovery and long-term health, yet there is significant variability in postoperative protocols among surgeons worldwide. This paper aims to define guidelines for returning to activity across diverse patient groups: early onset scoliosis (EOS), adolescent idiopathic scoliosis (AIS), young adults, adult spinal deformity (ASD), elite athletes, and general sports participants. This paper provides guidelines to foster a unified approach to postoperative care, improving outcomes and ensuring patients can safely and effectively resume their activities. This paper represents the proceedings of an SRS educational CME webinar. A summary of recommendations for each patient group is included aiming to enhance surgeon practice and patient care through standardized postoperative protocols.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"383-390"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772053","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":"Gut microbiota alterations in adolescent idiopathic scoliosis: a comparison study with healthy control and congenital scoliosis.","authors":"Yinyu Fang, Zhen Tian, Weibiao Li, Dongyue Li, Jie Li, Zongshan Hu, Yong Qiu, Zezhang Zhu, Zhen Liu","doi":"10.1007/s43390-024-00988-8","DOIUrl":"10.1007/s43390-024-00988-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to compare the composition of GM isolated from individuals with AIS or congenital scoliosis (CS) and age-matched control (Ctr).</p><p><strong>Methods: </strong>A total of 48 patients with AIS, 24 patients with CS, and 31 healthy individuals were recruited as the discovery cohort, and 9 pairs of siblings where one was affected by AIS were recruited as the validation cohort. The GM profile was determined with 16S rRNA sequencing, and the alpha-diversity and beta-diversity metrics were performed with Mothur. Linear discriminant analysis (LDA) analysis was performed to identify the enriched species.</p><p><strong>Results: </strong>The α diversity (Chao1 index) was significantly lower in AIS patients with low BMI (< 18.5) than those with normal BMI. The PcoA analysis showed a trend of clustering of GM in AIS compared to that in Ctr and CS groups (r² = 0.0553, p = 0.001). METASTAT analysis showed Cellulomonadaceae was significantly enriched in AIS groups compared to CS and Ctr. LDA analysis showed 9 enriched species in AIS patients. Compared to Ctr, two species including Hungatella genus and Bacteroides fragilis were significantly enriched, while the Firmicutes versus Bacteroidetes (F/B) ratio and the Ruminococcus genus were significantly decreased in AIS but not CS groups. The significantly reduced F/B ratio and Ruminococcus genus in AIS were replicated in the validation cohort.</p><p><strong>Conclusions: </strong>Our study elucidated an association between low BMI and GM diversity in AIS patients. The reduced F/B ratio and Ruminococcus genus in AIS patients were identified and validated in 9 pairs of AIS patients and their unaffected siblings. Our pilot results may help understand the anthropometric discrepancy in these patients and support a possible role of GM in the pathogenesis of AIS.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"497-507"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507401","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":"3D external shape analysis and barycentremetry can provide early signs of progression in adolescent idiopathic scoliosis.","authors":"Tristan Langlais, Claudio Vergari, Nicolas Mainard, Xavier du Cluzel, Matthieu Baudoux, Laurent Gajny, Kariman Abelin-Genevois, Jean Claude Bernard, Zongshan Hu, Jack Chun Yiu Cheng, Winnie Chiu Wing Chu, Ayman Assi, Mohamad Karam, Ismat Ghanem, Tito Bassani, Fabio Galbusera, Luca Maria Sconfienza, Marco Brayda-Bruno, Isabelle Courtois, Eric Ebermeyer, Raphael Vialle, Jean Dubousset, Wafa Skalli","doi":"10.1007/s43390-024-01001-y","DOIUrl":"10.1007/s43390-024-01001-y","url":null,"abstract":"<p><strong>Purpose: </strong>Our objective was to analysis the barycentremetry, obtained from the external envelope reconstruction of biplanar radiographs, in adolescent idiopathic scoliosis (AIS) and to determine whether assessing would help predict the distinction between progressive and stable AIS at the early stage.</p><p><strong>Methods: </strong>A retrospective study with a multicentre cohort of 205 AIS was conducted. All AIS underwent a biplanar X-ray between 2013 and 2020. Inclusion criteria were Cobb angle between 10° and 25°; Risser sign lower than 3; age higher than 10 years; and no previous treatment. A 3D spine reconstruction was performed, and the barycentremetry parameters were computed, i.e., the center of mass position at the apex and the axial torque at the apex, the upper and lower junction. A severity index, helping to distinguish stable and progressive AIS, was computed on the first radiograph, and weighted according to these parameters. A clinical and radiographic monitoring determined if AIS were classified such a stable or progressive scoliosis.</p><p><strong>Results: </strong>One hundred and sixty-two AIS were included (i.e., 87 were classified as stable and 75 as progressive). The apex center of mass position was different between the stable and progressive AIS groups (6 mm, SD = 4 mm for the whole cohort; 5 mm, SD = 4 mm for stable AIS versus 7 mm, SD = 4 mm for progressive AIS; p = 0.02). In AIS thoracic, the specificity and positive predictive value of the severity index increased by 19% and 16%, respectively, by adding the apex vertebral axial torque.</p><p><strong>Conclusion: </strong>Early assessment of the external envelope from biplanar X-ray reconstruction of idiopathic scoliosis showed that the apex centre of mass position was significantly different between progressive and stable scoliosis. The inclusion of the axial torque of the apex vertebra in the severity index is promising to help the clinician distinguish between stable and progressive thoracic AIS at an early stage.</p><p><strong>Level of evidence: </strong>II - Prognostic studies.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"551-560"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569319","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":"Preoperative anemia is associated with increased length of stay in adult spinal deformity surgery: evaluation of a large single-center patient cohort and future suggestions for patient optimization.","authors":"Mert Marcel Dagli, Connor A Wathen, Joshua L Golubovsky, Yohannes Ghenbot, John D Arena, Gabrielle Santangelo, Jonathan Heintz, Zarina S Ali, William C Welch, Jang W Yoon, Vincent Arlet, Ali K Ozturk","doi":"10.1007/s43390-024-01003-w","DOIUrl":"10.1007/s43390-024-01003-w","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the relationship of preoperative hemoglobin levels as an independent prognostic factor for hospital and intensive care unit (ICU) length of stay (LOS) in patients undergoing surgery for adult spinal deformity (ASD), with the intent of determining whether there exists a correlation and enhancing patient preoperative optimization protocols.</p><p><strong>Methods: </strong>The authors reviewed consecutive patients who underwent elective thoracolumbosacral posterior spinal fusion (PSF) involving six or more vertebrae for ASD from January 1, 2013, to December 13, 2021, with a minimum follow-up period of two years. This study primarily investigated the association of preoperative hemoglobin levels with hospital and ICU LOS. To analyze the data, both unadjusted and adjusted generalized linear models (GLM), incorporating cubic splines for non-linear variables, were applied.</p><p><strong>Results: </strong>A total of 598 patients were included. GLMs for hospital and ICU LOS demonstrated nonlinear relationships with preoperative hemoglobin levels. Specifically, hospital LOS decreased with increasing preoperative hemoglobin until a significance threshold of 13.5 g/dl. Similarly, ICU LOS significantly decreased with increasing preoperative hemoglobin until 13.0 g/dl. Lower preoperative hemoglobin was associated with more perioperative transfusions, less likely discharge to home, and greater risk of reoperation.</p><p><strong>Conclusions: </strong>Preoperative anemia is an independent non-linear risk factor that significantly affects LOS, disposition, and outcomes after surgery for ASD. These findings advocate for a systemic preoperative approach and highlight the need for future research to improve postoperative outcomes and reduce hospital resource utilization.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"625-637"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606614","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":"Editorial 13#2.","authors":"John E Lonstein","doi":"10.1007/s43390-025-01061-8","DOIUrl":"10.1007/s43390-025-01061-8","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"325"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450121","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":"Investigating the long-term outcomes and efficacy of surgical intervention in patients with adolescent idiopathic scoliosis and Cobb angles ranging between 40 and 50 degrees.","authors":"Adam S Friedman, Manisha Koneru, Pietro Gentile, David Clements","doi":"10.1007/s43390-024-00984-y","DOIUrl":"10.1007/s43390-024-00984-y","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with adolescent idiopathic scoliosis (AIS) are either managed with non-operative strategies or surgery depending on the severity of lateral curvature and impact on quality of life. However, supportive evidence for the appropriate treatment approach is lacking in AIS patients with Cobb angles between 40 and 50 degrees. Therefore, we investigated differences in long-term patient-centered outcomes in AIS patients with Cobb angles between 40 and 50 degrees who received either operative or non-operative management.</p><p><strong>Methods: </strong>A total of 919 patients aged 10-21 years old with adolescent idiopathic scoliosis and 40-50 degree Cobb angles were identified from the HARMS Study Group (HSG) registry and dichotomized based on operative or non-operative management. Baseline and 2 year follow-up SRS-22 scores from these patients were analyzed for significant differences between the total score values, domain values, and the magnitude of score change over time using multiple comparisons analyses. Multivariable regressions adjusting for age, body mass index, location of spinal deformity, and management strategy were also performed.</p><p><strong>Results: </strong>Operative versus non-operative strategy was significantly, independently associated with differences in SRS-22 total and domain scores over time (effect likelihood ratio test, p < 0.03 for all regressions). Operatively managed patients had significantly greater improvement in SRS-22 total and domain scores over the follow-up duration compared to non-operatively managed patients (p < 0.02 for all comparisons).</p><p><strong>Conclusions: </strong>This preliminary analysis suggests that operatively managed patients may have had better long-term outcomes than non-operatively managed patients within this AIS subpopulation. These findings support the need for further prospective investigation to determine the optimal management strategy to improve evidence-based, patient-reported outcomes for AIS patients with Cobb angles between 40 and 50 degrees.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"489-495"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142474265","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":"Surgical treatment algorithm for thoracic and lumbar hyperkyphosis in pediatric population.","authors":"Julián Calcagni, Carlos A Tello, Lucas Piantoni, Rodrigo Remondino, Eduardo Galaretto, Juan Pablo Arispe, Mariano Noel","doi":"10.1007/s43390-024-00986-w","DOIUrl":"10.1007/s43390-024-00986-w","url":null,"abstract":"<p><strong>Purpose: </strong>There is no standardized and universally accepted surgical treatment for thoracic and lumbar hyperkyphosis in children. A surgical treatment algorithm was developed to aid in the choice of the appropriate corrective technique.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients younger than 18 years who underwent primary correction surgery and posterior fusion for thoracic and lumbar hyperkyphosis. Patients were categorized according to the classification of Rajasekaran et al. and divided into 2 groups: a posterior column osteotomies (PCO) group and a three-column osteotomies (3CO) group. We analyzed the angularity and flexibility of the curve, global sagittal balance, and preoperative neurological status of the patient.</p><p><strong>Results: </strong>Forty-nine patients were included. The mean age was 12.8 years (1-18) and the mean preoperative kyphosis was 93.5° (40°-175°). In the PCO group (N = 30), the sagittal deformity angular ratio (DAR) was less than 16.5 in 26 patients (86.6%), while in the 3CO group (N = 19), sagittal DAR was greater than 16.5 in 17 patients (89.4%). In the PCO group (N = 28), the T1-Pelvic angle (TPA) was less than 17° in 19 patients (67.8%), while in the 3CO group (N = 15), TPA was greater than 17° in 10 patients (66.6%). Five patients (10.2%) had recent-onset or progressive neurological alteration, all of them (100%) required 3CO.</p><p><strong>Conclusion: </strong>An algorithm for kyphosis was developed based on the classification by Rajasekaran et al., preoperative analysis of the angularity and flexibility of the curve, global sagittal balance and neurological status of the patient, to aid in the choice of the appropriate corrective osteotomy.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"449-457"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142474266","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":"Making wrong site surgery a \"never event\" in spinal deformity surgery by use of a \"landmark vertebra\" to eliminate variability in identifying a target vertebral level.","authors":"Ritt R Givens, Matan S Malka, Kevin Lu, Amber Mizerik, Nicole Bainton, Thomas M Zervos, Benjamin D Roye, Lawrence G Lenke, Michael G Vitale","doi":"10.1007/s43390-024-00996-8","DOIUrl":"10.1007/s43390-024-00996-8","url":null,"abstract":"<p><strong>Purpose: </strong>Despite the introduction of \"standardized counting\" methods, errors in counting spinal levels and subsequent wrong-level surgery (WLS) remain critically important patient safety concerns. Previous work by our group has documented inconsistency in the identification of T12 despite the use of these systems including the Spinal Deformity Study Group (SDSG) conventions. To assist with consistent and repeatable identification of proposed preoperative surgical levels, the current study investigates a new strategy: utilization of a \"landmark vertebra\". It was hypothesized that individuals using a \"landmark vertebra\" strategy will achieve high concordance with target level identification between distinct time points as compared to conventional methods defining T12.</p><p><strong>Methods: </strong>Survey participants analyzed 99 pre-op radiographs, identifying and naming a \"landmark vertebra\" with concise descriptions like \"last bilaterally ribbed vertebra.\" They then noted the proposed lowest instrumented vertebra's (LIV) distance relative to landmark (i.e., one below landmark). After a waiting period, participants used their written descriptions of the landmark and distance to LIV to reidentify these vertebrae. Cohen's Kappa (k) was used to measure intra-rater agreeability. The landmark strategy was compared to our previous work evaluating consistency in defining T12 based on the SDSG system.</p><p><strong>Results: </strong>All raters showed perfect to near-perfect agreement when re-identifying the landmark and target vertebrae (k = 0.819-1.00; Table 1A). Raters at all training levels had higher agreeability in naming the landmark vertebra and target when compared to raters at similar training levels defining T12 (k = 0.34-0.91; Table 1B). This high agreement across training demonstrates the strategy's versatility and generalizability.</p><p><strong>Conclusion: </strong>Utilization of a landmark strategy proved to be highly effective in reducing intra-rater variability, with perfect to near-perfect agreement among all raters and consistently higher agreeability when compared to defining T12.</p><p><strong>Level of evidence: </strong>Level II-prospective survey.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"339-350"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676789","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}