Spine Surgery and Related Research最新文献

{"title":"Clinical Outcomes Following Cervical Fusion in Patients with Dialysis-Related Spondyloarthropathy: A Systematic Review.","authors":"Shahabeddin Yazdanpanah, Grayson M Talaski, Anthony N Baumann, Jacob C Hoffmann","doi":"10.22603/ssrr.2025-0244","DOIUrl":"10.22603/ssrr.2025-0244","url":null,"abstract":"<p><strong>Background: </strong>Dialysis-related spondyloarthropathy (DRSA) is a rare but serious spinal pathology among patients on long-term dialysis, most commonly affecting the cervical spine. DRSA often requires surgical intervention by means of fusion when accompanied by substantial neurological and/or clinical symptoms, although available data are limited. This systematic review investigates the collated outcomes after cervical fusion in patients with DRSA to inform surgical decision-making and improve dialysis-related spine surgery care.</p><p><strong>Methods: </strong>A pre-registered systematic review, conducted through June 20, 2025, searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and Web of Science for studies with outcome data on patients with DRSA undergoing cervical fusion. To determine study quality, the Methodological Index for Non-Randomized Studies scale was applied, and outcome certainty grading was performed. Demographics, operative details, functional recovery, and complications were extracted. Descriptive statistics were used for narrative evidence synthesis.</p><p><strong>Results: </strong>Nine retrospective observational studies (six \"moderate\", three \"low\" quality) with \"very low\" outcome certainty were included out of 91 retrieved.</p><p><strong>Patients: </strong>Patients (n=88; 39.8% female; frequency-weighted mean [FWM] age=60.0±8.3 years; follow-up=50.3±42.3 months) were on dialysis for a FWM of 17.1±7.0 years, with 3.2±1.4 intervertebral levels fused (67.0% posterior-utilizing approach). Most studies (88.9%) reported that at least 80% of their cohort experienced improvements in symptoms after fusion, and the FWM postoperative Japanese Orthopaedic Association score improvement was 4.5. Pseudoarthrosis occurred at a pooled rate of 15.0%, and total complications occurred at a pooled rate of 36.3%. Infections (16.1%) were the most common complication. Complication-related mortality was reported at a pooled rate of 9.1%.</p><p><strong>Conclusions: </strong>Cervical fusion in patients with DRSA appears to provide considerable functional improvement, though concerns remain regarding complications and mortality. Future high-quality studies of greater outcome quality and certainty are warranted to further advance evidence-based surgical decision-making in this complex yet rapidly growing dialysis-reliant population.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"164-173"},"PeriodicalIF":1.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692401","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":"Impact of Cigarette Smoking on Clinical Outcomes after Surgical Resection in Patients with Intramedullary Spinal Cord Tumors: A Retrospective Comparative Study.","authors":"Toshiki Okubo, Narihito Nagoshi, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.22603/ssrr.2025-0213","DOIUrl":"10.22603/ssrr.2025-0213","url":null,"abstract":"<p><strong>Introduction: </strong>Intramedullary spinal cord tumors (IMSCTs) are rare lesions associated with significant neurological impairment and decreased quality of life. Surgical resection is the primary treatment option; however, postoperative recovery is often limited and functional outcomes vary considerably. Although cigarette smoking is known to adversely affect outcomes in various spinal disorders, its impact on IMSCT surgery remains unclear. This study aimed to determine the influence of cigarette smoking on surgical outcomes and perioperative complications in patients with IMSCTs.</p><p><strong>Methods: </strong>This retrospective comparative study included 194 consecutive patients with IMSCTs who underwent surgical resection between 2012 and 2022. Participants were categorized into smoker (n=35) and nonsmoker (n=159) groups based on smoking status. Demographic, surgical, and clinical outcomes were compared between the two groups.</p><p><strong>Results: </strong>The smoker group had significantly lower pre- and postoperative Japanese Orthopaedic Association (JOA) scores for cervical and thoracic lesions than the nonsmoker group, with no significant improvement observed at the final follow-up. However, there were no significant differences between the groups in other demographic data, surgical data, perioperative complications, or postoperative modified McCormick scale grade changes for either cervical or thoracic IMSCTs. In addition, preoperative smoking status (the number of cigarettes smoked/day, years of smoking, total number of smoked cigarettes) showed no significant correlation with pre- or postoperative JOA scores.</p><p><strong>Conclusions: </strong>Although smoking does not affect the incidence of perioperative complications, it negatively impacts JOA scores in patients with IMSCTs, regardless of the number of cigarettes smoked or the duration of smoking.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 1","pages":"80-88"},"PeriodicalIF":1.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202547","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":"Accuracy and Feasibility of Intraoperative Computed Tomography Navigation with a Clavicular Reference Frame in Anterior Cervical Spine Surgery: A Preliminary Report.","authors":"Shutaro Yamada, Sadaaki Kanayama, Tsuyoshi Kono, Shota Takenaka","doi":"10.22603/ssrr.2025-0214","DOIUrl":"10.22603/ssrr.2025-0214","url":null,"abstract":"<p><strong>Introduction: </strong>The application of intraoperative computed tomography (CT) navigation in anterior cervical spine surgery remains limited because of challenges in securing a stable reference frame during supine positioning and the absence of reliable bony landmarks in the anterior cervical region. To overcome these limitations, we propose a novel technique involving reference frame placement on the proximal diaphysis of the clavicle and evaluate its feasibility and navigation accuracy.</p><p><strong>Technical note: </strong>Five patients (4 males, 1 female; mean age 59±15 years) underwent anterior cervical surgery for cervical ossification of the posterior longitudinal ligament (n=2), cervical disc herniation (n=2), and cervical spondylotic amyotrophy (n=1). The reference frame was affixed to the clavicle contralateral to the operating surgeon. Intraoperative CT scans were obtained using a robotic C-arm angiography system and navigation was performed via an optical surgical navigation system. Navigation accuracy was assessed in 3 planes: mediolateral (x), craniocaudal (y), and anteroposterior (z). Navigation errors (mean±standard deviation) were 0.29±0.24 mm (x), 0.47±0.31 mm (y), and 0.64±0.59 mm (z), all within clinically acceptable limits. No intraoperative or postoperative complications, including clavicle fracture, subclavian vessel injury, or supraclavicular nerve damage, were observed. Compared with previously reported techniques, this method demonstrated favorable accuracy.</p><p><strong>Conclusions: </strong>Clavicle-based reference frame placement offers high navigation accuracy and technical feasibility in anterior cervical spine surgery. Larger studies are warranted to confirm its clinical utility and safety.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 6","pages":"698-704"},"PeriodicalIF":1.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757257","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":"Optimizing Management of Spontaneous Cervical Epidural Hematoma: The Role of Early Intervention in Functional Recovery.","authors":"Hiroki Narita, Michihisa Narikiyo, Yusuke Hirokawa, Rento Miyazaki, Keita Hashimoto, So Ohashi, Hirokazu Nagasaki, Yoshifumi Tsuboi, Hidenori Matsuoka","doi":"10.22603/ssrr.2025-0233","DOIUrl":"10.22603/ssrr.2025-0233","url":null,"abstract":"<p><strong>Objective: </strong>To present 3 cases of spontaneous cervical epidural hematoma (SCEH) with acute neurological deterioration that achieved excellent functional recovery after surgical decompression, and to evaluate the influence of surgical timing on outcomes through a literature review.</p><p><strong>Methods: </strong>We report on 3 patients diagnosed with SCEH via cervical magnetic resonance imaging (MRI) following acute-onset neck pain, followed by hemiparesis or hemiplegia. Surgical decompression was performed at 19, 6, and 10 hours after symptom onset, respectively. A comprehensive literature review was also conducted to assess the relationship between surgical timing and neurological outcomes in SCEH.</p><p><strong>Literature search strategy: </strong>We performed a literature search using PubMed as the primary database, complemented by Google Scholar, covering the period from January 1980 to December 2024. Keywords included \"spinal epidural hematoma,\" \"cervical,\" \"spontaneous,\" and \"surgery.\" Inclusion criteria were case reports, case series, or reviews describing SCEH with surgical or conservative management and reported outcomes.</p><p><strong>Results: </strong>All 3 patients demonstrated complete neurological recovery despite presenting with severe motor deficits and undergoing surgery at different times. Their recovery periods ranged from 11 to 90 days. Our literature review, which included 158 cases, consistently indicated that surgical timing is a critical factor influencing outcomes. Specifically, 83.2% of patients showed neurological improvement with surgery within 12 hours, while 68.9% improved when operated on between 12 and 24 hours¹⁾. Another study reported 91% favorable outcomes with ultra-early intervention (within 6 hours), compared to 33% when delayed beyond 48 hours²⁾.</p><p><strong>Limitations: </strong>The proposed treatment algorithm is based on a small number of institutional cases combined with data from a narrative literature review. A formal meta-analysis or quantitative pooled analysis was not performed; therefore, the generalizability of the algorithm should be interpreted with caution.</p><p><strong>Conclusions: </strong>Prompt surgical decompression, ideally within 12-24 hours, can result in excellent functional recovery in SCEH, even in patients with severe initial neurological deficits. Early recognition of stroke-mimicking symptoms and urgent MRI evaluation are crucial for achieving optimal outcomes.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 1","pages":"55-63"},"PeriodicalIF":1.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202512","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":"Intraoperative Radiographic Factors Related to Postoperative Distal Adding-On in Lenke Type 1A Adolescent Idiopathic Scoliosis.","authors":"Takeshi Fujii, Satoshi Suzuki, Kazuki Takeda, Yasuhiro Kamata, Soya Kawabata, Takahito Iga, Toshiki Okubo, Masahiro Ozaki, Osahiko Tsuji, Narihito Nagoshi, Takehiro Michikawa, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.22603/ssrr.2025-0186","DOIUrl":"10.22603/ssrr.2025-0186","url":null,"abstract":"<p><strong>Introduction: </strong>Distal adding-on (DA) is a common radiographic complication following selective thoracic fusion for Lenke type 1A adolescent idiopathic scoliosis (AIS). This study aimed to investigate whether intraoperative radiographs can predict postoperative DA in Lenke type 1A AIS.</p><p><strong>Methods: </strong>A total of 79 patients with AIS and Lenke type 1A (group A) who underwent posterior selective thoracic fusion were retrospectively evaluated. For comparison, another 79 patients with Lenke type 1B and 1C (group BC) were included. The occurrence and factors associated with DA at 2 years postoperatively were investigated using intraoperative radiographs.</p><p><strong>Results: </strong>Of 158 total cases, eight patients (10%) in group A and 13 (16%) in group BC developed DA at two years postoperatively. Intraoperative radiographs in group A showed that the mean angulation of the first disc below the lowest instrumented vertebra (LIV) was significantly greater in the DA group (-2.3±2.3°) compared to the non-DA group (-0.6±1.7°). Patients with angulation of the first disc below the LIV greater than 3° were significantly associated with DA (odds ratio, 18.0; p<0.01) in group A, as well as in group BC (odds ratio, 22.0; p<0.01). In group A, the mean intraoperative LIV tilt angle was greater in the DA group (4.8±7.0°) than in the non-DA group (1.2±3.7°), with greater tilt observed in 1A-L (L4 tilted left) compared to type 1A-R (L4 tilted right). Multivariate analysis revealed that intraoperative LIV tilt was significantly associated with DA in group A, but not in group BC.</p><p><strong>Conclusions: </strong>Intraoperative radiographs showing angulation greater than 3° at the first disc below the LIV and larger LIV tilt angles were significantly associated with postoperative DA in Lenke type 1A. Surgeons should strive to achieve horizontalization of the LIV intraoperatively, especially in Lenke type 1A-L curves, to avoid postoperative DA.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"211-219"},"PeriodicalIF":1.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692356","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":"In Correction Surgery for Adolescent Idiopathic Scoliosis with Lenke Type 1 and 2 curves, Obtaining Kyphosis in the Upper Thoracic Spine Is Important for Preventing Postoperative Cervical Kyphosis.","authors":"Kanji Mori, Jun Takahashi, Hiroki Oba, Shinji Sasao, Shota Ikegami, Tetsuhiko Mimura, Shinji Imai","doi":"10.22603/ssrr.2025-0206","DOIUrl":"10.22603/ssrr.2025-0206","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with adolescent idiopathic scoliosis (AIS) frequently have cervical kyphosis, and, although it can be significantly improved by scoliosis correction surgery, cervical kyphosis remains frequent even after surgery. It has been reported that cervical kyphosis can increase the risk of pain, degenerative disc disease, and reduced quality of life, even in patients with AIS. However, it is unclear what indicators we should aim for during scoliosis correction surgery to prevent residual cervical kyphosis after surgery.</p><p><strong>Methods: </strong>A total of 45 consecutive patients (41 women, 4 men) with Lenke type 1 or 2 AIS who received posterior corrective surgery and were followed up for a minimum of 2 years were included. Data were extracted from our prospectively collected database. The patients were divided into 2 subgroups: those with cervical hyperkyphosis (cervical lordosis ≤-10°) and those without. We investigated the alignment we should aim for during posterior thoracic correction surgery to prevent postoperative cervical hyperkyphosis. According to the previous study, we focused particularly on upper thoracic kyphosis (TK1-5).</p><p><strong>Results: </strong>The cervical hyperkyphosis group was characterized by a large preoperative cervical kyphosis, a small preoperative and postoperative TK1-5, and a small postoperative T1 slope. In our multivariate logistic regression analysis, we found that postoperative TK1-5 was an independent associated factor for postoperative cervical hyperkyphosis.</p><p><strong>Conclusions: </strong>We clarified that during posterior correction surgery for Lenke type 1 and 2 curves AIS, formation of kyphosis in the thoracic spine, especially in the upper thoracic spine, is important for preventing postoperative cervical hyperkyphosis.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 1","pages":"89-95"},"PeriodicalIF":1.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202555","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":"Sex-Specific Associations between Schmorl Nodes, Modic Change, and Osteoporosis in the Low Thoracolumbar Spine in a Large Population-Based Study: The Wakayama Spine Study.","authors":"Masatoshi Teraguchi, Hiroshi Hashizume, Dino Samartzis, Hiroyuki Oka, Ryohei Kagotani, Keiji Nagata, Yuyu Ishimoto, Sakae Tanaka, Munehito Yoshida, Toshiko Iidaka, Noriko Yoshimura, Hiroshi Yamada","doi":"10.22603/ssrr.2025-0190","DOIUrl":"10.22603/ssrr.2025-0190","url":null,"abstract":"<p><strong>Background: </strong>The study examined sex-specific associations between Schmorl's nodes (SNs), Modic changes (MC), and osteoporosis (OP) in the low thoracolumbar region (Th10/11-L5/S1) using magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>This study included 970 participants (317 males, mean age=67.2 years; 653 females, mean age=66.0 years) aged 21-97 years from the Wakayama Spine Study. SN was defined as a small, well-defined herniation pit with a surrounding wall of hypointense signal. MC was defined as a diffuse high-signal change along either endplate. OP was defined according to the Japanese Society for Bone and Mineral Research criteria. We evaluated the prevalence of SN at each level and its detailed distribution in males and females. Univariate logistic regression analysis examined the association between the presence of SN in the low thoracolumbar region and age strata, body mass index (BMI), OP, and MC in males and females. Multiple logistic regression analysis identified independent factors, with significant factors in the univariate logistic regression analysis used as independent variables.</p><p><strong>Results: </strong>In females, but not males, advanced age was significantly associated with SN after adjustment for smoking and alcohol (50-59 years: odds ratio [OR] 3.2; 60-69 years: OR 6.0; 70-79 years: OR 12.1; >80 years: OR 14.8). OP and BMI were not significantly associated with SN in either males or females. MC was significantly associated with SN in females (OR, 1.5).</p><p><strong>Conclusions: </strong>This study demonstrated that SN was associated with MC, but not OP, in females. These findings may help elucidate the causes and mechanisms of SN.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"236-243"},"PeriodicalIF":1.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692337","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":"Objective Monitoring of Jewett Brace Compliance in Osteoporotic Vertebral Fractures: A Prospective Sensor-Based Study.","authors":"Toru Funayama, Kosuke Sato, Yosuke Shibao, Yosuke Ogata, Shun Okuwaki, Hisanori Gamada, Takane Nakagawa, Kousei Miura, Hiroshi Takahashi, Hiroshi Noguchi, Masaki Tatsumura, Masao Koda","doi":"10.22603/ssrr.2025-0215","DOIUrl":"10.22603/ssrr.2025-0215","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporotic vertebral fractures (OVFs) are the most common type of fragility fracture in elderly patients with osteoporosis. Bracing is widely used for conservative treatment; however, few studies have objectively assessed patient adherence to prescribed brace usage. This prospective study aimed to evaluate true patient compliance with the Jewett brace for acute OVFs using a temperature logger embedded in the brace.</p><p><strong>Methods: </strong>Patients aged ≥65 years with an acute OVF diagnosed within two weeks of injury were enrolled between February 2024 and January 2025. After two weeks of bed rest, patients began ambulation while wearing a Jewett brace. A button-type temperature logger was installed on the sternal pad of the brace to record the temperature every 30 minutes for 42 consecutive days. Wearing was defined as temperatures ≥30°C. Based on previous reports, wearing the brace for 15 hours daily was defined as 100% compliance. Compliance was calculated for the entire period, for hospitalization versus post-discharge, and at three 14-day intervals. Correlations between vertebral instability and compliance were also analyzed.</p><p><strong>Results: </strong>A total of 17 patients were included in the final analysis. The mean overall compliance rate was 85.8%, corresponding to an average wearing time of 12.9 hours per day. Brace compliance was consistently maintained at a high level during hospitalization and after discharge, as well as across the first, second, and last 14-day intervals. The daily wearing rate peaked at approximately 80% around mealtimes and remained above 70% during daytime hours. A significant, moderately positive correlation was observed between vertebral instability and compliance in the last 14 days.</p><p><strong>Conclusions: </strong>This study objectively demonstrated a remarkably high patient compliance rate of 85.8% (12.9 hours per day) with Jewett braces for OVFs during the 42-day period following the initial two-week hospitalized bed rest.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 1","pages":"64-72"},"PeriodicalIF":1.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202584","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":"Fulcrum Side-Bending Radiographs as Predictors of Postoperative Shoulder Imbalance in Lenke Type 5 Adolescent Idiopathic Scoliosis.","authors":"Tetsutaro Abe, Masashi Miyazaki, Noriaki Sako, Nobuhiro Kaku","doi":"10.22603/ssrr.2025-0226","DOIUrl":"10.22603/ssrr.2025-0226","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative shoulder imbalance (PSI) is a cosmetically and psychologically significant complication following surgical correction of adolescent idiopathic scoliosis (AIS). While commonly studied in thoracic curve patterns, its occurrence in Lenke type 5 curves remains under-investigated. This study aimed to identify radiographic predictors of PSI in Lenke type 5 AIS, with particular emphasis on preoperative fulcrum side bending (FSB) flexibility assessment.</p><p><strong>Methods: </strong>A retrospective review was conducted on 21 patients with Lenke type 5C AIS (mean age 14.6±2.6 years) who underwent posterior spinal fusion using all-pedicle screw constructs. Preoperative and postoperative radiographic parameters were analyzed, including Cobb angles of proximal thoracic, main thoracic (MT), and thoracolumbar/lumbar (TL) curves. Flexibility was assessed with active side bending (ASB) and FSB radiographs. ΔASB and ΔFSB were calculated as the difference from the standing Cobb angles. PSI was defined as a coracoid height difference ≥9 mm or a clavicle angle ≥2°.</p><p><strong>Results: </strong>PSI occurred in 7 patients (33.3%). The PSI group showed significantly greater ΔFSB in the TL curve (41.7°±5.7 vs. 35.3°±2.2, p=0.01), smaller ΔFSB in the MT curve (p=0.04), and a higher TL correction rate (p=0.03). Logistic regression identified ΔFSB in TL (odds ratio [OR] 1.21, p=0.03) and TL correction rate (OR 1.15, p=0.04) as independent predictors of PSI.</p><p><strong>Conclusions: </strong>Preoperative FSB radiographs are valuable not only for estimating curve flexibility but also for identifying patients at risk of PSI in Lenke type 5 AIS. Surgeons should consider not only the absolute flexibility of each curve but also the relative flexibility between TL and MT segments when determining correction magnitude; intraoperative moderation of TL correction may be warranted when the MT segment demonstrates limited compensatory flexibility.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"244-252"},"PeriodicalIF":1.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692331","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":"Tribute to Professor Jean Félix Dubousset (1936-2025).","authors":"Kazuhiro Hasegawa, Illés Tamás, Masafumi Machida","doi":"10.22603/ssrr.2025-0165","DOIUrl":"10.22603/ssrr.2025-0165","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 5","pages":"496-497"},"PeriodicalIF":1.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303329","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}