The Journal of Bone & Joint Surgery最新文献

{"title":"Spinal Fusion in Patients with GMFCS IV or V Cerebral Palsy: Durable Correction and Lasting Quality of Life Improvements: Five-Year Multicenter Outcomes.","authors":"Arun R Hariharan,Michael W Brown,Tracey Bryan,Craig R Louer,John S Vorhies,Robert H Cho,Paul Sponseller,Stefan Parent,Suken A Shah,Patrick Cahill,Joshua M Pahys,Vidyadhar V Upasani,Baron S Lonner,Peter O Newton,Amer F Samdani,Firoz Miyanji, ","doi":"10.2106/jbjs.25.00186","DOIUrl":"https://doi.org/10.2106/jbjs.25.00186","url":null,"abstract":"BACKGROUNDUnderstanding outcomes of spinal fusion (SF) in children with cerebral palsy (CP) beyond the short term is important to determine efficacy and durability. This study examined complications, unplanned returns to the operating room (UPROR), and radiographic and clinical outcomes after SF in children with CP.METHODSPatients with GMFCS IV or V CP who had been followed for a minimum of 5 years after SF were identified in a prospective multicenter database and analyzed. The major Cobb angle and pelvic obliquity (PO) were recorded. Data regarding complications and any UPROR were collected prospectively. The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire was completed preoperatively and at 2 and 5 years postoperatively. Data were analyzed using a generalized estimating equation (GEE), repeated-measures analysis of variance (RM-ANOVA), and the Kaplan-Meier method.RESULTSOne hundred and eighty-nine patients (mean age, 13.4 ± 2.7 years; 94 male and 95 female; 45% White, 24% Hispanic, 16% Black, and 4% Asian as self-reported) were included in the study. The preoperative Cobb angle (82.8° ± 23.0°) was improved at 2 years (29.9° ± 16.2°; p < 0.001), and the improvement was maintained at 5 years (30.2° ± 17.0°; p = 0.284). The preoperative PO (27.4° ± 15.6°) was improved at 2 years (9.7° ± 9.1°; p < 0.001), and the improvement was maintained at 5 years (9.9° ± 9.8°; p = 0.997). There were 46 patients (24.3%) with major complications and 25 patients (13.2%) who required UPROR, mostly within the first year. The probability of remaining free of major complications and of having no UPROR at 5 years was >75% and >87%, respectively. Improvements in CPCHILD scores were observed at 2 years and remained improved at 5 years compared with baseline. RM-ANOVA demonstrated no significant differences in the change in scores over time in patients with complications or UPROR compared with those who did not. Those with complications or UPROR showed no evidence of a major decline in CPCHILD scores.CONCLUSIONSSF resulted in durable radiographic correction and sustained improvements in caregiver-reported quality of life over a minimum of 5 years. Patients with major complications or UPROR showed no deterioration in CPCHILD scores. These findings support SF as an effective treatment option for appropriately selected patients with GMFCSIV or V CP.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071704","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":"Hamstring Tendon Versus Bone-Patellar Tendon-Bone Autograft for ACL Reconstruction with Concurrent Lateral Extra-Articular Procedure: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Kwangho Chung,Joo Hyung Han,Se-Han Jung,Hyun-Soo Moon,Min Jung,Sung-Hwan Kim","doi":"10.2106/jbjs.25.00068","DOIUrl":"https://doi.org/10.2106/jbjs.25.00068","url":null,"abstract":"BACKGROUNDNo studies have yet evaluated the clinical outcomes of different anterior cruciate ligament (ACL) autografts in combination with a lateral extra-articular procedure (LEP). Thus, we systematically reviewed randomized controlled trials (RCTs) and conducted a network meta-analysis (NMA) to compare graft options for ACL reconstruction (ACLR) with concurrent LEP.METHODSA systematic search in the PubMed, Embase, Cochrane Library, and Google Scholar databases identified RCTs on primary ACLR plus LEP. Data on ACLR failure, residual knee instability, patient-reported outcome measures, and complications were analyzed using NMA.RESULTSOn the basis of 13 studies (1,690 patients), ACLR with a hamstring tendon (HT) autograft plus LEP was associated with significantly lower odds of graft rupture (odds ratio [OR]: 0.28; 95% confidence interval [CI]: 0.16 to 0.50), graft failure (OR: 0.27; 95% CI: 0.15 to 0.47), clinical failure (OR: 0.48; 95% CI: 0.36 to 0.65), and residual pivot shift (OR: 0.43; 95% CI: 0.22 to 0.84) compared with isolated ACLR. Bone-patellar tendon-bone (BPTB) autograft plus LEP was associated with a significantly lower clinical failure rate (OR: 0.30; 95% CI: 0.12 to 0.80) compared with isolated ACLR. Both HT (mean difference [MD]: 2.40; 95% CI: 1.25 to 3.55) and BPTB (MD: 3.70; 95% CI: 0.85 to 6.55) autograft plus LEP were associated with higher Lysholm scores compared with isolated ACLR. The outcomes did not differ between the graft types when combined with LEP.CONCLUSIONSThe odds of graft rupture, graft failure, and clinical failure after ACLR with HT autograft plus LEP were lower by 72%, 73%, and 52%, respectively, than the odds after isolated ACLR. ACLR with BPTB autograft plus LEP significantly lowered only the odds of clinical failure, by approximately 70%, potentially due to the smaller sample size. Both grafts remain viable options for ACLR plus LEP, with the benefit of LEP requiring further validation.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068240","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":"Injection-Based Therapies for the Management of Hip and Knee Osteoarthritis.","authors":"K T Matthew Seah,Michael E Neufeld,Lisa C Howard,Donald S Garbuz,Bassam A Masri","doi":"10.2106/jbjs.25.00239","DOIUrl":"https://doi.org/10.2106/jbjs.25.00239","url":null,"abstract":"➢ Corticosteroid injections are largely safe, but patients and practitioners should be aware of the small risk of adverse side effects, and their limited duration of efficacy. The timing of injection should be coordinated with potential surgical dates.➢ The routine use of hyaluronic acid injections for osteoarthritis is not recommended, but there are certain subsets of patients, such as those who have undergone other therapies that failed, who may benefit from it.➢ Local anesthetics are frequently used in conjunction with corticosteroids for enhanced pain control; however, caution is needed because of concerns regarding chondrotoxicity. Proper patient selection is crucial, and their overuse for diagnostic purposes is not recommended.➢ There is currently insufficient evidence to support the routine use of prolotherapy, bone marrow aspirate concentrate, stromal vascular fraction, and mesenchymal stromal cell injections.➢ Intra-articular saline solution has been associated with improvements in both patient-reported pain and function scores, and this should be considered in future study designs.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068241","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":"Hip and Knee Arthroplasty in Patients with Obesity.","authors":"Chuan Kong Koh,Simon Garceau,George Grammatopoulos,Paul E Beaulé","doi":"10.2106/jbjs.25.00131","DOIUrl":"https://doi.org/10.2106/jbjs.25.00131","url":null,"abstract":"➢ Obesity is associated with increased postoperative complications and reoperation following total joint arthroplasty.➢ Meaningful functional improvement can be achieved with appropriate measures.➢ Preoperative measures include medical optimization, weight management, and consideration of bariatric surgery and glucagon-like peptide-1 receptor agonists.➢ Perioperative optimization requires an experienced multidisciplinary team and awareness of technical considerations for patients with obesity undergoing total joint arthroplasty.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043747","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":"The Broken Wing Sign: A New Clinical Test to Detect Gluteus Medius Pathology with and without Fatty Infiltration.","authors":"Rafael J Sierra,Sergio F Guarin Perez,Diego J Restrepo,Benjamin M Howe,Ta-Wei Tai","doi":"10.2106/jbjs.25.00427","DOIUrl":"https://doi.org/10.2106/jbjs.25.00427","url":null,"abstract":"BACKGROUNDGluteus medius tears and atrophy cause lateral hip pain, limp, and functional impairment. We developed the \"broken wing sign,\" a novel physical examination test for detecting gluteus medius tendon tears and muscle degeneration. This study evaluated its diagnostic accuracy and clinical utility against magnetic resonance imaging (MRI) and intraoperative findings.METHODSWe prospectively examined 59 patients (75 hips; mean age, 69.5 ± 10.8 years; 48 women) with suspected hip abductor insufficiency. The broken wing sign was tested with patients prone, the knee flexed at 90°, and the hip actively extended. A positive sign involved ≥10° of compensatory external hip rotation, visible as an inward drift of the foot, indicating gluteus medius (and resulting internal rotation) weakness. MRI served as the reference standard for classifying gluteus medius integrity as no tear, partial, full-thickness, or massive. Fatty infiltration was graded (Goutallier grades 0 to 4), quantified, and analyzed for a correlation with the examination findings. Diagnostic accuracy metrics were calculated.RESULTSThe broken wing sign demonstrated high accuracy (sensitivity, 81.8%; specificity, 80.0%; positive predictive value [PPV], 91.8%; negative predictive value, 61.5%; diagnostic odds ratio, 17.8). An external rotation threshold of ≥30° yielded 100% specificity and 100% PPV for a tear. The sign detected acute tears with no or minimal fatty infiltration (100% sensitivity for massive tears). The degree of the external rotation angle was strongly correlated with muscle atrophy with fatty infiltration, showing 88.0% sensitivity for Goutallier grade ≥3 and 100% sensitivity for grade 4.CONCLUSIONSThe broken wing sign is clinically useful for diagnosing gluteus medius tendon tears and muscle atrophy, particularly massive tears and advanced fatty degeneration. It effectively guides MRI utilization and surgical planning, serving as a valuable initial diagnostic tool in the clinical setting.LEVEL OF EVIDENCEDiagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043746","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":"Quantifying Changes in 3D Acetabular Morphology in Normal Hips Based on the Development of Secondary Ossification Centers.","authors":"Rajvarun S Grewal,Lukas G Keil,James D Bomar,Justin Ryan,Byron V L Beasley,Christine L Farnsworth,Matthew R Schmitz,Vidyadhar V Upasani","doi":"10.2106/jbjs.25.00428","DOIUrl":"https://doi.org/10.2106/jbjs.25.00428","url":null,"abstract":"BACKGROUNDAcetabular development in pediatric hips is driven by growth from the triradiate cartilage (TRC) and secondary ossification centers (SOCs) of the os pubis, os ischium, and os ilium. These SOCs appear and fuse at different ages, with sex-specific differences affecting their morphology. This study quantifies the impact of SOCs on acetabular coverage, version, tilt, and surface area during adolescence.METHODSThree-dimensional (3D) surface reconstructions of 540 normal hips (in 128 male and 142 female patients) aged 8 to 19 years with no hip pathology were generated from computed tomography (CT) scans. Acetabular parameters, including coverage angles in predefined octants, version, tilt, and surface area, were extracted with use of a previously published algorithm. The Proximal Femur Maturity Index (PFMI) was used to assess skeletal maturity. Contributions to acetabular morphology from the 3 SOCs were analyzed using generalized linear mixed models. Significance was defined as p < 0.05.RESULTSPFMI grades strongly correlated with chronological age (rs = 0.91; p < 0.001). Os ilium ossification was significantly associated with increased superior coverage (p < 0.001), and os ischium ossification was associated with increased posterior coverage (p < 0.001). Superior coverage demonstrated a strong correlation with lateral tilt (rs = 0.837; p < 0.001), and posterior coverage was strongly correlated with anteversion (rs = 0.788; p < 0.001). Female patients exhibited greater acetabular anteversion (17.7° ± 6.4° versus 12.2° ± 6.4°; p < 0.001) and lateral tilt (38.5° ± 4.7° versus 36.6° ± 5.7°; p < 0.001), whereas male patients demonstrated larger acetabular surface area (31.9 ± 6.4 versus 28.8 ± 4.2 cm2; p < 0.001). We did not find a significant association between os pubis ossification and increased anterior coverage in male (p = 0.38) or female (p = 0.065) patients, nor did we find a correlation between anterior coverage and age (p = 0.115).CONCLUSIONSOs ilium and os ischium ossification were associated with increased superior and posterior acetabular coverage, respectively, during adolescence. In contrast, os pubis ossification was not associated with changes in anterior coverage. The timing of SOC appearance and closure aligns with key developmental changes in acetabular morphology, reinforcing the role of SOCs in determining hip stability.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043744","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":"Modern Alignment Strategies in Total Knee Arthroplasty and How to Best Achieve Them.","authors":"Andrew B Harris,Jonathan M Vigdorchik,Harpal S Khanuja,Vishal Hegde","doi":"10.2106/jbjs.25.00480","DOIUrl":"https://doi.org/10.2106/jbjs.25.00480","url":null,"abstract":"➢ Adherence to accepted definitions of the various alternative total knee arthroplasty alignment strategies is important for research and communication between surgeons.➢ Technological advances, including robotics and navigation-assisted systems, have made precise execution of alternative alignment strategies feasible.➢ Modern studies have suggested that minor deviations (±3°) from neutral mechanical alignment do not significantly impact long-term total knee arthroplasty implant survivorship.➢ Individualized alignment strategies, such as kinematic, restricted kinematic, and functional alignment, aim to respect native anatomy and soft-tissue balance.➢ The majority of studies comparing intermediate-term outcomes of kinematic and mechanical alignment suggest noninferior outcomes with kinematic alignment; however, some studies have suggested superior outcomes with kinematic alignment.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043745","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":"Congenital Cervical Scoliosis at the Craniovertebral Junction: Clinical Characteristics and Surgical Strategies in 27 Patients with Mid-Term Follow-up.","authors":"Dazhao Tie,Tian Xia,Shuo Cao,Shengfa Pan,Xin Chen,Yanbin Zhao,Yu Sun,Feifei Zhou","doi":"10.2106/jbjs.24.01233","DOIUrl":"https://doi.org/10.2106/jbjs.24.01233","url":null,"abstract":"BACKGROUNDCongenital cervical scoliosis at the craniovertebral junction is an exceedingly rare condition, with limited existing research. In this study, we aimed to elucidate the clinical characteristics, surgical strategies, and postoperative outcomes associated with this unique pathology, providing a comprehensive analysis to enhance clinical understanding and management.METHODSWe conducted a retrospective analysis involving 27 patients with congenital cervical scoliosis at the craniovertebral junction who underwent surgery at a mean age of 7.81 ± 1.52 years. The median follow-up duration was 36.00 months. Patients were categorized into Group A and Group B on the basis of the absence or presence of concomitant subaxial cervical scoliosis, respectively. Three distinct surgical strategies were employed accordingly. Radiographic parameters were measured preoperatively, within 5 days postoperatively, and at the final follow-up. Other clinical and surgical characteristics were also collected.RESULTSPatients exhibited preoperative coronal imbalance, with a mean structural Cobb angle of 30.75° ± 13.09° and a mean head shift of 20.34 ± 13.23 mm. At the final follow-up, these parameters had significantly improved to a median of 3.00° and 8.59 mm (both p < 0.05). The mean operative time was 473.74 ± 134.29 minutes, and the mean intraoperative blood loss was 336.11 ± 166.52 mL. Among the 27 patients, 10 were in Group A and the other 17 were in Group B. Twenty-three patients/families reported being \"satisfied\" or \"very satisfied\" with the surgical outcome at the final follow-up. Postoperative complications occurred in 11 patients; no nerve root or vertebral artery injuries were observed.CONCLUSIONSCongenital cervical scoliosis at the craniovertebral junction is a complex deformity that severely influences coronal alignment. Nevertheless, tailored surgical strategies have shown promising effectiveness in achieving satisfactory clinical and psychological results.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035925","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":"Prophylaxis Against Complex Regional Pain Syndrome Recurrence with Vitamin C in Total Knee Arthroplasty: A Propensity Score-Matched Analysis of 960 Cases.","authors":"Jacques Hernigou,Esfandiar Chahidi,Johnatan Everaert,Liam Sabot,Alexandre Hupez,Gauthier Gamela Sedieto,Antoine Callewier,Olivier Bath,Sagi Martinov","doi":"10.2106/jbjs.24.01584","DOIUrl":"https://doi.org/10.2106/jbjs.24.01584","url":null,"abstract":"BACKGROUNDSeveral studies have investigated the risk of complex regional pain syndrome (CRPS) and its prevention with vitamin C. However, evidence regarding the effectiveness of vitamin C for prevention of CRPS development or recurrence after total knee arthroplasty (TKA) is lacking.METHODSThis retrospective single-center observational cohort study, which utilized propensity-score matching (PSM), was conducted from January 2017 to December 2021. It initially included 1,088 TKAs, 49 of which were in patients who had a previous CRPS. After exclusion of 50 TKAs, the study included 467 TKAs (45%) in patients who received vitamin C prophylaxis (1 g daily for 40 days) after surgery and 571 (55%) in patients who did not. After 1:1 matching on the basis of sex, age, body mass index, presence of diabetes mellitus and hypertension, use of tobacco and alcohol, anesthesia modality, tourniquet use, and anxiety and depression, the vitamin C group and the no-vitamin C group comprised 480 patients each. Twenty-eight of these 960 patients had a history of CRPS.RESULTSIn the PSM population, 6.9% (33) of the 480 patients who received vitamin C prophylaxis after TKA developed CRPS compared with 11.0% (53) of the 480 who did not receive vitamin C (odds ratio [OR] = 0.59 [95% confidence interval (CI), 0.37 to 0.9], p = 0.024). The rate of CRPS was significantly higher in patients with a history of CRPS (32% versus 8% for patients with no previous CRPS; OR = 5.4 [95% CI, 2.57 to 11.4], p < 0.001). In the 28 patients with a history of CRPS, vitamin C prophylaxis reduced the rate of CRPS recurrence after TKA to 19% (4 of 21) compared with 71% (5 of 7) in the patients not treated with vitamin C (OR = 0.09 [95% CI, 0.01 to 0.64], p = 0.02). In multivariable regression of the matched patients, vitamin C was also found to be independently associated with a lower rate of CRPS recurrence after TKA (OR = 0.53 [95% CI, 0.3 to 0.86], p = 0.011).CONCLUSIONSVitamin C prophylaxis may be appropriate for preventing CRPS after TKA. Furthermore, the study highlights the beneficial role of vitamin C in reducing the rate of CRPS recurrence in patients with a history of CRPS who are undergoing TKA.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025740","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":"Principles of Level Selection for Instrumentation in Adult Thoracolumbar Spinal Deformity Surgery: Guidelines for Treatment.","authors":"Zeeshan M Sardar,Josephine R Coury,Katherine Dong,Anson G Bautista,Lawrence G Lenke,Justin L Reyes","doi":"10.2106/jbjs.24.00910","DOIUrl":"https://doi.org/10.2106/jbjs.24.00910","url":null,"abstract":"➢ For primarily scoliotic deformities, the principles of the modular Lenke classification for adult idiopathic scoliosis can be used to guide level selection.➢ For hyperkyphotic deformities, the upper end vertebra is a suitable upper instrumented vertebra. The sagittal stable vertebra or the first lordotic vertebra is appropriate for the lower instrumented vertebra when fusion to the sacrum is not required.➢ Pelvic fixation can be considered in cases of sagittal and coronal malalignment when ≥4 levels of fusion to the sacrum are planned, L3 to L5 3-column osteotomies are planned, the patient has osteoporosis, or significant disc degeneration or stenosis exists at L5 to S1.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003191","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}