Clinics in Orthopedic Surgery最新文献

{"title":"Comparison of Landmark-Based Versus Transverse Carpal Ligament Penetrating Corticosteroid Injection for Bilateral Carpal Tunnel Syndrome: A Prospective Randomized Trial.","authors":"Seung Hyun Lee, Jae Kwang Kim, Young Ho Shin","doi":"10.4055/cios24367","DOIUrl":"10.4055/cios24367","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the effectiveness and complications between classic palmaris longus tendon landmark-based corticosteroid injection (CI) and transverse carpal ligament (TCL)-penetrating CI for carpal tunnel syndrome (CTS).</p><p><strong>Methods: </strong>We performed a landmark-based CI on one hand and a TCL-penetrating CI on the other side after randomization in 30 consecutive patients with bilateral CTS. The pain visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire (BCTQ) were assessed at baseline, 4 weeks, and 3 and 6 months after injection. Skin hypopigmentation of the injection site was evaluated using the modified Vancouver scar scale (mVSS). Pain during needle insertion was evaluated using a VAS for each hand.</p><p><strong>Results: </strong>The mean patient age was 56 ± 11 years (range, 32-77 years), and 27 patients (90.0%) were women. The pain VAS, BCTQ scores, and the incidence of skin hypopigmentation were not significantly different between the 2 groups after injection, but the mean mVSS scores were significantly higher in the landmark-based CI group at all time points. The pain VAS score during needle insertion was significantly higher in the TCL-penetrating CI group.</p><p><strong>Conclusions: </strong>When comparing the pain VAS and BCTQ scores, the difference between the 2 groups was not statistically significant. TCL-penetrating CI causes considerable pain during needle insertion but causes less severe skin hypopigmentation than landmark-based CI in CTS treatment.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"497-505"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antegrade Supraspinatus Advancement Yields Promising Clinical and Structural Outcomes for Retracted Irreducible Rotator Cuff Tears.","authors":"Chris Hyunchul Jo, Kyunghoon Kim, Eun Mi Ahn","doi":"10.4055/cios24222","DOIUrl":"10.4055/cios24222","url":null,"abstract":"<p><strong>Backgroud: </strong>To investigate the feasibility of the antegrade supraspinatus advancement (ASSA), which could be executed entirely arthroscopically without requiring a medial incision; to evaluate the impact of the ASSA on the lateral excursion of the torn end of the supraspinatus in retracted irreducible rotator cuff tears (RIRCTs); and to assess the safety and efficacy of arthroscopic rotator cuff repair with the ASSA.</p><p><strong>Methods: </strong>A total of 57 patients with RIRCTs who underwent the ASSA and were followed up for at least a year with magnetic resonance imaging (MRI) were included. The RIRCT was defined as the lateral excursion grade C (coverage less than the medial half of the greater tuberosity) or D (exposure of the glenohumeral joint). Clinical outcomes assessed nerve injury, pain, range of motion, strength, functional scores, and overall satisfaction and function. Structural outcomes evaluated the retear rate, fatty infiltration, and muscle atrophy of the rotator cuff muscles. The baseline for these structural measurements was time-zero MRIs.</p><p><strong>Results: </strong>The ASSA was feasibly performed all arthroscopically without a medial incision. There was no suprascapular nerve injury during the follow-up. The ASSA increased lateral excursion of the torn end in 86% of the patients from C or D to A or B. The ASSA significantly reduced pain and improved function of the shoulder at the final follow-up. All 11 patients who had had pseudoparalysis prior to repair regained the ability to raise their arm. The retear rate after the ASSA was 18.4%.</p><p><strong>Conclusions: </strong>This study demonstrated that the ASSA can be safely and effectively performed all arthroscopically, significantly increasing the lateral excursion of the supraspinatus, thereby ensuring successful rotator cuff repair. This leads to a superior quality of repair, which consequently results in better clinical and structural outcomes, including the reversal of pseudoparalysis.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"460-469"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant Rotator Cuff Tear with Frozen Shoulder: A Contemplation on the Necessity and Legitimacy of Magnetic Resonance Imaging Stratified by Age.","authors":"Hsien-Hao Chang, Tae-Hwan Yoon, Joon-Ryul Lim, Yong-Min Chun","doi":"10.4055/cios24240","DOIUrl":"10.4055/cios24240","url":null,"abstract":"<p><strong>Background: </strong>Frozen shoulder (FS) is often accompanied by a rotator cuff tear (RCT), but it can be challenging to diagnose a concomitant RCT without imaging studies. Therefore, having practical criteria to identify patients requiring imaging studies at initial presentation with FS would lead to more cost-effective use of these studies. This study investigated the relationship between RCT and stiffness in patients with FS and whether this relationship was modified by patient age.</p><p><strong>Methods: </strong>This study included 540 adults with shoulder pain who had ≥ 10° of limited passive range of motion in forward flexion, compared to the contralateral side. Patients were categorized into 2 groups depending on the degree of forward flexion stiffness: overhead stiffness (OHS) group, patients with ≥ 110° forward flexion (n = 349); and non-OHS group, patients with forward flexion < 110° (n = 191). The presence of concomitant RCT was determined by magnetic resonance imaging and compared between groups before and after stratification by age.</p><p><strong>Results: </strong>The OHS group had increased odds of concomitant RCT, compared to the non-OHS group (odds ratio [OR], 4.99; 95% CI, 3.36-7.42). OHS was also significantly associated with a more severe grade of RCT (no tear, partial-thickness tear, or full-thickness tear) (OR, 4.42; 95% CI, 3.05-6.39). The odds of RCT in the OHS group, compared to the non-OHS group, increased with age (50-59 years: OR, 3.83; 95% CI, 1.96-7.48; 60-69 years: OR, 5.94; 95% CI, 3.14-11.26; and 70-79 years: OR, 7.67; 95% CI, 2.71-21.66).</p><p><strong>Conclusions: </strong>Patients with FS and forward flexion range of motion ≥ 110° (i.e., OHS) at initial presentation had approximately 5-fold higher odds of concurrent RCT than patients with non-OHS. Moreover, in patients aged 50 years or above, these odds increased up to almost 8-fold. Therefore, we recommend confirming the rotator cuff integrity with magnetic resonance imaging in patients with FS and OHS.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"453-459"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Glenoid Concavity Restoration on Surgical Failure after Arthroscopic Bony Bankart Repair.","authors":"In Park, Dong-Hyeon Kim, Sang-Jin Shin","doi":"10.4055/cios24347","DOIUrl":"10.4055/cios24347","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the degree of glenoid concavity restoration and its effect on surgical failure after arthroscopic bony Bankart repair for recurrent anterior shoulder instability with a bony Bankart lesion.</p><p><strong>Methods: </strong>Forty-one patients who underwent arthroscopic bony Bankart repair for recurrent anterior shoulder instability with a bony Bankart lesion were retrospectively evaluated. All patients underwent 3-dimensional computed tomography (3D-CT) preoperatively to evaluate the glenoid concavity using the bony shoulder stability ratio (BSSR). Bony fragments were incorporated to the anterior glenoid during arthroscopic stabilization procedure. All patients were reevaluated by 3D-CT at postoperative 1 year to assess the changes in the BSSR and the final glenoid bone defect size after bony Bankart repair. Clinical outcomes including surgical failure were evaluated at least 2 years after surgery.</p><p><strong>Results: </strong>The BSSR significantly increased after surgery (26.0% ± 14.0% preoperatively and 35.5% ± 13.2% postoperatively, <i>p</i> < 0.001). Preoperative glenoid bone defect size was 16.2% ± 8.1%, and bony Bankart fragment size was 11.3% ± 7.2%. Four patients (9.8%) had recurrent instability requiring revision surgery. In patients with surgical failure, the BSSR was not improved after surgery (18.2% ± 13.3% preoperatively and 23.1% ± 17.3% postoperatively, <i>p</i> = 0.24). In contrast, patients without surgical failure showed significantly improved BSSR after surgery (26.9% ± 14.0% preoperatively and 36.9% ± 12.2% postoperatively, <i>p</i> < 0.001). No significant differences were found in the final glenoid bone defect size (6.6% ± 5.9% in patients with surgical failure vs. 6.2% ± 5.7% in patients without surgical failure, <i>p</i> = 0.92) and bony Bankart fragment nonunion rate (0% in patients with surgical failure vs. 5.4% in patients without surgical failure, <i>p</i> = 0.99) between patients with and without surgical failure.</p><p><strong>Conclusions: </strong>Glenoid concavity, as represented by the BSSR, improved after arthroscopic bony Bankart repair, and satisfactory restoration of the glenoid concavity led to successful clinical outcomes without surgical failure. The BSSR could be considered an important factor for predicting clinical outcomes after arthroscopic bony Bankart repair. However, further research including more contributing factors is needed to better analyze the impact of the BSSR on clinical outcomes.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"470-477"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological Parameters for Predicting the Risk of Flexor Tendon Rupture after Volar Plate Fixation for Distal Radius Fracture.","authors":"Il-Jung Park, Hyun Woo Park, Seungbae Oh, Soo-Hwan Kang","doi":"10.4055/cios24387","DOIUrl":"10.4055/cios24387","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to investigate postoperative radiographic parameters for predicting flexor tendon rupture after volar plate fixation for distal radius fractures.</p><p><strong>Methods: </strong>In this retrospective cohort study, postoperative radiographs of 15 cases of flexor tendon rupture were included as a flexor tendon rupture group. Additionally, data from 45 patients with non-flexor tendon rupture (control group), matched in terms of age, sex, and fracture type (1 : 3) to the flexor tendon rupture group, were reviewed in terms of fracture reduction and plate position. We assessed the Soong grade, plate-to-critical line distance (PCLD), and plate-to-volar rim distance to determine plate position and used other parameters to analyze anatomical reduction including radial tilt, ulnar variance, coronal carpal translation, radius-radial styloid distance, volar tilt, sagittal carpal alignment (SCA), and radius-volar lip distance (RVLD).</p><p><strong>Results: </strong>We identified 3 significant predictive factors for flexor tendon rupture after volar plate fixation for distal radius fractures. The mean PCLD and SCA were significantly greater in the flexor tendon rupture group than in the control group (<i>p</i> < 0.001). The mean RVLD was smaller in the flexor tendon rupture group than in the control group (<i>p</i> = 0.033). Logistic regression analysis was performed to examine the importance of the variables.</p><p><strong>Conclusions: </strong>Our findings underscore the importance of PCLD, SCA, and RVLD as significant risk factors for flexor tendon rupture. Accurate plate positioning, achieving appropriate anatomical reduction, and vigilant monitoring for signs of plate irritation in high-risk patients may help prevent flexor tendon rupture.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"488-496"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review on the Double Pulley-Triple Row Technique for Large to Massive Rotator Cuff Repair.","authors":"Vivek Kumar Morya, Jun Lang, Yong-Beom Lee, Jung Woo Kim, Kang Uk Lee, Kyu-Cheol Noh","doi":"10.4055/cios24424","DOIUrl":"10.4055/cios24424","url":null,"abstract":"<p><p>Rotator cuff tears are common shoulder injuries that often necessitate surgical intervention, particularly when nonoperative treatments fail. Arthroscopic rotator cuff repair is the current gold standard; however, challenges, such as high retear rates, especially in large tears, persist. Traditional techniques, such as single-row and double-row repairs, have limitations in fully restoring the anatomical footprint and ensuring optimal healing. This review examines the novel double pulley-triple row technique, which aims to overcome these limitations by enhancing the footprint contact area, load distribution, and tendon healing. By evaluating the double pulley-triple row method in comparison to established techniques, this study explores the potential advantages, limitations, and future directions of rotator cuff repair.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"359-371"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Outcomes between Cage Alone and Plate Fixation in Single-Level Anterior Cervical Fusion: A Retrospective Clinical Series.","authors":"Jae-Won Shin, Han-Bin Jin, Yung Park, Joong-Won Ha, Hak-Sun Kim, Kyung-Soo Suk, Sung-Hwan Moon, Si-Young Park, Byung-Ho Lee, Ji-Won Kwon, In-Uk Kim","doi":"10.4055/cios24036","DOIUrl":"10.4055/cios24036","url":null,"abstract":"<p><strong>Backgroud: </strong>To identify the optimal surgical technique for single-level anterior cervical discectomy and fusion (ACDF), this study compared surgical outcomes and incidence of adjacent segment degeneration (ASD) in patients undergoing single-level ACDF using cage alone single-level fusion and plate fixation techniques.</p><p><strong>Methods: </strong>This single-center retrospective study (2003-2018) included patients who underwent single-level ACDF with either plate fixation (PLATE) or cage (CAGE) alone. The radiologic and clinical outcomes between the 2 surgical groups were compared over a 4-year follow-up period. Outcomes of interest included parameters related to range of motion, sagittal alignment, as well as fusion, subsidence, and ASD rates. Clinical outcomes were evaluated using the Neck Disability Index (NDI) and visual analog scale (VAS) for pain. Dysphagia and hoarseness rates were estimated based on medical records.</p><p><strong>Results: </strong>Forty-seven patients were included (n=17 in CAGE group). In the CAGE group, 94.1% of the patients had Bridwell grade 1 or 2, compared to 83.3% in the PLATE group (<i>p</i> = 0.396). Subsidence occurred in 12.5% and 3.6% of the CAGE and PLATE cases, respectively (<i>p</i> = 0.543). Segmental kyphosis progressed in the CAGE group compared to the PLATE group at 12, 24, and 48 months (<i>p</i> < 0.001). Radiographic ASD was observed in 41.2% and 30.0% of patients in the CAGE and PLATE groups, respectively, with a higher incidence in the upper segments for both groups. Preoperative NDI scores were similar between the groups; however, postoperatively, the CAGE group had significantly lower NDI scores (3.50 ± 2.74 vs. 8.00 ± 5.81) at 4 years (<i>p</i> = 0.020). Neck pain VAS scores also showed significant improvement in the CAGE group (2.33 ± 2.94) compared with that in the PLATE group (3.07 ± 2.31) at 4 years (<i>p</i> = 0.045). Both groups showed comparable arm pain VAS scores at 2 and 4 years postoperatively. Postoperative dysphagia occurred in 1 patient in the PLATE group, resolving almost completely by 1 year.</p><p><strong>Conclusions: </strong>Single-level ACDF using a cage alone technique demonstrated favorable radiologic and clinical outcomes overall compared to plate-augmented ACDF. However, plate augmentation is recommended for patients with severe cervical kyphosis or those at high risk of subsidence.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"417-426"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Most Mason Type 2 Radial Head Fractures Can Be Managed Nonoperatively.","authors":"Nadia Azib, Huub H de Klerk, Michel P J van den Bekerom","doi":"10.4055/cios24035","DOIUrl":"10.4055/cios24035","url":null,"abstract":"","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"555-556"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Inferior Tibiofibular Ligament Periosteal Sleeve Avulsion: New Classification for Posterior Malleolar Fracture of the Ankle.","authors":"Sung Hwan Kim, Jae Hyun Kim, Seung Won Choi, Young Koo Lee","doi":"10.4055/cios24432","DOIUrl":"10.4055/cios24432","url":null,"abstract":"<p><strong>Background: </strong>Not reducing the posterior malleolar fragment could have an impact on the alignment and stability of syndesmosis since the posterior inferior tibiofibular ligament (PITFL) originates at the posterior malleolar fragment. Given that these alignment and stability changes may contribute to discomfort and pain, further research may be required. We think that our new classification method will be able to help improve understanding of treatment methods for posterior malleolar fractures.</p><p><strong>Methods: </strong>We retrospectively analyzed 206 patients who underwent surgeries for ankle fractures in our orthopedic clinic between April 2014 and December 2022 and were verified to have posterior malleolar fractures in plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). We performed a probing test to determine whether syndesmosis was stable.</p><p><strong>Results: </strong>We were able to classify the 206 cases into the following 5 types: type 1 (31 cases, 15.0%), extraincisural fragment with an intact fibular notch; type 2 (98 cases, 47.5%), posterolateral fragment extending into the fibular notch; type 3 (37 cases, 17.9%), posteromedial 2-part fragment involving the medial malleolus; type 4 (19 cases, 9.2%), large posterolateral triangular fragment; and type 5 (21 cases, 10.1%), shell-like PITFL avulsion (< 2 mm) in a CT axial view or PITFL periosteal sleeve avulsion (PITPSA) in arthroscopic or MRI findings.</p><p><strong>Conclusions: </strong>This new system that adds the PITPSA type for the classification of posterior malleolar fractures may be a useful approach to managing these injuries and may aid in treatment decision-making. It could be important to consider ligament surgery when treating PITPSA.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"523-529"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of the Thoracolumbar Junction on Spinopelvic Parameters in Lenke 1 Adolescent Idiopathic Scoliosis with Selective Fusion.","authors":"Muhammed Fatih Serttas, Alauddin Kochai, Fevzi Saglam, Buğra Han Eryılmaz, Uğur Özdemir, Mustafa Erkan İnanmaz","doi":"10.4055/cios24273","DOIUrl":"10.4055/cios24273","url":null,"abstract":"<p><strong>Background: </strong>To compare the effect of the thoracolumbar junction angle (TLJ) on postoperative changes in both sagittal spinal and spinopelvic parameters in patients with Lenke type 1 adolescent idiopathic scoliosis (AIS) undergoing selective fusion surgery.</p><p><strong>Methods: </strong>We retrospectively reviewed 42 patients with Lenke 1 AIS who were younger than 18 years of age and underwent posterior selective fusion in our center between 2010 and 2020. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), TLJ, cervical lordosis (CL), and sagittal vertical axis were evaluated using the Surgimap (https://www.surgimap.com/) measurement system. Patients were divided into 2 groups: kyphotic and lordotic TLJ.</p><p><strong>Results: </strong>Of the 42 AIS patients, 25 (60%) had kyphotic and 17 (40%) had lordotic TLJ alignment. Both groups had a median follow-up of 10 years. In the TLJ kyphotic group, PT was lower in the preoperative, immediate postoperative, and final follow-up examinations compared to the TLJ lordotic group, while TK was higher compared to the TLJ lordotic group (<i>p</i> < 0.05). PI was significantly lower immediately postoperatively, while no statistically significant difference was observed preoperatively and at final follow-up. When all cases were evaluated, a statistically significant difference was found between preoperative, immediate postoperative, and final follow-up SS measurements (<i>p</i> = 0.009). TK and LL were significantly decreased in both groups. While CL was significantly higher in the TLJ kyphotic group in the preoperative and immediate postoperative periods, no statistically significant difference was found at the final follow-up (<i>p</i> > 0.05). Although the CL decreased in the kyphotic group, it remained within the lordotic alignment.</p><p><strong>Conclusions: </strong>The fact that the PI and PT values of patients with thoracolumbar junction kyphotic were lower than those of the TLJ lordotic group should suggest that patients may have less compensatory abilities in sagittal alignment in advanced ages, and surgeons should consider this situation when applying spinal fusion. In addition, it was observed that the cervical spine in TLJ lordotic patients was prone to kyphosis to provide sagittal alignment.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 3","pages":"427-437"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}