Search Results (365)

Background: Scoliosis, a three-dimensional spinal deformity, can impair posture, function, and quality of life. Conservative approaches such as structured physical therapy are widely used, but evidence from long-term, real-world settings remains limited. In this study, “structured” refers to a standardized, supervised program delivered three times per week, incorporating postural correction, Klapp-based positioning, core strengthening, flexibility training, and progressive intensity adjustments rather than ad hoc or unsupervised exercise. Methods: In this 12-month longitudinal study, 240 patients aged 15–19 years with idiopathic scoliosis (Cobb angle 15–25°) were enrolled; 222 completed the program and were included in analyses. All participants were near or beyond skeletal maturity, representing a population with low residual risk of curve progression. Spinal alignment was assessed by Cobb angle at baseline, 6 months, and 12 months, with monthly clinical evaluations to track progress. Outcomes were analyzed by baseline severity, age, sex, and skeletal maturity (Risser stage) using paired-samples t-tests, repeated-measures ANOVA, subgroup analyses, and multivariable regression. Clinically meaningful improvement was defined as a ≥20% reduction in Cobb angle from baseline. Results: Mean Cobb angle decreased from 18.59° at baseline to 14.85° at 12 months (Δ = −3.74°, 20.3% relative reduction; p < 0.001). The largest improvement occurred in the first 6 months (−3.04°, p < 0.001), followed by a smaller gain between months 6 and 12 (−0.70°, p = 0.012). Patients with milder baseline curves improved more than those with greater deviations (4.45° vs. 3.21°, p < 0.001). Monthly clinical follow-ups suggested gradual improvement between radiographic assessments, though detailed statistical analyses were limited to baseline, 6 months, and 12 months. In multivariable regression, baseline severity remained the only significant predictor of improvement (p < 0.001), while age, sex, and Risser stage were not significant (all p > 0.05). Overall, 24.3% of participants achieved clinically meaningful improvement. Conclusions: A structured 12-month physical therapy program produced significant, sustained improvements in spinal alignment across diverse patient groups. Early intervention in milder curves maximized benefit. These findings support physiotherapy exercise programs as an effective conservative option for scoliosis management. Full article

Background: Intraoperative neurophysiological monitoring (IONM) has become an invaluable tool for spinal deformity surgery. This study aims to present our experience of using transcranial motor evoked potential (Tc-MEP) as an IONM tool in adolescent idiopathic scoliosis patients undergoing navigation-assisted deformity correction and explore the potential risk factors associated with false-positive and true-positive IONM findings. Methods: A retrospective study was conducted in 103 patients (mean age 16.2 ± 4.0 years) undergoing corrective surgery for spinal deformity. All pediatric spinal deformity correction surgeries at the center were performed by a single senior spine surgeon, utilizing navigation and Tc-MEP to enhance the neurological safety profile. The sensitivity and the specificity of Tc-MEP were calculated. Results: Of the total cases, 87 patients (84.5%) exhibited no IONM signal alert and did not experience any postoperative neurological deficits, representing true negatives. There were no false-negative cases, which gives a negative predictive value of 100%. Significant IONM signal alerts were observed in 16 patients (15.5%), but only two patients (1.9%) experienced a postoperative motor deficit, representing true positives, which yielded a positive predictive value of 12.5%. Conclusions: This study demonstrated the sensitivity and specificity of Tc-MEP to be 100% and 86.3%, respectively, with a false-positive rate of 13.7%. Blood loss was the only factor significantly associated with IONM alerts, while age, gender, surgical duration, and anesthetic modality showed no significant differences. Full article

Background: Sacral and pelvic insufficiency fractures (SIFs and PIFs) are increasingly recognized yet frequently underdiagnosed complications after adult spinal deformity (ASD) surgery, particularly in patients undergoing long-segment spinal fusion to the sacrum or pelvis. Methods: We present a representative case of sacral and pelvic insufficiency fractures following extensive spinal fusion, highlighting diagnostic and therapeutic challenges. In addition, a systematic review of the literature was performed according to PRISMA guidelines through PubMed, MEDLINE, and Scopus databases, including studies up to December 2024. Data regarding demographics, risk factors, diagnostic modalities, management strategies, and outcomes were extracted and narratively synthesized. Results: A total of 21 studies comprising 89 patients were included. The majority were elderly postmenopausal women with osteoporosis and additional risk factors such as chronic corticosteroid therapy or high body mass index. Diagnosis was frequently delayed due to low sensitivity of plain radiographs, whereas computed tomography was the most reliable modality. Management was surgical in 49 patients (55%)—most commonly extension of fixation to the pelvis or use of S2-alar-iliac screws—with favorable fracture healing reported in most cases. Conservative treatment, employed in 40 patients (45%), included bracing, restricted activity, and bone health optimization, also leading to healing in the majority of cases. Conclusions: Sacral and pelvic insufficiency fractures represent an underrecognized but clinically significant complication after ASD surgery. Early recognition through cross-sectional imaging (CT/MRI) is crucial, and both surgical and conservative approaches can be effective if tailored to patient and fracture characteristics. Full article

Objective: The purpose of this study is to present a kyphosis measurement method based on quadratic spline fitting through three key vertebral landmarks: T12, T8 and T4. This approach aims to capture thoracic spine curvature more continuously and accurately than traditional methods such as the Cobb angle and circle fitting. Methods: A dataset of 560 lateral thoracic spine radiographs was retrospectively analyzed, including cases of postural kyphosis, Scheuermann’s disease, osteoporosis-induced kyphosis and ankylosing spondylitis. Two trained raters independently performed three repeated landmark annotations per image. The kyphosis angle was computed using two methods: (1) a quadratic spline fitted through the three landmarks, with the angle derived from tangent vectors at T12 and T4; and (2) a least-squares circle fit with the angle subtended between T12 and T4. Agreement with reference Cobb angles was evaluated using Pearson correlation, MAE, RMSE, ROC analysis and Bland–Altman plots. Reliability was assessed using intraclass correlation coefficients (ICC). Results: Both methods showed excellent intra- and inter-rater reliability (ICC ≥ 0.967). The spline method achieved lower MAE (5.81°), lower RMSE (8.94°) and smaller bias compared to the circle method. Both methods showed strong correlation with Cobb angles (r ≥ 0.851) and excellent classification performance (AUC > 0.950). Conclusions: Spline-based kyphosis measurement is accurate, reliable and particularly robust in cases with severe spinal deformity. Significance: This method supports automated, reproducible kyphosis assessment and may enhance clinical evaluation of spinal curvature using artificial intelligence-driven image analysis. Full article

Background: The occurrence of ALL rupture during posterior correction of adult spinal deformity (ASD) was rare before the introduction of lateral lumbar interbody fusion (LLIF) but has become more frequent recently. It remains unclear whether this phenomenon is unique to LLIF-combined procedures or primarily related to enhanced corrective ability. Methods: The research method used in this study is finite element analysis (FEA). Using preoperative computed tomography images, LLIF cage (L group) or posterior lumbar interbody fusion (PLIF) cage (P group) were placed in the disc space with identical lordotic angles and distances from the anterior vertebral body edge for the same patients’ samples. Finite element simulations of corrective procedures were conducted. A spring simulating the ALL was introduced into the FEA, and the load on the ALL was evaluated with either LLIF or PLIF cage placement. Spring elongation directly measured the load on the ALL, while the location of the rotation center served as an indirect evaluation. Two different types of corrective procedures were created, one of which is mimicking ASD correction. For both procedures, the load to ALL was measured using abovementioned parameters when either LLIF cage (L group) or PLIF cage (P group) was used. The load to ALL was compared between L group and P group. Results: The degree of spring elongation during the simulation of a corrective procedure significantly decreased in the L group compared to the P group only in the model which is mimicking ASD correction (p = 0.006, Cohen’s d = 2.33, Power (1−β) = 0.956). The rotation center was significantly more posteriorly located in the P group than that in the L group in both models. These differences were more obvious in the model mimicking ASD correction (p = 0.0013, Cohen’s d = 2.00, Power (1−β) = 0.891). Conclusions: Our findings suggest that the use of a PLIF cage, which has a longer anterior–posterior cage length, caused the posterior edge of the cage to act as a pivot point. This configuration places greater leverage on the ALL, potentially leading to rupture during posterior correction procedures. This phenomenon, ALL rupture during posterior correction for ASD, is thought to be associated with increased corrective capabilities rather than being specific to the geometry of the LLIF cage. Full article

Objectives: Myelomeningocele is one of the most common dysraphic defects. Does shortening the time of exposure to the toxic effects of amniotic fluid and mechanical trauma in utero on the herniated spinal cord and spinal nerves, thanks to prenatal surgery, reduce the risk of hydrocephalus with improved musculoskeletal function and better function of the urinary and digestive systems? The aim of the study was to compare the clinical effects of prenatal and postnatal surgery for myelomeningocele in pediatric patients. Methods: Comparison of urological, digestive and motor function in children following prenatal versus postnatal repair of myelomeningocele. The study group consisted of 110 children- 46 operated prenatally and 64 patients postnatally. Information about the children’s assessment of shunt-dependent hydrocephalus, motor skills, bladder and bowel function was obtained from a validated survey questionnaire completed by the children’s parents. Results: In the prenatal group, there was a significantly (p = 0.011) lower percentage of hydrocephalus treated with a shunt (45.71%) compared to the postnatal group (78.26%). The prenatal group revealed a lower percentage of paresis (p = 0.0422) and contractures of the lower limbs (p = 0.0108) and varus deformity (p = 0.0272). Also, in the prenatal group, fewer children move with only the use of a wheelchair (p = 0.0280) and more move independently or with orthopedic equipment (p = 0.0280). In prenatal children, the overall grade of vesico-ureteral reflux was significantly lower (p = 0.0105) and there was also a higher percentage of children with self-controlled defecation (p = 0.0395) and fewer children using enemas (p = 0.0269) and oral pharmacological agents (p = 0.0026). Conclusions: In children with myelomeningocele operated prenatally, compared to the postnatal group, shunt-dependent hydrocephalus and bladder and bowel incontinence were observed with significantly less frequency, and there was better musculoskeletal function. More children operated prenatally moved independently or with orthopedic equipment, and fewer used an orthopedic wheelchair. Further studies, particularly in even larger patient groups, are required to assess clinical benefits of prenatal surgery for children with myelomeningocele. Full article

Background: Obstetrical brachial plexus palsy (OBPP) often results in medial shoulder contracture, with limited abduction and external rotation due to muscle imbalance and joint deformities. Late nerve transfers, such as spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer, combined with soft tissue release, represent a therapeutic option for shoulder reanimation in children presenting after infancy. Methods: 56 children treated between 2007 and 2019 have been evaluated. Inclusion criteria were as follows: age at time of surgery > 9 months, no primary reconstruction of the brachial plexus, late presentation, two years of follow-up. Patients were divided into groups based on age (<18 months vs. >18 months) and procedures: SAN to SSN transfer associated with subscapularis release (58.9%), SAN to SSN transfer associated with coracohumeral ligament release (17.9%), isolated SAN to SSN (12.5%), multiple nerve transfer (10.7%). Universal Mallet Grading Score was applied. A review of literature on the topic published on Pub Med up to December 2024 was associated with the retrospective analysis of clinical data. Results: At 2 years 84% of patients achieved Mallet Scores > 3, with progressive improvement up to 5 years. No significant differences were observed between age groups or type of palsy. Coracohumeral ligament release demonstrated comparable effectiveness to subscapularis release with fewer complications. Secondary surgical interventions were required in 30% of cases, mainly in those undergoing multiple nerve transfers. Conclusions: SAN to SSN transfer is a reliable and effective procedure for restoring shoulder external rotation. Coracohumeral ligament release provides a minimally invasive means to improve passive range of motion while preserving internal rotation muscle integrity. These combined interventions may reduce the need for more invasive secondary surgeries. Full article

Background: Massive intraoperative blood loss (IBL) is a serious complication in complex spine surgeries such as deformity correction, multilevel fusion, tumor resection, and revision procedures. While no strict definition exists, blood loss exceeding 1500 mL or 20% of estimated blood volume is generally considered clinically significant. Excessive bleeding increases the risk of hemodynamic instability, transfusion-related complications, postoperative infection, and prolonged hospitalization. Methods: This narrative review summarizes the current understanding of the incidence, risk factors, anatomical vulnerabilities, and evidence-based strategies for managing IBL in spine surgery through comprehensive literature analysis of recent studies and clinical guidelines. Results: Key risk factors include patient characteristics (anemia, obesity, advanced age, medication use), surgical variables (multilevel instrumentation, revision status, operative time), and pathological conditions (hypervascular tumors, severe deformity). Perioperative medication management is critical, requiring discontinuation of NSAIDs (5–7 days), antiplatelet agents (5–7 days), and NOACs (48–72 h) preoperatively to minimize bleeding risk. The thoracolumbar junction and hypervascular spinal lesions are especially prone to bleeding due to dense vascular anatomy. Evidence-based management strategies include comprehensive preoperative optimization, intraoperative hemostatic techniques, antifibrinolytic agents, topical hemostatic products, cell salvage technology, and structured transfusion protocols. Conclusions: Effective management of massive IBL requires a multimodal approach combining preoperative risk assessment and medication optimization, intraoperative hemostatic strategies including tranexamic acid administration, advanced monitoring techniques, and coordinated transfusion protocols. Particular attention to perioperative management of anticoagulant and antiplatelet medications is essential for bleeding risk mitigation. Understanding patient-specific risk factors, surgical complexity, and anatomical considerations enables surgeons to implement targeted prevention and management strategies, ultimately improving patient outcomes and reducing complications in high-risk spine surgery procedures. Full article

Background/Objectives: Congenital scoliosis (CS) is a developmental disorder characterized by abnormal vertebral development during embryogenesis. Despite the identification of genes involved in vertebral development, the underlying genetic causes of CS remain largely unknown. Monozygotic (MZ) twins discordant for CS offer a unique opportunity to explore de novo or postzygotic causes. This exploratory case study aimed to investigate potential causative variants underlying CS using whole-exome sequencing (WES). Methods: We performed WES on a Kazakhstani family with MZ twins discordant for congenital scoliosis. Variant prioritization included homozygous mutation analysis in the affected twin, family-based comparisons via de novo, autosomal recessive, and autosomal dominant models, and cross-referencing with variants previously implicated in spinal deformities. Results: Key findings include potential associations of the STOX1 (storkhead box 1), HOXD8 (homeobox D8), and C1QTNF9 (C1q- and TNF-related 9) genes with congenital scoliosis. However, subsequent validation revealed low read depth and strand bias. Notably, no unique variants were detected in genes previously known to cause CS. Conclusions: The first WES analysis of CS-discordant twins from a single family highlights the feasibility of a combined family-based and twin-comparative analytical pipeline. Our results provide new insights into the genetic architecture of CS and establish a foundation for future twin studies to elucidate the genetic basis of rare developmental disorders. Full article

Background/Objectives: Early-onset scoliosis (EOS) is often treated with growing rods, which use distraction-based correction to control deformity while allowing spinal growth. Although effective in the coronal plane, this technique may adversely affect sagittal alignment, particularly thoracic kyphosis and lumbar lordosis. Whether final fusion surgery is necessary after the growing rod treatment remains controversial. This study compared radiographic outcomes, including coronal and sagittal parameters, between patients with and without final fusion to clarify the value of final fusion. Methods: We retrospectively reviewed 19 EOS patients treated with growing rods between 2015 and 2019. Patients undergoing posterior spinal fusion after lengthening were classified as the final fusion group (n = 9), while those with more than 12 months of follow-up without fusion formed the graduated group (n = 10). Demographics, surgical variables, and radiographic parameters (Cobb angle, correction rate, coronal balance, clavicular angle, thoracic kyphosis, lumbar lordosis, sagittal vertical axis) were compared. Results: Baseline characteristics were similar. At final follow-up, the final fusion group had significantly better outcomes in Cobb angle (24.2° vs. 34.9°, p = 0.002), correction rate (66.6% vs. 40.1%, p = 0.001), and coronal balance (−1.5 mm vs. 19.7 mm, p = 0.004). Sagittal alignment did not differ significantly, but preservation of thoracic kyphosis tended to favor the fusion group. Conclusions: Final fusion surgery after growing rod treatment achieved superior coronal correction and balance compared with observation alone. Although sagittal alignment was not statistically different, a trend toward better thoracic kyphosis preservation was observed. Final fusion should be considered for larger residual curves or coronal imbalance, while observation may suffice in well-corrected cases. Full article

Background and Clinical Significance: Thoracic dorsal arachnoid web (DAW) is a rare intradural extramedullary condition characterized by a thin band of arachnoid tissue compressing the dorsal spinal cord. A hallmark imaging feature is the “scalpel sign”, which refers to anterior displacement of the thoracic spinal cord with dorsal cerebrospinal fluid (CSF) accumulation, producing a sagittal profile resembling a surgical scalpel. Although highly specific for DAW, this sign may also appear in other intradural conditions such as idiopathic ventral spinal cord herniation and arachnoid cysts. The clinical presentation is typically progressive and nonspecific, including lower limb weakness, sensory changes, gait disturbances, and, less frequently, sphincter dysfunction. Diagnosis is often delayed due to the subtle nature of the lesion and limited resolution of conventional Magnetic Resonance Imaging (MRI). High-resolution Three-Dimensional Constructive Interference in Steady State (3D-CISS) sequences improve diagnostic accuracy by highlighting indirect signs such as spinal cord deformation and dorsal CSF flow obstruction. Case Presentation: We report the case of a 57-year-old woman presenting with chronic cervico-dorsalgia, bilateral lower limb weakness, paresthesia, and progressive gait instability. Neurological examination revealed spastic paraparesis and hyperreflexia. Conventional MRI was inconclusive. However, sagittal T2-weighted and 3D-CISS sequences demonstrated the scalpel sign at the T4–T5 level, with anterior cord displacement and dorsal subarachnoid space enlargement. Surgical exploration confirmed the presence of a dorsal arachnoid web, which was resected. Postoperative follow-up showed clear improvement in motor function and gait. Conclusions: DAW should be considered in cases of unexplained thoracic myelopathy or cervico-dorsalgia with neurological signs. Early recognition of the scalpel sign using advanced MRI sequences is critical for timely diagnosis and surgical planning, which may lead to significant clinical improvement. Full article

Patient-specific technologies within the field of adult spinal deformity (ASD) aid surgeons in pre-surgical planning, accurately help identify anatomical landmarks, and can project optimal post-surgical sagittal alignment. This narrative review aims to discuss the current uses of patient-specific technologies in ASD and identify new innovations that may very soon be integrated into patient care. Pre-operatively, machine learning or artificial intelligence helps surgeons to simulate post-operative alignment and provide information for the 3D-printing of pre-contoured rods and patient-specific cages. Intraoperatively, robotic surgery and intraoperative guides allow for more accurate positioning of implants. Implant materials are being developed to allow for better osseointegration and patient outcome monitoring. Despite the significant promise of these technologies, work still needs to be performed to ensure their accuracy, safety, and cost efficacy. Full article

Background: Temporary internal distraction is a safe surgical technique that has been shown to improve correction of severe scoliosis. The traditional surgical adjunct for scoliosis treatment in the perioperative period is halo gravity traction, but there are several known disadvantages of this technique. We describe the technical nuances of temporary internal distraction using the construct-to-construct technique, a surgical adjunct that utilizes two rods joined by lateral domino connectors to enact powerful internal distraction or compression forces on the spine for achieving spinal deformity correction. Methods: This study was designed as a retrospective review and illustrative surgical technique report. The primary aim was to describe the construct-to-construct internal distraction and compression technique for scoliosis correction, with illustrative models and representative clinical cases. Results: Internal distraction using the construct-to-construct configuration is performed early in the surgery to take advantage of the viscoelastic properties of the spine as gradually increasing distraction forces are applied. The surgical technique for applying internal distraction and compression using the construct-to-construct configuration is discussed in detail. Conclusions: Construct-to-construct internal distraction and compression techniques are powerful methods to correct severe scoliosis curves, serially distract traditional growing rod constructs, and close three-column osteotomies. Full article

Background/Objectives: Currently, clinicians and physiotherapists pay only limited attention to spinal deformities in children with cerebral palsy (CP). To enhance awareness, a tool based on a traffic light system (TLS-Spine) was developed for use by pediatricians and physiotherapists caring for children with CP. The objective of the study was to evaluate the applicability of this assessment tool in routine clinical practice. Methods: A review group consisting of 48 pediatricians and physiotherapists was recruited. Each participant was asked to apply the TLS-Spine to a minimum of 10 CP patients and to complete a questionnaire concerning its value and applicability in daily practice. Responses were rated on a scale from 1 (complete agreement) to 6 (complete disagreement). Results: The TLS-Spine was correctly applied in 96.3% cases. The questionnaires of 48 reviewers based on 537 completed survey sheets were analyzed. Overall, reviewers reported no difficulties with the introduction and use of the TLS-Spine in daily clinical routine practice (median/range: 1/1–4). The tool was considered straightforward to use (1/1–3), not time consuming (1/1–4), helpful in performing the clinical examination (2/1–6), understanding the findings (2/1–6) and deciding on further management of the patients (2/1–5). Physicians rated the TLS-Spine significantly higher than physiotherapists in four of nine dimensions. Conclusions: The TLS-Spine is a practical and user-friendly assessment tool. It may increase the awareness for spinal deformities and support early referral to orthopedic specialists for early detection and treatment. Full article

Background/Objectives: This case represents the successful treatment of cervical spine injury from high-speed rear-impact motor vehicle collision and abnormal cervical kyphosis with left arm radiculopathy, utilizing conservative spine care rehabilitation methods. This patient was treated with a multimodal treatment approach integrating a cervical spine extension traction protocol. Subject and Methods: A 50-year-old male with a history of motor vehicle collision presented with left arm radiculopathy, as well as cervical and upper thoracic spine pain. Notably the cervical spine presented with kyphotic deformity. The patient presented, after a being struck during a rear-end motor vehicle collision, with neck, upper back, and left arm radiculopathy. Prescription medication and traditional chiropractic care proved ineffective for substantive symptom and quality-of-life improvement. Treatment frequency was three times per week for eight weeks using the Chiropractic Biophysics^® protocol of mirror image (MI^®) postural exercise, spinal adjustment, and cervical spinal traction. On completion of in-office care, the patient was treated monthly, performed home care at least three times per week, and was re-examined at one year. Results: Final examination after eight weeks of care showed significant improvement in cervical lordosis (21.8 degrees), resulting in reduced cervical kyphosis. The patient completed outcome indices before, during, and 12 months after cessation of active care, all indicating improvement. Conclusions: This case report demonstrates both subjective and objective improvement in cervical spine kyphosis and attendant symptoms. The successful treatment of chronic pain, peripheral weakness, and radiculopathy with long-term follow-up using CBP care is documented as well. The treatment was designed to improve sagittal balance and reduce radiographic abnormalities evincing spinal misalignment. Administration of subjective, objective, and health-related quality-of-life outcome indices during, following, and 12 months post-treatment are suggestive of long-term efficacy of Chiropractic BioPhysics^® (CBP) treatment methods. Larger studies are needed to substantiate this given the limitations of a case report. Full article