Search Results (344)

Spinal deformities—such as kyphosis, scoliosis, and lordosis—are observed across all major vertebrate groups. Reports in wild reptiles are increasing but are mainly published in natural history notes as curiosities, with little exploration of their aetiology, pathology, prevalence, or consideration of potential ecological, evolutionary, and life history implications. Addressing this gap, I compiled the most comprehensive database to date by reviewing the peer-reviewed and grey literature and collecting unpublished records via standardised social media inquiries. I identified 690 observations from 146 sources, covering 109 reptile species in 24 families across 37 countries. Spinal deformities appear across all major reptile clades, though Testudines are over-represented (78.6% of all observations and 42.2% of all species). A phylogenetic meta-analysis of 54 effect sizes from 37 species yielded a global prevalence estimate of 0.21%, with no significant effects of phylogeny, habitat use, or habitat type detected, possibly due to dataset limitations. However, kyphosis was more common in (semi)aquatic Testudines, whereas scoliosis was more frequent in terrestrial squamates. Although deformities may impair key life history traits, supporting evidence remains scarce. The findings highlight the understudied nature of spinal deformities in wild reptiles and underscore the need for standardised, ecologically informed reporting to better understand their causes and consequences. Full article

Objectives: This study aimed to assess the precision of dose delivery to the target in adaptive carbon ion radiotherapy (CIRT) for locally advanced non-small cell lung cancer (LA-NSCLC) in cumulative dosimetry. Methods: Forty-six patients who received CIRT were included (64 Gy[relative biological effectiveness, RBE] in 16 fractions) with treatment plan computed tomography (CT) and weekly CT scans. Offline adaptive radiotherapy (ART) was administered if the dose distribution significantly worsened. Daily doses were calculated from weekly CTs and integrated into plan CT scans using deformable image registration. The dosimetry parameters were compared between the as-scheduled plan and adaptive replan in patients receiving ART. Survival outcomes and toxicity were compared between the ART and non-ART groups. Results: ART was implemented for 27 patients in whom adaptive replans significantly increased the median V_98% of the clinical tumor volume from 96.5% to 98.1% and D_98% from 60.5 to 62.7 Gy(RBE) compared with the as-scheduled plans (p < 0.001). The conformity and uniformity of the dose distribution improved (p < 0.001), with no significant differences in the doses to normal tissues (lungs, heart, esophagus, and spinal cord) from the as-scheduled plans (p > 0.05). The ART and non-ART groups demonstrated comparable local control, progression-free survival, and overall survival (p > 0.05). No grade 3 or higher radiation-related toxicities were observed. Conclusions: ART enhanced target dose coverage while maintaining acceptable normal tissue exposure, supporting weekly CT monitoring integration during CIRT for the timely intervention for anatomical variations, ensuring precise dose delivery in LA-NSCLC. Full article

Background/Objectives: Given the different biomechanical properties and surgical techniques between the L5-S1 and ≥L4-5 levels, it is necessary to explore RF risk factors at ≥L4-5 levels separately from the lumbosacral junction. This study aims to investigate the risk factors for rod fracture (RF) occurring at ≥L4-5 levels following adult spinal deformity (ASD) surgery. RF occurrence was assessed at the segment level. Methods: Patients who underwent ≥ 5-level fusion, including the sacrum or pelvis, with a minimum follow-up of 2 years were included in this study. Presumed risk factors in terms of patient, surgical, and radiographic variables were compared between the non-RF and RF groups at the segment level. Multivariate logistic regression analysis was performed to identify independent risk factors for RF at ≥L4-5 levels. Results: A total of 318 patients (mean age, 69.3 years; 88.4% female) were included, and 1082 segments were evaluated. During the mean follow-up duration of 47.4 months, RF developed in 45 (14.2%) patients for 51 (4.7%) segments. In multivariate logistic regression analysis, several risk factors were identified, as follows: the use of perioperative teriparatide (odds ratio [OR] = 0.26, p = 0.012), operated levels (L2-3 and L3-4 vs. L4-5 level [OR = 0.45, p = 0.022; OR = 0.16, p < 0.001, respectively]), fusion methods (posterior fusion and anterior column realignment vs. posterior lumbar interbody fusion [OR = 8.04, p < 0.001; OR = 5.37, p = 0.002, respectively]), pedicle subtraction osteotomy (PSO) (OR = 3.14, p = 0.020), and number of rods (four-rod configuration vs. dual-rod fixation [OR = 0.34, p = 0.044]). Conclusions: In this study, the factors related to RF at ≥L4-5 levels included the perioperative use of teriparatide, operated levels, fusion methods, performance of PSO, and rod configuration. Considering that surgical procedures vary by each segment, our findings may help establish segment-specific preventive strategies to reduce RF at ≥L4-5 levels. Full article

Background/Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity often requiring surgical correction in severe cases. Halo-gravity traction (HGT) is commonly employed preoperatively to enhance spinal flexibility and reduce curve severity. This study aimed to evaluate the effectiveness of HGT in reducing Cobb angles in AIS and to assess how patient age, skeletal maturity (Risser score), and curve type (Lenke classification) influence treatment response. Methods: We conducted a retrospective cohort study of 28 AIS patients with Cobb angles > 65° who underwent preoperative HGT followed by posterior spinal fusion. Traction was applied for a mean of 24.64 days, reaching 40–50% of each patient’s body weight. Radiographic measurements were collected pre-traction, post-traction, and postoperatively. Statistical analyses included paired t-tests, Pearson correlations, Kruskal–Wallis tests, and linear regression. Results: Mean primary Cobb angle was reduced from 82.46° pre-traction to 61.00° post-traction (26.09% reduction) and further to 29.54° postoperatively (64.58% total reduction). Similar reductions were observed in secondary curves. No statistically significant correlations were found between age or Risser score and the magnitude of correction. Lenke type 3 showed the highest traction response, while type 5 had the greatest surgical gain. Curve type and skeletal maturity did not significantly affect final outcomes. Conclusions: Halo-gravity traction is a safe and effective adjunct in the surgical treatment of severe AIS, achieving substantial Cobb angle reduction. The degree of correction was not significantly influenced by age, Risser score, or curve type, supporting the broad applicability of HGT across adolescent patients. Full article

Intervertebral disc degeneration is a leading cause of back and leg pain and a major contributor to disability worldwide. Despite its prevalence, treatments remain limited due to incomplete understanding of its pathology. In vivo models pose challenges for controlled conditions, while in vitro cell cultures lack key cell–cell and cell–matrix interactions. To address these limitations, we developed a novel tissue slice culture model of mouse discs, in which intact mouse discs were sliced down to 300 μm thickness with a vibratome and cultured ex vivo at various time points. The cell viability, matrix components, structure integrity, inflammatory responses, and macrophage interactions were evaluated with biochemistry, gene expression, histology, and 3D imaging analyses. Disc slices maintained structural integrity and cell viability, with preserved extracellular matrix in the annulus fibrosus (AF) and mild degeneration in nucleus pulposus (NP) by day 5. Interleukin-1 (IL-1) induced disc degeneration manifested by increased glycosaminoglycan release in media and reduced aggrecan and collagen II mRNA levels in disc cells. Cultured disc slices promoted macrophages towards pro-inflammatory phenotype with elevated mRNA levels of il-1α, il-6, and inos. Macrophage overlay and 3D imaging demonstrated macrophage infiltration into the NP and AF tissues up to ~100 µm in depth. The disc tissue slice model captures key features of intervertebral discs and can be used for investigating mechanisms of disc degeneration and therapeutic evaluation. Full article

A remarkably well-preserved skeleton of a male Mammuthus meridionalis, approximately 60 years old, from the Early Pleistocene that is housed at the Castle of L’Aquila (Italy) exhibits a fractured left tusk with severe bone erosion of the alveolus and premaxillary bone, as well as marked spinal deformities. The cranial region underwent ultrasonographic, radiological, and histological examinations, while morphological and biomechanical analyses were conducted on the vertebral column. Microscopic analysis revealed intra vitam lesions, including woven bone fibers indicative of early bone remodeling and lamellar bone with expanded and remodeled Haversian systems. These findings are consistent with osteomyelitis and bone sequestration, likely resulting from chronic pulpitis following the tusk fracture, possibly due to an accident or interspecific combat. The vertebral column shows cervical scoliosis, compensatory curves, fusion between the first cervical vertebrae, and asymmetric articular facets, suggesting postural adaptations. Evidence of altered molar wear and masticatory function also support long-term survival post-trauma. Additionally, lesions compatible with spondyloarthropathy, an inflammatory spinal condition not previously documented in Mammuthus meridionalis, were identified. These findings provide new insights into the pathology and adaptive responses of extinct proboscideans, demonstrating the critical role of (paleo)histological methods in reconstructing trauma, disease, and aspects of life history in fossil vertebrates. Full article

Background/Objectives: Adult Spinal Deformity (ASD) is a pathologic malalignment of the spine that can lead to significant reductions in quality of life, functional limitations, and increased morbidity. While poor mental health is commonly observed among patients undergoing ASD surgery, its impact on surgical outcomes remains poorly understood. We conducted a systematic review and meta-analysis to examine the association between preoperative mental health and outcomes following surgical correction for ASD. Methods: A comprehensive search of MEDLINE, Embase, Web of Science, and Scopus was performed from inception to April 2025 to identify studies investigating the relationship between preoperative mental health and postoperative health-related quality of life outcomes or complications. Data was pooled using a restricted maximum likelihood (REML) random-effects model. Heterogeneity was assessed using Cochran’s Q statistic, and between-study variance was reported as τ². Study quality was assessed with the Newcastle–Ottawa Scale, and risk of bias was evaluated using the ROBINS-I tool. Results: Twenty-four studies comprising a total of 248,427 patients met inclusion criteria. In pooled analyses, patients with poor preoperative mental health showed comparable improvements in health-related quality of life measures after surgery (standardized mean difference [SMD] −0.04, 95% CI −0.30 to 0.22; I² = 91.5%, τ² = 0.42) and in pain scores (SMD −0.15, 95% CI −0.42 to 0.11; I² = 71.8%, τ² = 0.09). However, patients with poor mental health had significantly higher odds of postoperative complications (odds ratio [OR] 1.44, 95% CI 1.23 to 1.67; I² = 97.4%, τ² = 0.08). These patients also demonstrated worse preoperative disease severity (SMD –0.94, 95% CI −1.41 to −0.47; I² = 95.5%, τ² = 1.64) and worse postoperative disease severity (SMD –0.34, 95% CI −0.44 to −0.25; I² = 48.9%, τ² = 0.03). Conclusions: While patients with poor preoperative mental health have a greater disease severity both before and after ASD surgery, they appear to experience comparable benefits from surgical intervention compared to those without. Recognizing and managing mental health may be useful in preoperative management of ASD patients. Further prospective studies to further elucidate these associations are necessary. Full article

Background/Objectives: Correction surgery for adult spinal deformity (ASD) reduces disability but may lead to spinal stiffness. Cultural diversity may also influence how this stiffness affects daily life. We aimed to evaluate the impact of correction surgery on Japanese patients with ASD using a newly developed questionnaire and to clarify how these patients adapt to their living environment postoperatively in response to spinal stiffness. Methods: This retrospective study included 74 Japanese patients with operative ASD (mean age: 68.2 ± 7.5 years; fusion involving >5 levels) with a minimum follow-up of 1 year. Difficulties in performing various activities of daily living (ADLs) were assessed using a novel 20-item questionnaire tailored to the Oriental lifestyle. The questionnaire also evaluated lifestyle and environmental changes after surgery. Sagittal and coronal spinal parameters were measured using whole-spine radiographs, and clinical outcomes were assessed using the ODI and SRS-22 scores. Results: Coronal and sagittal alignment significantly improved postoperatively. Although the total ADL score remained unchanged, four trunk-bending activities showed significant deterioration. The lower instrumented vertebrae level and pelvic fusion were associated with lower scores in 11 items closely related to trunk bending or the Oriental lifestyle. After surgery, 61% of patients switched from a Japanese-style mattress to a bed, and 72% swapped their low dining table for one with chairs. Both the ODI and SRS-22 scores showed significant postoperative improvements. Conclusions: Trunk-bending activities worsened postoperatively in Japanese patients with ASD, especially those who underwent pelvic fusion. Additionally, patients often modified their living environment after surgery to accommodate spinal stiffness. Full article

Background/Objectives: We sought to characterize the variance and overlap among definitions of Proximal Junctional Kyphosis (PJK) used in the adult spinal deformity (ASD) literature. PJK is defined as excess in PJK angle, a Cobb angle between the upper-instrumented vertebra (UIV) and a supra-adjacent vertebra (SAV), either one (UIV+1) or two (UIV+2) levels rostral of the UIV. No expert consensus exists for threshold angle or which SAV to use. Methods: A total of 116 thoracolumbar fusion patients ≥ 65 years old were reviewed. The UIV+1 and UIV+2 angles were measured. Six definitions of PJK from the literature were evaluated. These definitions were selected based on citation frequency, historical relevance, and accessibility through commonly used databases. Pearson’s Chi-squared and pairwise comparisons were performed to evaluate the distinctness and agreement rates among these definitions. Results: The six definitions of PJK were as follows: [PJK20] PJK angle ≥ 20° with UIV+2 as the (SAV), [PJK10] PJK angle ≥ 10° with a >10° change from pre-op with UIV+2 as the SAV, [PJK2SD] PJK angle > 2 standard deviations from average with UIV+1 as the SAV, [PJK10+10] PJK angle ≥ 10° with a >10° change from pre-op with UIV+1 as the SAV, [PJK15] PJK angle > 15° with UIV+1 as the SAV, and [PJK30] PJK angle > 30° with UIV+2 as the SAV, or displaced rod fracture, or reoperation within 2 years for junctional failure, pseudoarthrosis, or rod fracture. [PJK10] and [PJK2SD] were the most distinct definitions while [PJK20], [PJK10+10], [PJK15], and [PJK30] showed no significant pairwise differences. [PJK2SD] was stringent, while definition [PJK30] included unique diagnostic information not captured by other definitions. Conclusions: The use of [PJK20], [PJK10+10], [PJK15], or [PJK30] is recommended for consistency, with [PJK15] presenting the best balance. Stringent [PJK2SD] may be beneficial for identifying severe PJK, though with low sensitivity. Overall, PJK definitions must be standardized for the consistent reporting of clinical outcomes and research comparability. Full article

Background/Objective: This study examines the composite influence of frailty, malnutrition, and anemia on postoperative outcomes for patients with adult spinal deformity (ASD). Methods: In this retrospective cohort study using the 2011–2022 NSQIP database, we utilized CPT and ICD codes to identify ASD patients who underwent PSF. Subjects were stratified based on frailty status. Frail patients were then classified according to malnutrition and anemia status. Frailty was determined using the revised risk analysis index (RAI-rev). Our primary outcomes were extended length of stay (LOS), non-routine discharge (NRD), 30-day adverse events (AE), and 30-day mortality. For each outcome, we fitted four nested multivariable logistic regression models (RAI-rev + anemia + malnutrition, RAI-rev + anemia, RAI-rev + malnutrition, and RAI-rev alone) and compared the incremental discrimination of each model using receiver operating characteristic (ROC) analysis. Results: Of 3639 patients, 460 were frail alone, 266 were frail + anemic, 37 were frail + malnourished, 121 were frail + anemic + malnourished, and 2755 were not frail. RAI-rev (aOR: 1.84, 95% CI: 1.45–2.35), anemia (aOR: 1.84, 95% CI: 1.45–2.35), and malnourishment (aOR: 2.34, 95% CI: 1.69–3.24) were independent predictors of extended LOS. RAI-rev (aOR: 1.07, 95% CI: 1.04–1.11) and anemia (aOR: 2.09, 95% CI: 1.66–2.61) were associated with an increased risk of 30-day AEs. RAI-rev and malnutrition were independent predictors of NRD (RAI-rev: aOR: 1.11, 95% CI: 1.06–1.16; Malnutrition: aOR: 1.57, 95% CI: 1.08–2.29) and 30-day mortality (RAI-rev: aOR: 1.10, 95% CI: 1.04–1.17; Malnutrition: aOR: 3.79, 95% CI: 1.24–11.60). Based on ROC analysis, RAI-rev + anemic + malnourished was a superior predictor of LOS and 30-day AEs (both p < 0.001). Compared to RAI-rev, RAI-rev + anemic superiorly predicted LOS and 30-day AEs, and RAI-rev + malnutrition superiorly predicted LOS (all p < 0.001). Conclusions: Our results reveal RAI-rev combined with malnutrition and anemia superiorly predicts 30-day AEs and LOS in postoperative ASD patients. Future studies should investigate the feasibility and efficacy of these models for perioperative risk stratification and optimized recovery planning to improve outcomes for ASD patients. Full article

The management of adult spinal deformity (ASD) has evolved dramatically over the past century, transitioning from external bracing and in situ fusion to complex, technology-driven surgical interventions. This review traces the historical development of spinal deformity correction and highlights contemporary enabling technologies that are redefining the surgical landscape. Advances in stereoradiographic imaging now allow for precise, low-dose three-dimensional assessment of spinopelvic parameters and segmental bone density, facilitating individualized surgical planning. Robotic assistance and intraoperative navigation improve the accuracy and safety of instrumentation, while patient-specific rods and interbody implants enhance biomechanical conformity and alignment precision. Machine learning and predictive modeling tools have emerged as valuable adjuncts for risk stratification, surgical planning, and outcome forecasting. Minimally invasive deformity correction strategies, including anterior column realignment and circumferential minimally invasive surgery (cMIS), have demonstrated equivalent clinical and radiographic outcomes to traditional open surgery with reduced perioperative morbidity in select patients. Despite these advancements, complications such as proximal junctional kyphosis and failure remain prevalent. Adjunctive strategies—including ligamentous tethering, modified proximal fixation, and vertebral cement augmentation—offer promising preventive potential. Collectively, these innovations signal a paradigm shift toward precision spine surgery, characterized by data-informed decision-making, individualized construct design, and improved patient-centered outcomes in spinal deformity care. Full article

Background: Intraoperative neurophysiological monitoring (IONM) is increasingly used during spinal surgery to reduce the risk of neurological complications. This systematic review evaluates both the clinical outcomes and cost-effectiveness of IONM in contemporary spinal surgery. Methods: A comprehensive literature search was conducted to identify studies evaluating IONM in spinal surgery. Twenty-three studies were included: twenty-one reporting clinical outcomes and two focusing on economic analysis. Data on neurological deficits, monitoring accuracy, and cost-effectiveness were extracted and analyzed. Results: Analysis of the included studies showed that IONM reduced the risk of neurological deficits across various types of spinal surgery. The diagnostic accuracy varied by modality, with MEP showing the highest sensitivity (90.2%) and SSEP demonstrating high specificity (97.1%). The greatest benefit was observed in deformity surgery and spinal tumors. D-wave monitoring showed efficacy for intramedullary tumors. Economic analysis demonstrated that IONM is cost-effective when the neurological complication rate exceeds 0.3%, with potential savings of over USD 23,000 per case. Conclusions: IONM significantly improves neurological outcomes in spinal surgery and is cost-effective in most clinical scenarios, particularly in high-risk procedures. Multimodal monitoring approaches provide the most comprehensive neurological assessment. These findings support the routine use of IONM in contemporary spinal surgery, especially for complex cases. Full article

Background/Objectives: Spinoplastic surgery is an emerging multidisciplinary field developed to address and reduce the complication of pseudoarthrosis following complex spinal reconstructions. While the number of spinal fusion procedures continues to rise every year, fusion failure rates remain as high as 40%. Although pseudoarthrosis may not always manifest clinically, it remains a leading cause of persistent pain and need for subsequent revision surgeries. The multidisciplinary collaboration between spine and plastic surgeons in spinoplastic surgery has therefore emerged as a proactive strategy aimed at preventing complications, particularly in patients identified as high-risk for pseudoarthrosis. As the patient population expands and spinoplastic surgery continues to evolve, refining patient selection criteria becomes essential for achieving optimal surgical outcomes. This review aims to provide a comprehensive overview of recent advancements in spinoplastic surgery, highlighting current indications, surgical techniques, recent case reports, and strategies for identifying suitable candidates. Methods: We performed a narrative review of English language literature through April 2025. Spinoplastic case reports and case series published within the last 20 years were included in the review. Results: Indications for use of a spinoplastic approach clustered into prior fusion failure, extensive oncologic resection, severe spinal deformity, procedures requiring extensive spinal involvement, and/or patients at risk for impaired bone healing. Succesful radiographic union and improvement of symptoms were widely reported across all 9 case reports/series. Conclusions: Although evidence is presently limited, spinoplastic surgery appears to achieve high bone graft fusion rates with acceptable morbidity and functional improvement in a carefully selected group of high-risk spinal reconstruction patients. Still, larger prospective studies are warranted to refine patient selection and validate functional benefit. Full article

Background and Objectives: Proximal junctional kyphosis (PJK) remains a significant complication in adult spinal deformity (ASD) surgery, often resulting in severe clinical consequences. This study evaluates the effectiveness of the thoracolumbar junction (TLJ) distraction technique in reducing PJK incidence, with a focus on its potential to preserve sagittal alignment and mitigate mechanical stress at the proximal junction. Materials and Methods: This retrospective cohort study included 122 patients who underwent ASD surgery between February 2018 and June 2022. Patients were stratified into a control group and an intervention group based on the application of the TLJ distraction technique. Radiographic and clinical outcomes, including proximal junctional angle (PJA), thoracolumbar angle (TLA), and PJK incidence, were assessed one year postoperatively. Statistical analyses were performed using t-tests and chi-square tests. Results: The incidence of PJK was significantly lower in the intervention group compared with that in the control group (24.6% vs. 44.3%, p = 0.036). Additionally, the intervention group exhibited a significant reduction in postoperative TLA (−10.6° ± 6.3° vs. −6.8° ± 6.8°, p = 0.002) and ΔTLA (2.6° ± 9.0° vs. −2.4° ± 9.5°, p = 0.003). Although improvements in radiographic parameters were associated with a trend toward reduced rates of proximal junctional failure (PJF), statistical significance was not achieved. Conclusions: The TLJ distraction technique effectively reduces PJK incidence by optimizing thoracolumbar alignment and minimizing abrupt sagittal transitions. This simple and reproducible approach presents a promising strategy for mitigating proximal junctional complications in ASD surgery, warranting further validation in multicenter trials. Full article

Background/Objectives: This is a study of adolescents with idiopathic scoliosis (IS), treated by the Functional Individual Therapy of Scoliosis (FITS) method. The hypothesis was that active parental involvement in the treatment process enhances the outcomes of therapy. Materials and Methods: A total of 208 adolescent girls with IS were examined and divided into two groups. Only in Group I were the parents present. Trunk morphology before and after was evaluated by measuring change of the Anterior Trunk Symmetry Index (ATSI), Posterior Trunk Symmetry Index (POTSI), Posterior Trunk Symmetry Index in Correction (POTSI COR), and the angle of trunk rotation (ATR). Results: Statistically significant improvements in ATSI values were observed in both groups (Group I: p < 0.001; Group II: p = 0.001). POTSI values showed improvement only in Group I (p < 0.001). Similarly, POTSI COR values improved significantly in Group I (p < 0.001). ATR improved significantly better in Group I. Conclusion and Significance: Children with IS who underwent specific physiotherapy demonstrated better outcomes when their parents actively participated in the therapy. Full article