Spine deformity最新文献

Background: Early-onset scoliosis (EOS) is a complex spinal deformity that typically manifests before the age of ten. It has a significant impact on pulmonary function and thoracic development. A comprehensive summary of global EOS research trends remains lacking, despite growing interest in the field. This bibliometric analysis aims to provide an overview of EOS research published between 2000 and 2025, highlighting funding sources, journals, countries, top authors, institutions, publishing patterns, and research subjects.

Methods: A systematic search of the Scopus database was conducted on 15 September 2025 using the query: TITLE-ABS-KEY("early onset scoliosis") AND PUBYEAR > 2000 AND PUBYEAR < 2025. Extraction of authorship, institutions, nations, collaboration networks, publication features, and citation metrics was done. Descriptive statistics were used to summarise research output and trends. VOSviewer was used for bibliometric mapping and network visualisation.

Results: A total of 2037 publications were identified and analysed. There was a marked increase in annual output, peaking at 187 in 2024, original articles dominated by 77.5% followed by book chapters 9.1%. The United States (n = 859) led the countries, followed by China (n = 196) and the United Kingdom (n = 165). The most productive institutions were The Children's Hospital of Philadelphia and Boston Children's Hospital (n = 118 each). Spine Deformity, Journal of Pediatric Orthopaedics, and Spine were the top publishing journals. Key funding sources were the NIH, the National Natural Science Foundation of China, and the Scoliosis Research Society.

Conclusion: EOS research has expanded substantially over the past two decades, driven by collaborative international efforts, institutional leadership, and targeted funding. This bibliometric analysis provides a framework to guide future research priorities and foster global collaboration. Despite increasing publication volume, studies addressing long-term comparative effectiveness, patient-reported outcomes, cost-effectiveness, and complication management remain underrepresented.

Purpose: Higher rates of hypothyroidism have been identified in patients with degenerative spine disease. This study examines the rate of hypothyroidism in patients with adult spinal deformity and aims to identify any potential relationships between Cobb angle and markers of thyroid dysfunction.

Methods: In this multi-center retrospective study, adults aged 60 years or older with imaging evidence of spinal deformity as measured by Cobb angle from August 2015 to November 2024 were reviewed. Demographic data, hypothyroidism diagnosis, and thyroid panel values were obtained from medical records. Imaging was used to identify spinal deformity, Cobb angle, and bone mineral density.

Results: Among 834 patients, the mean age was 80 years, with 596 females. Adult spinal deformity patients were subcategorized into adult degenerative scoliosis (80.3%) and adolescent idiopathic scoliosis that progressed into adulthood (19.7%) with an average Cobb angle of 18.3° and 28.4°, respectively. Hypothyroidism was diagnosed in 278 patients (33.3%). Hypothyroidism, an increase of 1 mIU/L in TSH, and female gender were significantly associated with severity of disease as measured by an increase in Cobb angle in patients with adult degenerative scoliosis. Neither hypothyroidism, TSH, nor free T4 was not associated with worsened bone mineral density.

Conclusion: The prevalence of hypothyroidism was higher in patients with adult spinal deformity compared to the general population. Hypothyroidism, TSH values, and female gender were significantly associated with larger Cobb angles. Bone mineral density was not associated with Cobb angle. Future studies are needed to understand the relationship between hypothyroidism and spinal deformity.

Purpose: Arthrogryposis multiplex congenita (AMC) is a rare syndrome characterized by congenital joint contractures involving at least two different body areas. AMC patients often develop scoliosis and may undergo posterior spinal fusion (PSF). However, such procedures can be challenging due to a spectrum of underlying differences in body structure and comorbidities. The present study aimed to investigate odds of postoperative adverse events and reoperation in patients with AMC following PSF relative to matched controls with idiopathic scoliosis (IS).

Methods: Pediatric AMC and IS patients undergoing primary PSF were identified from 2010-2023Q1 PearlDiver dataset. Those with versus without AMC were matched 1:4 based on age, sex, and number of spinal segments fused. Ninety-day adverse events were assessed using multivariable logistic regression, and 5-year reoperation risk was compared with log-rank test (P < 0.05).

Results: Among 4,600 patients undergoing PSF for deformity, AMC was noted for 115 (2.5%). After matching, 84 patients with AMC were found to have greater odds of experiencing any, severe, and minor 90-day adverse events. In addition, reoperation analysis showed patients with AMC were at a significantly higher odds undergoing 5-year reoperations following PSF (21.4% versus 5.8%, P < 0.001).

Discussion: PSF patients with AMC were found to be at significantly greater odds of complications and reoperations compared to matched patients with idiopathic scoliosis. These findings highlight the importance of such considerations in surgical planning and suggest that further research is needed to mitigate these risks.

Level of evidence: III.

Purpose: To biomechanically assess the influence of intraoperative correction and presenting Sanders maturity scores (SS) on growth modulation correction after 2 years in pediatric idiopathic scoliosis treated with Vertebral Body Tethering (VBT).

Methods: Lumbar VBT was simulated using patient-specific finite element models (FEMs) from 20 cases of pediatric idiopathic scoliosis (average thoracolumbar/lumbar Cobb 47°; min: 34°, max: 63°), calibrated for preoperative SS, weight, and spine flexibility. The validated FEM included lateral decubitus positioning and VBT instrumentation at the actual upper instrumented vertebra (UIV: T9-T12) and lower instrumented vertebra (LIV: L2-L4). Simulations tested three intraoperative nominal correction levels (35, 50, and 70%) across SS stages (3A, 3B, 4, 5), with immediate and 2-year postoperative corrections computed and analyzed.

Results: A 35% intraoperative correction resulted in an immediate post-operative Cobb angle of 37° (23°-54°) but led to under-correction, with a final deformity of 38° (22°-63°) at 2 years. Curve progression occurred in 40% of SS3A cases, particularly in heavier patients (54 kg vs. 38 kg, p < 0.05). A 50% intraoperative correction yielded an immediate post-operative Cobb angle of 27° (16°-40°), with significant improvement at 2 years only in SS3A (p < 0.05). Clinically successful growth modulation (>5° improvement) correlated with lower weight (40 ± 6 kg vs. 54 ± 6 kg, p < 0.05). A 70% intraoperative correction produced an immediate post-operative Cobb angle of 17° (11°-22°) and significant improvement across all SS levels (p < 0.05), with final 2-year angles of 1° (-27° to 10°) for SS3A, 10° (-5° to 10°) for SS3B, 12° (0°-18°) for SS4, and 13° (4°-19°) for SS5. Overcorrection occurred in SS3A (4 cases) and SS3B (1 case).

Conclusion: Successful outcomes at 2 years depend on the interaction of key factors, such as intraoperative correction, residual growth potential as defined by preoperative SS, patient weight, spinal flexibility, and mechanobiological growth modulation. The advanced and validated planning tool used for the simulations incorporates these elements, integrating both biomechanical and biological growth dynamics to support a more precise and personalized surgical approach.

Purpose: To compare the impact of lumbar lordosis correction achieved by cephalad versus caudal distribution on radiographic alignment and surgical outcomes among adult spinal deformity (ASD) patients.

Methods: Patients who underwent ASD surgery with uppermost instrumented vertebrae (UIV) at or above L1, had preoperative pelvic incidence-lumbar lordosis (PI-LL) > 10°, and had full-body radiographs available were included. Eligible patients were categorized by the focus of lordosis correction: caudal (L4-S1 lordosis between 35 and 45°) and cephalad lordosis-based correction. Patient demographics, preoperative and 2 years spinopelvic alignment and PROMs, and 2 years postoperative surgical complications were compared.

Results: In total, 187 (111 caudal and 76 cephalad) patients were included, with mean age of 66.2 years, 78.6% female, and mean frailty score of 3.6. Caudally-restored patients often had an upper thoracic UIV, sacrum/ilium LIV, longer length of fusion, and no lateral lumbar interbody fusion (LLIF) while cephaladly-restored patients had two or more LLIFs above L4 (p < 0.001). Preoperatively, there were no significant differences in radiographic alignment and PROMs between the two groups (p > 0.02). Two years postoperatively, caudally-restored patients had higher L1-S1 LL (p = 0.015) and L4-S1 LL (p < 0.001), and lower PI-LL (p = 0.039) and SVA (p = 0.001). In addition, they had higher SRS-22 activity (p = 0.045), pain (p = 0.047), appearance (p = 0.046), and total (p = 0.016) scores. Finally, they had lower rates of sensory deficits (p < 0.001), motor deficits (p = 0.003), implant failure (p = 0.092), and reoperation (p = 0.020).

Conclusion: Caudal lordosis-based correction of spinal deformity patients was associated with higher PROMs and lower rates of neurologic deficits, implant failure, and revisions at 2 years. These findings, while subject to unmeasured confounding, indicate that great caution should be taken when considering cephalad-based correction of ASD.

Purpose: Comparison of the clinical outcomes of halo-gravity traction (HGT) and halo-pelvic traction (HPT) was performed in the treatment of patients with severe rigid spinal deformity, with the aim of elucidating the clinical value of HGT and HPT in managing such deformities and providing evidence-based recommendations for surgical treatment planning.

Methods: A retrospective study was conducted of 20 patients treated at two large tertiary hospitals (2019-2022). All underwent posterior osteotomy correction and were categorized into HGT (n = 14) and HPT (n = 6) groups. Key parameters analyzed included radiographic measures (Cobb angles), pulmonary function tests (before and after traction/surgery), and intraoperative metrics such as blood loss, surgery duration, and osteotomy grade. Health-related quality of life was evaluated using the SRS-22 questionnaire.

Results: Baseline characteristics were comparable between groups. Compared to the HPT group, the HGT group showed significantly lower correction rates in both coronal and sagittal Cobb angles (P < 0.01), longer surgical duration, greater intraoperative blood loss, and higher osteotomy grade (P < 0.05). Improvements in FVC% and FEV1% were significantly smaller in the HGT group (P < 0.001). While both groups showed postoperative gains in SRS-22r scores, the differences between them were not statistically significant. No neurological complications occurred in either group; one case of iliac pin breakage in the HPT group was managed successfully without impacting the surgical outcome.

Conclusion: Both HGT and HPT were feasible and safe in the preoperative management of patients with severe rigid spinal deformity. In this limited cohort, HPT was associated with greater angular correction, improved pulmonary function, and reduced intraoperative complexity compared to HGT. While these findings are encouraging, larger prospective studies are warranted to validate the long-term efficacy and safety of HPT and to better inform clinical decision-making in high-risk spinal deformity cases.

Purpose: The complex relationship between spine deformity and self-image is incompletely understood. This study aims to evaluate how age affects self-image in idiopathic scoliosis.

Methods: Single-center study of adult (AdIS) and adolescent (AIS) idiopathic scoliosis patients treated with posterior spinal fusion (PSF). Preoperative and two-year postoperative patient-reported, radiographic, and perioperative outcomes were compared. Patients were grouped according to age, AIS (< 1 8 years), young adults (yAdIS, 18-40 years) and older adults (oAdIS, > 40 years).

Results: 176 patients were included, 54 AIS (ave. 15.8 years), 47 yAdIS (mean 25.2 years), and 74 oAdIS (mean 56.5 years). Preoperative curve magnitude was similar between groups (p = 0.0863). Postoperative, AIS and yAdIS had similar curves, but smaller than oAdIS (p = 0.0104) with similar corrections (p = 0.6476). AIS had lower EBL (p < 0.0001), shorter OR times (p < 0.0001), fewer levels (p < 0.0001) and pelvic instrumentation (p < 0.0001). AIS had greater preoperative self-image scores (3.5 vs. 3.1 vs. 2.5, p < 0.0001) with no difference seen postoperative (4.4 vs. 4.3 vs. 4.2, p = 0.1230). However, the greatest improvement was observed in oAdIS patients (p < 0.0001). Independent predictors of self-image scores varied by age and included anxiety/depression (β = - 1.057), BMI (β = 0.033), and postoperative CVA (β = - 0.021) for AIS; anxiety/depression (β = - 0.513) and curve correction (β = 0.0143) in yAdIS; and postoperative pelvic tilt (β = - 0.028, p = 0.0037) for oAdIS.

Conclusion: AIS patients had the highest preoperative self-image scores, followed by yAdIS and then oAdIS. However, the greatest improvement was observed in the older patients, despite more surgical morbidity. Mental health diagnoses were associated with worse self-image scores in AIS and yAdIS, though not oAdIS.

Study design: Retrospective case-series OBJECTIVE: The purpose of this study is to validate novel radiographic measures, specifically Rib-2 height (R2H) and T1-Rib-2 Change (T1R2C), as predictors of postoperative shoulder balance following adolescent idiopathic scoliosis (AIS) surgery. Shoulder balance following posterior spinal fusion (PSF) in AIS continues to be important for optimal aesthetic outcomes and patient satisfaction. Using currently accepted radiographic measures intraoperatively (e.g., T1-tilt) for the achievement of shoulder balance remains a challenge. Power analysis determined 28 patients were needed to achieve 80% power with an effect size Pearson's r = 0.5.

Methods: AIS patients who underwent PSFs were retrospectively identified when no further deformity correction was completed after the last intraoperative long-cassette radiograph. Traditional radiographic measures were completed. For intra-op patients, a reference vertical was used for all measurements. All measures were Pearson correlated with radiographic shoulder height (RSH) 6 weeks post-op (6wk) and 2y.

Results: There were 29 patients (26 female, 90%) whose mean age at surgery was 14.1 years. The mean RSH changed from -14.9mm pre-op to 5.4mm 2y post-op (p =1.9e-6). T1R2C and R2H demonstrated strong positive correlations pre-op (T1R2C r=0.7, p =0.0001) / (R2H r=0.6, p =0.001) to post-op (T1R2C r=0.8, p =2.23e-7) / (R2H r=0.6, p =2e-4). All radiographic variables showed significant correlations with RSH pre-op to post-op (p<0.001). Intraoperative R2H had intermediate associations with RSH at 6wks (r=0.48, p=0.018) and 2y post-op (r=0.4, p =0.04). Intra-op T1R2C and remaining coronal measurements showed no correlation with RSH. Linear regression models show a significant predictive relationship between RSH at 2y and intra-op R2H. The model was not improved when corroborated with intra-op T1R2C.

Conclusion: R2H was a significant predictor of RSH pre-op to post-op and intra-op to post-op, performing better than T1R2C and other radiographic measures. R2H could be used as an objective radiographic measurement tool to plan surgery and during surgery to optimize shoulder balance following PSF including T1-Rib-2 Change.

Introduction: Anterior vertebral body tethering (AVBT) has recently been utilized as a surgical alternative to posterior spinal fusion for a subset of pediatric scoliosis patients. Indications for AVBT are evolving and, while early results have been promising, there is a paucity of literature examining the behavior of the lumbar curve after exclusive tether of the thoracic region. It was hypothesized that thoracic tether leads to a spontaneous decrease in the un-instrumented lumbar curve.

Methods: The study population consisted of 166 patients with idiopathic scoliosis enrolled in the Pediatric Spine Study Group registry undergoing thoracic tether with a minimum of two-year follow-up. Exclusion criteria included: patients with non-idiopathic scoliosis, patients with prior spine surgery, and patients instrumented below L1.

Results: Overall curve correction was notable, with mean pre-op, immediate post-op, and two-year follow-up angles of 51.3°, 29.7°, and 30.3° respectively for the thoracic curve and 32.7°, 22.9°, and 24.1° respectively for the un-instrumented lumbar curve. Overall, 124 subjects (74.7%) had a decrease in lumbar curve > 5° immediately post-op. Over a two-year follow-up period, 32 subjects (19%) had a continued decrease in lumbar curve > 5°, 91 subjects (54%) had minimal change, and 43 subjects (26%) had an increase in lumbar curve > 5°. In a subgroup analysis of 36 subjects with a decrease in thoracic curve > 5° from post-op to two-year follow-up, 11 subjects (31%) had a concomitant decrease in lumbar curve with only 5 (14%) showing an increase in lumbar curve > 5°. The changes in lumbar curve from pre-op to post-op and from post-op to two-year follow-up were found to be associated with changes in the thoracic curve for the same periods (rho = 0.603, p < 0.001; rho = 0.413, p < 0.001 respectively). When considering Lenke lumbar modifiers, the un-instrumented lumbar curve corrected an average of 35%, 27%, and 20% following surgery and 27%, 30%, and 17% at two-year follow-ups for A, B, and C curves respectively (p < .001 for all data points compared to pre-op).

Conclusion: Lumbar curves tended to mirror the behavior of the maximal thoracic curve in terms of correction or decompensation both during surgery and during the two-year follow-up. Furthermore, un-instrumented lumbar curves with a Lenke C modifier tended to achieve a lower percentage correction. These data provide clearer insights into the response of the lumbar curve following thoracic tethering and the effect of growth modulation.