Spine deformity最新文献

Purpose: Vertebral compression fractures (VCFs) are the most common fractures in patients with osteoporosis, contributing to approximately 700,000 spinal fractures annually. Wedge fractures, characterized by anterior vertebral body collapse, are the most prevalent type of VCFs and a significant cause of spinal deformity, such as thoracic kyphosis. This study aimed to develop and validate a finite element model (FEM) of wedge fractures to understand their biomechanics and clinical implications, and help future studies to elucidate spine fractures in osteoporotic patients.

Methods: CT-based finite element models of T9-T12 vertebral bodies were developed using scans from four cadaveric spines. Axial compression tests were performed on the corresponding vertebrae using a Materials Test Systems (MTS) machine to induce wedge fractures. Key biomechanical parameters, including stiffness and strength, were measured and compared to FEM predictions for validation.

Results: The FEM demonstrated strong agreement with the experimental data, achieving coefficients of determination (R²) of 0.71 (p < 0.01) for stiffness and 0.88 (p < 0.01) for strength. The FEM predicted a stiffness of 5.9 ± 0.6 kN/mm and a strength of 3.2 ± 0.4 kN, which closely matched the experimental values of 5.83 ± 1.2 kN/mm and 3.54 ± 0.6 kN, respectively. The FEM also qualitatively reproduced fracture patterns, including mid-fracture lines and delamination of the anterior cortical shell.

Conclusions: This study validates FEM as a robust tool for modeling wedge fractures and understanding their role in spinal deformity. The model offers insight into vertebral compression fractures and can be further developed for use in other clinical applications, to provide the volume needed to restore the height of the vertebrae.

Purpose: Children with non-ambulatory cerebral palsy (CP) often have neuromuscular scoliosis (NMS) that requires surgical correction. Many of these children also have co-existing spasticity treated with an intrathecal baclofen pump (ITBP). Theoretically, ITBPs can complicate spine surgery due to the proximity of the pump and catheter to the surgical area, but the evidence on effects of ITBP on spinal deformity surgery outcomes is varied. The aim of this study was to compare surgical outcomes and incidence of complications between children with and without ITBPs.

Methods: This retrospective study included children with CP from a single center who underwent spinal fusion between 2001 and 2021. Complications and outcomes were abstracted from the medical record and compared between those with and without ITBP using Fisher's exact tests or Mann-Whitney U tests.

Results: A total of 334 patients were eligible (ITBP: n = 163; no ITBP: n = 171). In general, children with ITBP were not more likely to experience complications compared to those without (p = 0.19). However, those with ITBP had greater odds of surgical site infection (OR 3.11, p = 0.03), longer surgery duration (p < 0.001), and higher percentage of blood loss (p = 0.01). ITBP-related complications occurred in 11% of children with ITBP.

Conclusions: The presence of ITBP did not increase the general risk of complications for children with ITBP. However, children with ITBP experienced more surgical site infections, longer surgery durations, and a higher percentage of blood loss. Results will improve counseling between surgeons, children, and caregivers regarding the risk of spinal fusion surgery when ITBPs are present.

Objective: Pediatric scoliosis is the most prevalent spinal disorder, often leading to abnormal curvature and deformation of the spine. Early detection is essential for timely intervention, particularly in growing adolescents. In this study, we present a novel, fully automated, radiation-free method for Cobb angle evaluation, combining fringe projection profilometry with deep learning technologies.

Materials and methods: A three-dimensional reconstruction of the participant's back surface is achieved using a seven-step phase-shifting algorithm. Convolutional neural networks are then utilized to extract asymmetry features from the 3D surface and predict the Cobb angle, a key clinical indicator of scoliosis severity. A total of 48 participants clinically diagnosed with scoliosis based on radiographic imaging were recruited from the hospital.

Results: The experimental results demonstrate a strong correlation between the predicted and actual Cobb angles, with a correlation coefficient of 0.94 and a coefficient of determination of 0.8796 during Adam's forward bend test. The mean time required from scanning to Cobb angle prediction is approximately 3.3 s.

Conclusions: The proposed evaluation method exhibits excellent discriminative capability and shows significant potential as an alternative to the traditional scoliometer for large-scale Cobb angle screening programs in schools.

Purpose: Osteogenesis Imperfecta (OI) is a rare connective tissue disorder often associated with severe, brace-resistant scoliosis. Posterior spinal fusion (PSF) with pedicle screws can achieve up to 60% coronal correction, while preoperative halo-gravity traction (HGT) may provide additional benefits but carries potential risks. This study evaluated whether HGT offers perioperative or radiographic advantages compared with PSF alone in pediatric OI patients.

Methods: Thirty-six patients treated between 2002 and 2020 with ≥ 2 years' follow-up were retrospectively analyzed. Patients were divided into HGT + PSF (N = 19) and PSF-only (N = 17) groups, comparable in baseline characteristics. The primary outcome was coronal correction rate (CR); secondary outcomes included operative time, blood loss, length of stay (LOS), complications (Modified Clavien-Dindo-Sink Classification, MCDS), and loss of correction at follow-up. Statistical comparisons used Mann-Whitney U and Chi-Squared tests (p < 0.05).

Results: Postoperative major and minor curve CR were 60.2% and 66.5% in the HGT + PSF group vs. 55.1% and 37.7% in PSF (p = 0.337 and p = 0.003). At last follow-up, CR was 51.1% and 38.8% for HGT + PSF vs. 44.9% and 25.2% for PSF (p = 0.298 and p = 0.238). Mean blood loss (1235 vs. 1368 mL, p = 0.972), operative time (443 vs. 410 min, p = 0.490), and LOS (12.6 vs. 9.5 days, p = 0.186) were not significantly different. Complications occurred in 57.9% of HGT + PSF vs. 29.4% of PSF patients (p = 0.367), with more major complications in the HGT + PSF group.

Conclusions: In this cohort, HGT provided only modest additional coronal correction without clear perioperative advantages compared with PSF alone. Given these limited and partly transient effects, its routine use should be considered cautiously and in the context of individual patient characteristics. Larger prospective multicenter studies are needed to clarify the specific clinical scenarios in which preoperative HGT may offer meaningful benefit in the surgical management of OI-related scoliosis.

Objective: This study aimed to evaluate the clinical efficacy and safety of the dual growing rods (DGR) technique combined with preoperative halo-femoral traction (HFT) in treating early onset scoliosis (EOS), with a focus on spinal deformity correction, preservation of spinal growth, and complication management. The integral role of preoperative HFT in enabling DGR implantation for severe rigid curves was a primary focus of the analysis.

Methods: A retrospective study was conducted on 42 EOS patients treated with the DGR technique, with a mean follow-up of 38.10 ± 12.95 months. Radiographic parameters-including Cobb angle, T1-S1 distance, apical vertebral translation (AVT), and sagittal alignment-were measured preoperatively, postoperatively, and at final follow-up. Complications were recorded and analyzed. Subgroup analysis compared patients with and without preoperative HFT.

Results: At final follow-up, the main Cobb angle correction rate was 64.30% ± 17.51%, and the T1-S1 distance increased significantly (p < 0.05), indicating preserved spinal growth. The overall complication rate was 19.1% (8/42), including screw loosening or displacement (n = 3), hook disengagement (n = 2), proximal junctional kyphosis (n = 2), and wound-healing issues (n = 2). No significant association was found between complications and age, etiology, or HFT use (p > 0.05). Patients undergoing preoperative HFT showed improved spinal flexibility, enabling successful DGR placement despite severe rigidity.

Conclusion: The DGR technique combined with preoperative HFT is a safe and effective treatment for EOS, achieving substantial deformity correction and supporting spinal growth. Preoperative HFT is a necessary adjunct for severe rigid deformities, directly enabling DGR implantation and enhancing correction efficacy.

Background: Osteogenesis imperfecta (OI) is a rare genetic condition that leads to poor bone quality and scoliosis development. To date, the surgical management of scoliosis in the setting of OI is poorly defined, be it with traditional posterior spinal fusion (PSF) or newer growth-friendly instrumentation (GFI) approaches. Correspondingly, the aim of this study was to quantitatively pool the available metadata in the literature regarding the surgical outcomes of OI patients undergoing surgical correction.

Methods: Multiple electronic databases from inception to August 2025 were searched following PRISMA guidelines. Respective cohort-level outcomes were then abstracted and pooled by means of meta-analysis utilizing random-effects modeling, and trends were evaluated by meta-regression analysis.

Results: A total of 14 studies were identified for inclusion, describing 321 OI patients surgically treated by PSF (n = 301, 94%) and GFI (n = 20, 6%). Across the cohort, median male percentage and mean age at surgery were 46% and 14.1 years, respectively; 20% were OI type 1, 51% were OI type 3, and 9% were OI type 4 as reported by Sillence Classification. Adjuncts described included traction in 8/14 (57%) studies, preoperative bisphosphonates in 6/14 (43%) studies, and intraoperative cement in 3/14 (21%) studies. Meta-analysis demonstrated overall incidence of postoperative complications following surgical correction of scoliosis to be 21% (95% CI 12-31%), with a statistical difference between PSF and GFI groups (P-heterogeneity < 0.01). Trim-and-fill analyses imputed 3 additional studies to re-estimate the complication incidence to be lower at 14% (95% CI 3-24%) for the PSF-only group. Pooled incidence of revision surgery was 6% (95% CI 2-12%), with a statistical difference between PSF and GFI groups (P-heterogeneity < 0.01) as well. Certainty of outcomes was deemed very low, with quality of evidence ranging from high to moderate.

Conclusion: Overall, there are non-negligible complication and revision rates in the surgical treatment of scoliosis in the setting of OI. These rates are lower in the setting of PSF alone, and the use of surgical adjuncts and GFI approaches requires further study to understand their role in the treatment paradigm of OI scoliosis. Larger, collaborative efforts will improve the granularity of our findings in the future.

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.