Purpose: Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare neurodevelopmental disorder marked by the absence of horizontal eye movement and gradual progressive scoliosis during childhood. Here, we report two biological siblings that presented with a shared diagnosis; however, the curves are in opposite directions and one presents with dextrocardia.
Methods: Two siblings presented with acute scoliosis and conjugate absence of horizontal gaze. The diagnosis was confirmed based on characteristic clinical presentation, congenital absence of horizontal gaze, and supportive radiographic imaging. Both patients were followed from early infancy through skeletal maturity with radiographs and clinical evaluations. Curve progression, response to conservative measures, and indications for surgical intervention were documented.
Results: Both patients developed progressive thoracic scoliosis despite early casting and bracing, with curves exceeding 70° by early adolescence ultimately requiring an anterior and posterior spinal fusion and instrumentation (PSFI). Postoperatively, both patients demonstrated stable spinal alignment and achieved satisfactory correction with long-term follow-up. Interestingly, evaluation of the radiographs demonstrates opposite convex thoracic curve patterns, each with an apex at T9, one with a left thoracic curve and an associated dextrocardia and the other with a right thoracic curve and normal left-sided heart position.
Conclusion: This report provides rare long-term data spanning more than a decade with a unique phenotypic presentation among siblings. It is notable for their opposing curve directions-one right-sided and one left-sided with the presence of conjugate dextrocardia in the left thoracic scoliosis. These findings may suggest an underlying influence of asymmetric cardiothoracic development or potential link of blood supply pattern on spinal curve direction. Recognition of this unique phenomenon might offer new insight into the etiology of scoliosis in HGPPS and warrants further investigation into the developmental factors contributing to curve morphology.
Objective: This study introduces eccentric cranial traction (ECT) as a traction method for congenital cervical scoliosis (CCS) at the craniovertebral junction (CVJ) and evaluates its benefits when combined with concave-side distraction surgery.
Methods: A retrospective analysis was conducted on 18 patients with CCS at the CVJ treated between 2019 and 2023 using ECT followed by concave-side distraction. Radiographic parameters were assessed at five time points: pre-operation, pre-traction, post-traction, post-operation, and final follow-up. Baseline demographic and surgical data were recorded. Patients were stratified into high- and low-responder groups based on the median value of the traction correction rate, and outcomes were compared between groups. The correlation between traction correction rate and surgical correction rate was also analyzed.
Results: The median age at ECT initiation was 8 years, and the median duration of traction was 8 days. All patients presented with deformities involving the CVJ. ECT significantly reduced head-neck tilt from 16.5 ± 9.3° to 9.5 ± 5.9° (P < 0.001), yielding a mean traction correction rate of 43.1%. All patients subsequently underwent concave-side distraction at the CVJ, which resulted in a significant improvement in the Cobb angle from 36.0 ± 13.6° to 6.1 (IQR, 4.0, 10.9) (P < 0.05). At a median follow-up of 25.0 months (IQR, 24.0-30.0), the Cobb angle had increased slightly to 6.2° (IQR, 4.5-13.2), but the change was not statistically significant. Compared with the low-responder group, the high-responder group showed no significant differences in baseline parameters but had significantly shorter operative times (P < 0.05). No complications occurred during the traction period. Intraoperative complications included transient nerve root palsy and cerebrospinal fluid leakage, all of which resolved without long-term sequelae.
Conclusions: The combination of eccentric cranial traction and concave-side distraction offers a feasible and safe option for congenital cervical scoliosis at the craniovertebral junction. Traction responsiveness showed preliminary value in reflecting deformity flexibility and surgical complexity.
Purpose: Selective thoracic fusion (STF) in adolescent idiopathic scoliosis (AIS) corrects the primary thoracic curve while achieving spontaneous lumbar curve correction (SLCC) and preserving flexibility. This study introduces a novel preoperative radiographic parameter defined as the ratio of the tilt of the upper and lower end vertebrae of the lumbar curve to the corresponding lumbar Cobb angle as a predictor of SLCC.
Methods: A multicenter retrospective review identified Lenke 1-4 patients with lumbar modifiers B or C undergoing STF. Radiographic parameters through 2-year follow-up included lumbar Cobb angle, UEV/LEV tilt, lumbar flexibility, and apical translation. LEV:Cobb and UEV:Cobb ratios were calculated by dividing vertebral tilt by preoperative lumbar Cobb. Univariate and multivariate regression assessed predictors of SLCC. Subgroup analyses were performed by lumbar modifier and fusion level relative to the stable vertebra.
Results: 193 patients met inclusions criteria (mean age at time of surgery 15.0 ± 2.0 years, 86% female). Mean preoperative lumbar Cobb was 41.2° ± 7.2, with mean SLCC of 56.8% ± 17.6% at 2 years. In multivariate analysis, lower LEV:Cobb ratio (p = 0.012) and greater lumbar flexibility (p = 0.001) independently predicted higher SLCC; pelvic tilt trended toward significance (p = 0.071). Subgroup analysis showed stronger associations between tilt ratios and SLCC in modifier B curves (UEV:Cobb p = 0.001; LEV:Cobb p = 0.003).
Conclusions: LEV:Cobb ratio and lumbar flexibility are independent, preoperative predictors of SLCC in AIS patients undergoing STF. Incorporating these simple metrics into preoperative planning may improve fusion level selection, reduce residual deformity, and enhance postoperative balance.
Level of evidence: Level IV.
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.
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