Pub Date : 2025-10-10DOI: 10.1016/j.semss.2025.101212
Abdullah AlDuwaisan , Firoz Miyanji
Pediatric patients undergoing scoliosis surgery were historically at risk for large amounts of blood loss and high transfusion requirements. Through modern blood conservation strategies, surgery has become much safer for patients with scoliosis, and by association, a decrease in transfusion rates for these patients has been observed. A successful blood conservation program incorporates pre-operative risk assessment strategies and optimization, intra-operative surgical and anesthetic techniques and pharmacological to limit the intra-operative bleeding and overall transfusion requirements. A detailed understanding of the tools available to decrease overall transfusion needs will aid surgical planning and improve overall outcomes in this patient population.
{"title":"Perioperative blood loss management","authors":"Abdullah AlDuwaisan , Firoz Miyanji","doi":"10.1016/j.semss.2025.101212","DOIUrl":"10.1016/j.semss.2025.101212","url":null,"abstract":"<div><div>Pediatric patients undergoing scoliosis surgery were historically at risk for large amounts of blood loss and high transfusion requirements. Through modern blood conservation strategies, surgery has become much safer for patients with scoliosis, and by association, a decrease in transfusion rates for these patients has been observed. A successful blood conservation program incorporates pre-operative risk assessment strategies and optimization, intra-operative surgical and anesthetic techniques and pharmacological to limit the intra-operative bleeding and overall transfusion requirements. A detailed understanding of the tools available to decrease overall transfusion needs will aid surgical planning and improve overall outcomes in this patient population.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101212"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.semss.2025.101221
Lawrence G. Lenke , Edwin S. Kulubya , Erik Lewerenz , Fthimnir M. Hassan
Posterior Column Osteotomies (PCOs) and Three-Column Osteotomies (3COs) are powerful techniques used to correct pediatric spinal deformity. PCOs are most often used as they are highly effective in achieving correction in idiopathic scoliosis. 3COs, specifically the posterior vertebral column resection (pVCR), are highly effective in severe rigid and angular deformities. The purpose of this manuscript will be to explain the uses of PCOs and 3COs in pediatric deformity correction and detail the indications, techniques, surgical results, complications and outcomes of these procedures.
{"title":"Posterior column and three column osteotomies for pediatric scoliosis","authors":"Lawrence G. Lenke , Edwin S. Kulubya , Erik Lewerenz , Fthimnir M. Hassan","doi":"10.1016/j.semss.2025.101221","DOIUrl":"10.1016/j.semss.2025.101221","url":null,"abstract":"<div><div>Posterior Column Osteotomies (PCOs) and Three-Column Osteotomies (3COs) are powerful techniques used to correct pediatric spinal deformity. PCOs are most often used as they are highly effective in achieving correction in idiopathic scoliosis. 3COs, specifically the posterior vertebral column resection (pVCR), are highly effective in severe rigid and angular deformities. The purpose of this manuscript will be to explain the uses of PCOs and 3COs in pediatric deformity correction and detail the indications, techniques, surgical results, complications and outcomes of these procedures.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101221"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.semss.2025.101217
Jaysson T. Brooks , Christopher J Carron , Hong Zhang , Daniel J. Sucato
Background
Despite the predominance of posterior spinal instrumentation for pediatric scoliosis, anterior approaches remain essential in select cases, offering advantages such as improved access to vertebral body endplates and facilitation of anterior column shortening for severe deformities. The purpose of this study is to describe the indications, anatomy, techniques, and outcomes associated with anterior release (AR) and anterior spinal instrumentation and fusion (ASIF) in pediatric spine deformity surgery.
Methods
A review of historical and recent literature was performed, outlining thoracoscopic AR techniques, including prone-lateral approaches, and the surgical steps of thoracolumbar and lumbar ASIF. The review discusses the learning curve, relevant anatomic considerations, intraoperative decision-making, and perioperative management based on published literature and institutional experience.
Results
Though less commonly performed today, anterior approaches can significantly enhance spinal flexibility in rigid curves, particularly when combined with posterior spinal fusion (PSF). Prone-lateral thoracoscopic AR reduces respiratory complications and operative time while maintaining correction efficacy. ASIF remains relevant in specific cases such as Lenke 5C curves and patients with poor posterior bone stock. Recent studies show comparable outcomes between ASIF and PSF with no long-term pulmonary compromise.
Conclusion
Anterior spinal surgery, though less frequently employed in modern practice, remains a vital tool for pediatric spine surgeons. Mastery of anterior release and fusion techniques, particularly via thoracoscopic approaches, expands the surgical armamentarium and enables tailored management of complex scoliosis cases.
{"title":"Going anterior for the surgical management of pediatric scoliosis: Indications and technique pearls","authors":"Jaysson T. Brooks , Christopher J Carron , Hong Zhang , Daniel J. Sucato","doi":"10.1016/j.semss.2025.101217","DOIUrl":"10.1016/j.semss.2025.101217","url":null,"abstract":"<div><h3>Background</h3><div>Despite the predominance of posterior spinal instrumentation for pediatric scoliosis, anterior approaches remain essential in select cases, offering advantages such as improved access to vertebral body endplates and facilitation of anterior column shortening for severe deformities. The purpose of this study is to describe the indications, anatomy, techniques, and outcomes associated with anterior release (AR) and anterior spinal instrumentation and fusion (ASIF) in pediatric spine deformity surgery.</div></div><div><h3>Methods</h3><div>A review of historical and recent literature was performed, outlining thoracoscopic AR techniques, including prone-lateral approaches, and the surgical steps of thoracolumbar and lumbar ASIF. The review discusses the learning curve, relevant anatomic considerations, intraoperative decision-making, and perioperative management based on published literature and institutional experience.</div></div><div><h3>Results</h3><div>Though less commonly performed today, anterior approaches can significantly enhance spinal flexibility in rigid curves, particularly when combined with posterior spinal fusion (PSF). Prone-lateral thoracoscopic AR reduces respiratory complications and operative time while maintaining correction efficacy. ASIF remains relevant in specific cases such as Lenke 5C curves and patients with poor posterior bone stock. Recent studies show comparable outcomes between ASIF and PSF with no long-term pulmonary compromise.</div></div><div><h3>Conclusion</h3><div>Anterior spinal surgery, though less frequently employed in modern practice, remains a vital tool for pediatric spine surgeons. Mastery of anterior release and fusion techniques, particularly via thoracoscopic approaches, expands the surgical armamentarium and enables tailored management of complex scoliosis cases.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101217"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.semss.2025.101219
Vivek P. Gupta , Joshua M. Pahys , Steven W. Hwang , Amer F. Samdani
Anterior vertebral body tethering (VBT) is a fusionless surgical technique for treating patients with adolescent idiopathic scoliosis. It serves as an alternative to posterior spinal fusion by correcting spinal curvature while preserving motion, though at the expense of a higher risk of reoperation. It is optimally employed in skeletally immature patients with moderate curve magnitude. While short term outcomes are promising, further investigation into longer term outcomes is needed. This article aims to summarize the evidence for VBT, describe current indications, and provide a comparison to posterior spinal fusion as a treatment option for patients with adolescent idiopathic scoliosis.
{"title":"Anterior non-fusion treatment for scoliosis","authors":"Vivek P. Gupta , Joshua M. Pahys , Steven W. Hwang , Amer F. Samdani","doi":"10.1016/j.semss.2025.101219","DOIUrl":"10.1016/j.semss.2025.101219","url":null,"abstract":"<div><div>Anterior vertebral body tethering (VBT) is a fusionless surgical technique for treating patients with adolescent idiopathic scoliosis. It serves as an alternative to posterior spinal fusion by correcting spinal curvature while preserving motion, though at the expense of a higher risk of reoperation. It is optimally employed in skeletally immature patients with moderate curve magnitude. While short term outcomes are promising, further investigation into longer term outcomes is needed. This article aims to summarize the evidence for VBT, describe current indications, and provide a comparison to posterior spinal fusion as a treatment option for patients with adolescent idiopathic scoliosis.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101219"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.semss.2025.101218
Raisa Rauf, Paul D. Sponseller
Pelvic fixation reinforces lumbosacral constructs, counteracting forces that risk pseudarthrosis, particularly in long-segment arthrodesis. Indications span neuromuscular, syndromic, early-onset scoliosis, and high-grade spondylolisthesis, where pelvic obliquity and poor trunk control necessitate fixation. Techniques include sacral, iliac, S2 alar-iliac (SAI), iliosacral screws, unit rods, Galveston rods, and sacral hooks, each with unique biomechanical profiles and complication risks. SAI screws have emerged as the gold standard for their robust fixation, lower prominence, and reduced soft tissue disruption. However, pelvic fixation increases surgical site infections and implant-related failures. Optimal technique selection and meticulous wound management are critical to minimize complications and ensure construct durability.
{"title":"Pelvic fixation strategies in pediatric spinal deformity","authors":"Raisa Rauf, Paul D. Sponseller","doi":"10.1016/j.semss.2025.101218","DOIUrl":"10.1016/j.semss.2025.101218","url":null,"abstract":"<div><div>Pelvic fixation reinforces lumbosacral constructs, counteracting forces that risk pseudarthrosis, particularly in long-segment arthrodesis. Indications span neuromuscular, syndromic, early-onset scoliosis, and high-grade spondylolisthesis, where pelvic obliquity and poor trunk control necessitate fixation. Techniques include sacral, iliac, S2 alar-iliac (SAI), iliosacral screws, unit rods, Galveston rods, and sacral hooks, each with unique biomechanical profiles and complication risks. SAI screws have emerged as the gold standard for their robust fixation, lower prominence, and reduced soft tissue disruption. However, pelvic fixation increases surgical site infections and implant-related failures. Optimal technique selection and meticulous wound management are critical to minimize complications and ensure construct durability.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101218"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.semss.2025.101215
Elyette Lugo, Paul Sponseller, Amit Jain
The surgical management of thoracolumbar/lumbar (TL/L) curves in adolescent idiopathic scoliosis (AIS) has evolved significantly over the past two decades. Anterior spinal fusion (ASF), which had been the preferred option, has largely been replaced by posterior spinal fusion (PSF) with pedicle screw constructs due to excellent correction, better control over the sagittal alignment, and decreased morbidity. This transition has refined focus on the selection of the optimal upper (UIV) and lower instrumented vertebrae (LIV), as these are key to achieving long-term correction while avoiding complications such as proximal junctional kyphosis (PJK) and coronal imbalance (CIB).
{"title":"Management of thoracolumbar curves in adolescent idiopathic scoliosis","authors":"Elyette Lugo, Paul Sponseller, Amit Jain","doi":"10.1016/j.semss.2025.101215","DOIUrl":"10.1016/j.semss.2025.101215","url":null,"abstract":"<div><div>The surgical management of thoracolumbar/lumbar (TL/L) curves in adolescent idiopathic scoliosis (AIS) has evolved significantly over the past two decades. Anterior spinal fusion (ASF), which had been the preferred option, has largely been replaced by posterior spinal fusion (PSF) with pedicle screw constructs due to excellent correction, better control over the sagittal alignment, and decreased morbidity. This transition has refined focus on the selection of the optimal upper (UIV) and lower instrumented vertebrae (LIV), as these are key to achieving long-term correction while avoiding complications such as proximal junctional kyphosis (PJK) and coronal imbalance (CIB).</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101215"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.semss.2025.101211
Vivek P. Gupta , Joshua Pahys , Steven Hwang
The success of deformity surgery to address scoliosis is predicated on proper preoperative evaluation and optimization to minimize the risk of perioperative complications while maximizing the chances of achieving surgical goals. Tailoring this approach to the specific etiologies of scoliosis will allow for targeted evaluation and mitigation of their different complication profiles. This article will provide a broad general overview of preoperative evaluation and management for pediatric patients with scoliosis while also addressing specific considerations for individual types of scoliosis, including idiopathic, neuromuscular, syndromic, and congenital varieties.
{"title":"Preoperative evaluation and optimization of scoliosis","authors":"Vivek P. Gupta , Joshua Pahys , Steven Hwang","doi":"10.1016/j.semss.2025.101211","DOIUrl":"10.1016/j.semss.2025.101211","url":null,"abstract":"<div><div>The success of deformity surgery to address scoliosis is predicated on proper preoperative evaluation and optimization to minimize the risk of perioperative complications while maximizing the chances of achieving surgical goals. Tailoring this approach to the specific etiologies of scoliosis will allow for targeted evaluation and mitigation of their different complication profiles. This article will provide a broad general overview of preoperative evaluation and management for pediatric patients with scoliosis while also addressing specific considerations for individual types of scoliosis, including idiopathic, neuromuscular, syndromic, and congenital varieties.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101211"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.semss.2025.101220
Patrick J. Cahill , Katerina M. Kourpas , Jason B. Anari
Pediatric spine deformity pathology may present anywhere in the pediatric spinal column from the cranio-cervical to the lumbosacral junction and at any time from infancy to skeletal maturity. Multimodal intraoperative neurophysiological monitoring has become standard of care for children undergoing spinal deformity correction to optimize the safety of these operations while minimizing the potential risk of post-operative loss of function. Surgeons must thoroughly understand the various techniques used to monitor the pediatric spinal column as well as the impact of age, underlying medical diagnoses, and presenting spinal pathology on multimodal intraoperative neurophysiological monitoring. This article reviews the fundamentals of neuromonitoring in pediatric spine deformity surgery in 2025.
{"title":"Neuromonitoring considerations in pediatric scoliosis surgery","authors":"Patrick J. Cahill , Katerina M. Kourpas , Jason B. Anari","doi":"10.1016/j.semss.2025.101220","DOIUrl":"10.1016/j.semss.2025.101220","url":null,"abstract":"<div><div>Pediatric spine deformity pathology may present anywhere in the pediatric spinal column from the cranio-cervical to the lumbosacral junction and at any time from infancy to skeletal maturity. Multimodal intraoperative neurophysiological monitoring has become standard of care for children undergoing spinal deformity correction to optimize the safety of these operations while minimizing the potential risk of post-operative loss of function. Surgeons must thoroughly understand the various techniques used to monitor the pediatric spinal column as well as the impact of age, underlying medical diagnoses, and presenting spinal pathology on multimodal intraoperative neurophysiological monitoring. This article reviews the fundamentals of neuromonitoring in pediatric spine deformity surgery in 2025.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101220"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.semss.2025.101216
Hans K Nugraha, Adam P Rasmussen, Ahmad Nassr, A․Noelle Larson
Spinal surgery instrumentation has evolved from early bone grafting and rod systems to advanced pedicle screw fixation, improving stability and fusion success for scoliosis and other deformities. While pedicle screws dominate, anatomical challenges sometimes require alternatives such as sublaminar tapes or pelvic anchors. Modern techniques, including free-hand screw placement, fluoroscopy, and CT-guided navigation, enhance precision, especially in complex cases. Innovations include 3D-printed drill guides, robotic navigation, and optical systems further improve accuracy and reduce radiation exposure. These advancements have lowered revision rates and enabled early mobilization without bracing. Ongoing research aims to optimize cost-effectiveness and align radiographic outcomes with patient-reported benefits, with pedicle screws remaining central to spinal deformity correction.
{"title":"Traditional & enabling methods for spinal instrumentation","authors":"Hans K Nugraha, Adam P Rasmussen, Ahmad Nassr, A․Noelle Larson","doi":"10.1016/j.semss.2025.101216","DOIUrl":"10.1016/j.semss.2025.101216","url":null,"abstract":"<div><div>Spinal surgery instrumentation has evolved from early bone grafting and rod systems to advanced pedicle screw fixation, improving stability and fusion success for scoliosis and other deformities. While pedicle screws dominate, anatomical challenges sometimes require alternatives such as sublaminar tapes or pelvic anchors. Modern techniques, including free-hand screw placement, fluoroscopy, and CT-guided navigation, enhance precision, especially in complex cases. Innovations include 3D-printed drill guides, robotic navigation, and optical systems further improve accuracy and reduce radiation exposure. These advancements have lowered revision rates and enabled early mobilization without bracing. Ongoing research aims to optimize cost-effectiveness and align radiographic outcomes with patient-reported benefits, with pedicle screws remaining central to spinal deformity correction.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101216"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.semss.2025.101213
Nicholas D. Fletcher , Anson G. Bautista , Joshua S. Murphy , K.Aaron Shaw
Severe pediatric spinal deformities may require staged correction strategies to mitigate neurologic risk and optimize cardiopulmonary outcomes. This paper reviews two adjunctive techniques—halo gravity traction (HGT) and temporary internal distraction (TID)—used in the management of rigid scoliosis. HGT enables gradual preoperative spinal elongation and coronal/sagittal realignment, improving pulmonary function and nutritional status while reducing the need for three-column osteotomies. TID offers an internal, staged distraction approach for patients contraindicated for external traction, allowing incremental correction via posterior instrumentation followed by definitive fusion. Clinical studies report Cobb angle reductions of 30–80 %, with low rates of neurologic complications when neuromonitoring and mean arterial pressure protocols are rigorously applied. Technical considerations include halo pin torque settings, traction weight progression, and intraoperative distraction parameters. Both techniques demonstrate efficacy in reducing deformity severity, improving perioperative safety, and enhancing long-term outcomes. Their integration into multidisciplinary care pathways supports safer and more effective surgical management of complex pediatric spinal deformities.
{"title":"Halo gravity traction and temporary internal distraction","authors":"Nicholas D. Fletcher , Anson G. Bautista , Joshua S. Murphy , K.Aaron Shaw","doi":"10.1016/j.semss.2025.101213","DOIUrl":"10.1016/j.semss.2025.101213","url":null,"abstract":"<div><div>Severe pediatric spinal deformities may require staged correction strategies to mitigate neurologic risk and optimize cardiopulmonary outcomes. This paper reviews two adjunctive techniques—halo gravity traction (HGT) and temporary internal distraction (TID)—used in the management of rigid scoliosis. HGT enables gradual preoperative spinal elongation and coronal/sagittal realignment, improving pulmonary function and nutritional status while reducing the need for three-column osteotomies. TID offers an internal, staged distraction approach for patients contraindicated for external traction, allowing incremental correction via posterior instrumentation followed by definitive fusion. Clinical studies report Cobb angle reductions of 30–80 %, with low rates of neurologic complications when neuromonitoring and mean arterial pressure protocols are rigorously applied. Technical considerations include halo pin torque settings, traction weight progression, and intraoperative distraction parameters. Both techniques demonstrate efficacy in reducing deformity severity, improving perioperative safety, and enhancing long-term outcomes. Their integration into multidisciplinary care pathways supports safer and more effective surgical management of complex pediatric spinal deformities.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 4","pages":"Article 101213"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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