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Optimizing Outcomes in Scoliosis and Complex Spinal Surgery
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Optimizing Outcomes in Scoliosis and Complex Spinal Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 25 October 2025 | Viewed by 1163

Special Issue Editor

Dr. Francis Lovecchio

E-Mail Website
Guest Editor
Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
Interests: spine surgery; adult degenerative scoliosis; degenerative disc disease; herniated discs; kyphosis

Special Issue Information

Dear Colleagues,

Correction of adult spine deformity (ASD) often requires a substantial surgical insult, subjecting patients to an arduous, prolonged, and uncertain recovery that can compromise the value of the procedure. The first step of recovery is to avoid medical complications, which occur in 30-50% of patients undergoing ASD reconstruction. Once out of the hospital, randomized trials have shown that it takes patients 6 months to reach 50% of their expected improvement, and only half of patients reach the minimal clinically important difference in many patient reported outcomes. Reoperations for mechanical failures (approximately 20-30% at two-year follow-up) and neurologic complications (up to 10%) are two major reasons that patient outcomes may remain unsatisfactory. If these outcome and complication rates continue, third-party payors will inevitably begin limiting who can perform and who can receive complex spine surgery.

We may tackle this problem in several ways. First, understanding why complications occur is crucial. There remain critical knowledge gaps in how we understand spinal alignment, patient-level risk factors, and modes of instrumentation failure. Second, we must come to a consensus on surgical technique. There are infinite strategies available to the modern spine surgeon, and we must determine which techniques are worthwhile. Finally, we must embrace a systems-based approach. Multidisciplinary pre-, intra-, and post-operative care protocols may have a greater impact on patient outcomes than the execution of the surgery itself.

In this issue, you will find several original works and literature reviews that fit into one of the three approaches listed above, but all with the same goal—helping to optimize outcomes in scoliosis and complex spine surgery.

Dr. Francis Lovecchio
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • outcomes
  • complications
  • scoliosis
  • adult spinal deformity
  • proximal junctional kyphosis
  • complex spine
  • pseudarthrosis

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Published Papers (2 papers)

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Research

14 pages, 2334 KiB  
Article
Balance or Strength? Reconsidering Muscle Metrics in Sagittal Malalignment in Adult Sagittal Deformity Patients
by Donghua Huang, Zhan Wang, Mihir Dekhne, Atahan Durbas, Tejas Subramanian, Gabrielle Dykhouse, Robert N. Uzzo, Luis Felipe Colón, Stephane Owusu-Sarpong, Han Jo Kim and Francis Lovecchio
J. Clin. Med. 2025, 14(10), 3293; https://doi.org/10.3390/jcm14103293 - 9 May 2025
Abstract
Background/Objectives: Atrophy of the paraspinal and psoas major muscles is closely linked to sagittal malalignment in adult spinal deformity (ASD). However, most studies overlook the balance between these muscle groups. This study investigates the relationship between trunk muscle balance and sagittal alignment [...] Read more.
Background/Objectives: Atrophy of the paraspinal and psoas major muscles is closely linked to sagittal malalignment in adult spinal deformity (ASD). However, most studies overlook the balance between these muscle groups. This study investigates the relationship between trunk muscle balance and sagittal alignment in ASD patients. Methods: A single-institution database was reviewed for patients with sagittal malalignment (PT > 20° and PI–LL > 10°). Standard sagittal parameters were measured based on standing X-rays. The cross-section area (CSA) of trunk posterior muscles (CSAP: erector spinae and multifidus) and anterior muscles (CSAA: psoas) at L4 were measured based on a T2-weighted MRI. Patients with prior lateral fusions were excluded. Muscle balance was evaluated by the CSA ratio of trunk posterior to anterior muscles (CSAP/A). The relationship between sagittal alignment parameters and CSAP, CSAA, as well as CSAP/A were analyzed using linear and quadratic regressions. Akaike information criteria (AIC) compared model fit. Subgroup analyses examined the relationship between sagittal alignment changes and different CSAP/A levels. Results: A total of 112 patients met inclusion and exclusion criteria. CSAP correlated linearly with SS (r2 = 0.057, p = 0.011), PT (r2 = 0.043, p = 0.028), and T4–L1PA mismatch (r2 = 0.044, p = 0.027). CSAA showed no significant linear or quadratic relationships with sagittal spinal alignment parameters. In contrast, CSAP/A was quadratically associated with LL (r2 = 0.056, p = 0.044), SS (r2 = 0.134, p < 0.001), PI (r2 = 0.096, p = 0.004), L1PA (r2 = 0.114, p = 0.001), and T4–L1PA mismatch (r2 = 0.094, p = 0.005). Quadratic models of CSAP/A consistently had higher r2 and lower AIC values compared to the linear models of CSAP for most sagittal alignment parameters, especially in SS, PI, L1PA, and T4–L1PA mismatch (AIC difference ≥4). Higher CSAP/A is correlated to larger PI (and consequently, larger LL, SS, and L1PA). Conclusions: Trunk posterior–anterior muscle balance (CSAP/A) demonstrates a stronger relationship with sagittal alignment than individual muscle metrics. Quantitative MRI-based definitions of sarcopenia may need to be adjusted for PI. Full article
(This article belongs to the Special Issue Optimizing Outcomes in Scoliosis and Complex Spinal Surgery)
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12 pages, 1901 KiB  
Article
A Feasibility Study of a Controlled Standing Fulcrum Side-Bending Test in Adolescent Idiopathic Scoliosis
by Christian Wong, Christos Koutras, Hamed Shayestehpour, Benny Dahl, Miguel A. Otaduya and John Rasmussen
J. Clin. Med. 2024, 13(24), 7809; https://doi.org/10.3390/jcm13247809 - 20 Dec 2024
Viewed by 801
Abstract
Background/Objectives: Spinal flexibility radiographs are important in adolescent idiopathic scoliosis (AIS) for clinical decision-making. In this study, we introduce a new method, the ‘quantitatively controlled standing fulcrum side-bending’ test (CSFS test). This is a feasibility study; we aimed to quantify the applied [...] Read more.
Background/Objectives: Spinal flexibility radiographs are important in adolescent idiopathic scoliosis (AIS) for clinical decision-making. In this study, we introduce a new method, the ‘quantitatively controlled standing fulcrum side-bending’ test (CSFS test). This is a feasibility study; we aimed to quantify the applied force and track the temporospatial changes in the spine specifically by measuring the continuous change in the Cobb angle (in degrees) during lateral bending. Methods: In this cross-sectional study, we included patients with AIS. Using a low-dose cinematic fluoroscopic technique, we captured the lateral bending of the thoracolumbar vertebral spine while inducing quantified lateral force on the ribs by a force gauge in a three-point fixation setup of controlled lateral bending. Trial registration number: H-1703423. Results: Twenty-one patients with small-curve AIS were included as subjects. All subjects performed the CSFS test adequately. They had small curves with a mean Cobb angle of 12.0 (range: 0.0–26.0, SD: 7.1). The measured median stiffness was 3.66 N/degrees (°) of the Cobb angle (range: 0.02–11.81) with a median coefficient of determination R2 of 0.58 (range: 0.002–0.92) by regression analyses. When analysed concerning the median-term clinical outcome of either progression/regression or stationary curves, various Cobb angle measurements and the other experimental parameters, there were no significant relationships. Conclusions: The CSFS test is feasible to quantify the force applied and the temporospatial changes in the spine during lateral bending. The CSFS test has been utilised in basic research for mechanical characterisation of the scoliotic spine and has the potential of being implemented directly in patient-specific bracing to estimate the forces needed for brace correction and adjustment so as not to supersede the allowed skin pressure. Full article
(This article belongs to the Special Issue Optimizing Outcomes in Scoliosis and Complex Spinal Surgery)
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