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Challenges in Spinal Deformity
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Challenges in Spinal Deformity

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

Deadline for manuscript submissions: closed (15 January 2025) | Viewed by 5577

Special Issue Editor

Dr. Peter G. Passias

E-Mail Website
Guest Editor
Departments of Orthopedic and Neurological Surgery, NYU Langone Health/New York Spine Institute, New York, NY 10016, USA
Interests: scoliosis and spinal deformities; spondylolisthesis; cervical disc herniation; spinal cord compression; spinal stenosis; minimally invasive spine surgery; disc replacement; non-fusion technologies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The prevalence of Adult Spinal Deformity (ASD) has grown over the last three decades as the importance of spinal health is increasingly recognized.  Patients with adult spinal deformities often have other medical co-morbidities, including high levels of frailty, which makes ASD surgery particularly challenging and complex. Yet, surgical correction of ASD has been demonstrated to reduce the physiological and psychological burden of spinal malalignment, though significant challenges remain regarding the prevention and identification of post-operative outcomes complications. Whether it be the elucidating of novel hurdles of minimally invasive technique, or tackling complex multi-dimensional correction of severe deformity, improving corrective strategies and addressing the ever-increasing complexities and challenges that ASD surgery presents to physicians, patients, and institutions remains of paramount importance. In the present Special Issue, we present an overview of each technique, focusing our interest on the challenges of treating adult spinal deformity, as well as presenting the most recent approaches and techniques to address such hurdles.

Dr. Peter G. Passias
Guest Editor

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Keywords

  • osteoarthritis
  • cartilage
  • pain
  • pathogenesis
  • imaging
  • epidemiology
  • randomized controlled trial
  • cost-effectiveness
  • platelet rich plasma
  • stem cells
  • exercise therapy
  • arthroplasty
  • biomaterials

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Published Papers (6 papers)

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Research

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13 pages, 2354 KiB  
Article
Hip Adduction Asymmetry in Girls with Adolescent Idiopathic Scoliosis
by Piotr Kurzeja, Tomasz Szurmik, Karol Bibrowicz, Jarosław Prusak, Bartłomiej Gąsienica-Walczak and Katarzyna Ogrodzka-Ciechanowicz
J. Clin. Med. 2025, 14(9), 2864; https://doi.org/10.3390/jcm14092864 - 22 Apr 2025
Viewed by 197
Abstract
Background: The aim of the study was to assess the difference in hip adduction in extended joint position in girls with adolescent idiopathic scoliosis (AIS). Methods: The study group consisted of 69 girls aged 9 to 14 years. The observational cross-sectional [...] Read more.
Background: The aim of the study was to assess the difference in hip adduction in extended joint position in girls with adolescent idiopathic scoliosis (AIS). Methods: The study group consisted of 69 girls aged 9 to 14 years. The observational cross-sectional study involved interview, the clinical examination (body weight measurement, measuring the body height in an upright position, assessment of the alignment of the spinous processes of the thoracic and lumbar vertebrae, assessment of the location of selected anatomical landmarks of the torso), physical examination in which the shape of the ridge surface was analyzed with the use of the photogrammetric method and the moiré effect projection and tests (test of adduction of both hips). Results: Significant differences were noted in the values of abduction for the left and right hip. In the studied group, the mean adduction angle for the left hip was 26.3° and only 19.2° for the right hip. The difference was statistically significant (p < 0.001). Similarly, significant relationships were noted by the authors with reference to values of the difference in abduction for both hips and the sizes of thoracic (p = 00012) and lumbar curvature (p < 0.0001). A significant relationship was also noted between the values of lumbar curvature and the size of adduction for the right hip (p < 0.0001). Conclusions: Abductive contracture of the right hip was noted in the examined girls with AIS. The degree of scoliotic deformity of the lumbar spine is related to the size of the abductive contracture of the right hip joint. Full article
(This article belongs to the Special Issue Challenges in Spinal Deformity)
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14 pages, 2063 KiB  
Article
Pelvic Asymmetry and Stiffness of the Muscles Stabilizing the Lumbo–Pelvic–Hip Complex (LPHC) in Tensiomyography Examination
by Karol Bibrowicz, Katarzyna Ogrodzka-Ciechanowicz, Zuzana Hudakova, Tomasz Szurmik, Bartosz Bibrowicz and Piotr Kurzeja
J. Clin. Med. 2025, 14(7), 2229; https://doi.org/10.3390/jcm14072229 - 25 Mar 2025
Viewed by 389
Abstract
Background: The pelvic girdle is an important component of the human stabilization system, both during the maintenance of an upright standing position and during motor activities. Frequent functional and structural asymmetries within it can affect the structure and function of many organs and [...] Read more.
Background: The pelvic girdle is an important component of the human stabilization system, both during the maintenance of an upright standing position and during motor activities. Frequent functional and structural asymmetries within it can affect the structure and function of many organs and systems of the human body. The mechanism of their occurrence is not fully explained. The objective of the present study was to verify the hypothesis regarding the relationship between the value of pelvic asymmetry and the functional state of muscles that stabilize the lumbo–pelvic–hip complex, as measured by changes in their stiffness. Methods: The study group consisted of 40 young women aged from 19 to 29 years. The observational cross-sectional study incorporated the following elements: an interview, an anthropometric test, an inclinometric assessment of the magnitude of hip girdle rotation utilizing a duometer and tensiomyography. Results: Analysis of the variables examined in subjects with symmetric or rotated pelvises did not show significant differences between the studied sides in the two groups. Evaluation of associations between the magnitude of pelvic rotation and tensiomyography findings showed that with increased pelvic rotation, the stiffness of the back extensor muscles and the rectus thigh muscles increased only slightly bilaterally, and the contraction rate of the rectus abdominis and biceps thigh muscles decreased. Conclusions: The results of the tensiomyography study did not unequivocally demonstrate that changes in pelvic symmetry in the transverse plane are associated with dysfunction of the muscles that stabilize the pelvic girdle. Full article
(This article belongs to the Special Issue Challenges in Spinal Deformity)
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11 pages, 2197 KiB  
Article
3D Digital Anatomical Models Based on Computed Tomographic Morphometric Analysis of C1 and C2 for Surgical Navigation
by Wongthawat Liawrungrueang, Watcharaporn Cholamjiak and Peem Sarasombath
J. Clin. Med. 2025, 14(1), 243; https://doi.org/10.3390/jcm14010243 - 3 Jan 2025
Viewed by 741
Abstract
Background/Objectives: Injuries involving the Atlas (C1) and Axis (C2) vertebrae of the cervical spine present significant clinical challenges due to their complex anatomy and potential for severe neurological impairment. Traditional imaging methods often lack the detailed visualization required for precise surgical planning. This [...] Read more.
Background/Objectives: Injuries involving the Atlas (C1) and Axis (C2) vertebrae of the cervical spine present significant clinical challenges due to their complex anatomy and potential for severe neurological impairment. Traditional imaging methods often lack the detailed visualization required for precise surgical planning. This study aimed to develop high-resolution 3D models of the C1 and C2 vertebrae to perform a comprehensive morphometric analysis, identify gender differences, and assess bilateral symmetry to enhance surgical accuracy. Methods: A retrospective analysis was conducted using CT scans from 500 patients aged 18 and older from a single-center hospital. Three-dimensional models were generated using InVesalius 3.1 and visualized with Meshmixer. Morphometric measurements included screw placement angles, lamina length and height, bicortical diameters, and pedicle widths. Statistical analyses were conducted using SPSS, with the Student’s t-test applied for gender and bilateral comparisons. Results: Significant gender differences were found in certain measurements, such as pedicle width (4.85 ± 0.90 mm in males vs. 4.60 ± 0.85 mm in females, p = 0.048) and C2 lamina height (12.90 ± 1.40 mm in males vs. 12.40 ± 1.25 mm in females, p = 0.033). Most measurements exhibited bilateral symmetry, supporting their applicability across genders. These results align with previous studies and highlight the importance of tailored surgical approaches. Conclusions: Three-dimensional models of the C1 and C2 provide comprehensive morphometric data that enhance preoperative planning and surgical precision. Integrating these models into clinical practice can reduce intraoperative risks and improve patient outcomes in cervical spine surgeries. Full article
(This article belongs to the Special Issue Challenges in Spinal Deformity)
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15 pages, 3568 KiB  
Article
The Assessment of the Dynamics of Changes in the Torques of Redressing and Derotating Forces Acting on the Spine During Active Kyphosis-Deepening Exercises in the Dynamic Individual Stimulation and Control for Spine Device (DISC4SPINE, D4S)
by Tomasz Szurmik, Karol Bibrowicz, Patrycja Romaniszyn-Kania, Damian Kania, Katarzyna Ogrodzka-Ciechanowicz, Piotr Kurzeja and Andrzej W. Mitas
J. Clin. Med. 2024, 13(24), 7746; https://doi.org/10.3390/jcm13247746 - 18 Dec 2024
Viewed by 609
Abstract
Background: The study aimed to assess the dynamics of changes in the torques of derotating and redressing forces acting on the apexes of deformation curvature arches during active, kyphosis-inducing exercises using the D4S device. Methods: The study group included 12 girls [...] Read more.
Background: The study aimed to assess the dynamics of changes in the torques of derotating and redressing forces acting on the apexes of deformation curvature arches during active, kyphosis-inducing exercises using the D4S device. Methods: The study group included 12 girls aged 9 to 10 years (age X = 9.36, SD = 1.52; weight X = 31.34 kg, SD = 3.28; height X = 134.23 cm, SD = 8.25). The study was carried out using the D4S interactive spine and posture rehabilitation system with dynamic, personalised stimulation. Measurements were taken during six successive therapeutic visits of each patient, each containing five repeated sets. A single set involved applying pressure on the device heads 20 times for 8 s. For each patient, the resistance head was in the right top (RT) setting, individually adjusted for patient needs. Results: The results showed that the values of the measured moments of the derotating-redressing forces acting on the curvature peak vertebrae ranged from 24.1 N/cm2 to 39.9 N/cm2. The analysis of the differences in the values of the pressure of the derotating head on the spine in subsequent measurements, accounting for all measurements taken in subsequent cycles of the study, indicates significant variation in pressure values (K-W = 31.0660, p = 0.00029 *). Similar dynamics of changes and variation in the results were noted for the values of the pressure applied with the derotating head in subsequent cycles of the study. In this case, the variation in the results was also statistically significant (K-W = 24.4747, p = 0.00018 *). Conclusions: The values of forces increase slightly with the subsequent series of exercises. The assessment of the value of forces may be an element of optimal and more effective training plans in the therapy discussed. Full article
(This article belongs to the Special Issue Challenges in Spinal Deformity)
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14 pages, 1028 KiB  
Article
Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery
by Peter G. Passias, Tyler K. Williamson, Jamshaid M. Mir, Justin S. Smith, Virginie Lafage, Renaud Lafage, Breton Line, Alan H. Daniels, Jeffrey L. Gum, Andrew J. Schoenfeld, David Kojo Hamilton, Alex Soroceanu, Justin K. Scheer, Robert Eastlack, Gregory M. Mundis, Bassel Diebo, Khaled M. Kebaish, Richard A. Hostin, Jr., Munish C. Gupta, Han Jo Kim, Eric O. Klineberg, Christopher P. Ames, Robert A. Hart, Douglas C. Burton, Frank J. Schwab, Christopher I. Shaffrey, Shay Bess and on behalf of the International Spine Study Groupadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(17), 5565; https://doi.org/10.3390/jcm12175565 - 26 Aug 2023
Cited by 1 | Viewed by 1494
Abstract
Background: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. Objective: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. Study [...] Read more.
Background: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. Objective: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. Study Design/Setting: Retrospective cohort study of a prospectively collected multicenter database. Methods: ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. Results: A total of 930 patients were considered. Following PSM, 253 “optimal” (O) and 253 “not optimal” (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, p = 0.021) and major mechanical complications (12% vs. 22%, p = 0.002), and less reoperations (23% vs. 33%, p = 0.008). Adjusted analysis revealed O patients more often met MCID (minimal clinically important difference) in SF-36 PCS, SRS-22 Pain, and Appearance. Cost-utility-adjusted analysis determined that the O group generated better cost-utility by one year and maintained lower overall cost and costs per QALY (both p < 0.001) at two years. Conclusions: Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success. Full article
(This article belongs to the Special Issue Challenges in Spinal Deformity)
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Review

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18 pages, 10620 KiB  
Review
Instrumentation Failure in Adult Spinal Deformity Patients
by David P. Falk, Ravi Agrawal, Bijan Dehghani, Rohit Bhan, Sachin Gupta and Munish C. Gupta
J. Clin. Med. 2024, 13(15), 4326; https://doi.org/10.3390/jcm13154326 - 24 Jul 2024
Cited by 1 | Viewed by 1252
Abstract
In recent years, advances in the surgical treatment of adult spinal deformity (ASD) have led to improved outcomes. Although these advances have helped drive the development of deformity surgery to meet the rising volume of patients seeking surgical treatment, many challenges have yet [...] Read more.
In recent years, advances in the surgical treatment of adult spinal deformity (ASD) have led to improved outcomes. Although these advances have helped drive the development of deformity surgery to meet the rising volume of patients seeking surgical treatment, many challenges have yet to be solved. Instrumentation failure remains one of the most common major complications following deformity surgery, associated with significant morbidity due to elevated re-operation rates among those experiencing mechanical complications. The two most frequently encountered subtypes of instrumentation failure are rod fracture (RF) and proximal junctional kyphosis/proximal junctional failure (PJK/PJF). While RF and PJK/PJF are both modes of instrumentation failure, they are two distinct entities with different clinical implications and treatment strategies. Considering that RF and PJK/PJF continue to represent a major challenge for patients with ASD and deformity surgeons alike, this review aims to discuss the incidence, risk factors, clinical impact, treatment strategies, preventive measures, and future research directions for each of these substantial complications. Full article
(This article belongs to the Special Issue Challenges in Spinal Deformity)
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