Search Results (295)

Objective: The objective of this study was to examine the association between baseline psychological distress, joint hypermobility, body mass index (BMI), and physical activity with Quality of Life (QoL) in adolescents with Idiopathic Scoliosis (AIS) 12 months on. Design: This is a prospective longitudinal study. Adolescents (10–18 years) with AIS were recruited. At baseline (n = 69), participants completed questionnaires covering demographics, psychological distress (Depression, Anxiety and Stress Scale, DASS-21), physical activity (International Physical Activity Questionnaire, IPAQ), and QoL (SRS-22r). Clinical assessments included joint hypermobility and BMI measurement. After 12 months, participants (n = 49) completed the SRS-22r to re-evaluate QoL. Factors associated with QoL were explored using bivariate and multiple linear regression analyses. Results: Multiple linear regression models assessing factors associated with QoL 12 months after baseline measurements explained 53.3% of variance in SRS-22 scores (p < 0.001), with an adjusted R² of 44.6%. Among baseline explanatory variables, thoracolumbar/lumbar Cobb angle contributed most significantly (β = 0.476, p < 0.05), followed by BMI (β = 0.342, p < 0.05) and DASS-Stress scores (β = −0.309, p < 0.05). Conclusions: Cobb angle, BMI, and stress emerged as important factors associated with QoL, highlighting the importance of addressing both clinical and psychosocial factors in AIS care. Full article

Background: Currently, there is a lack of biomechanical studies on traditional dual-growing rods (TDGR) combined with apical osteotomy and short-segment fusion (hybrid technique, HT). This study compared the differences in clinical outcomes and biomechanics between TDGR and HT in the treatment of severe early-onset scoliosis (sEOS) via finite element analysis (FEA) and in vitro biomechanical experiments. Methods: Two scoliotic FEA models and 12 in vitro scoliotic models were created. In the FEA, the initial surgeries for TDGR and HT, two subsequent lengthenings, and up to 12 months of physeal spinal growth were simulated. In the in vitro biomechanical experiments, the initial surgeries were simulated. Correction outcomes, spinal height, and stress were compared between the TDGR and HT groups. Results: (1) FEA: Compared with TDGR, HT achieved better correction (62.4% vs. 36.2%) and a greater increase in spinal height (26.43 mm vs. 12.58 mm) after the initial surgery. During follow-up, HT resulted in better correction maintenance and could better sustain spinal growth than TDGR. HT reduced the stress on the proximal and distal instrumented vertebral bodies, junctional intervertebral discs, and instrumentation compared with TDGR. (2) In vitro biomechanical experiment: After the initial surgery, the mean Cobb angle of the main curve (24.58 ± 2.80° vs. 38.97 ± 3.23°) and AVT (8.87 ± 1.64 mm vs. 13.15 ± 3.58 mm) in the HT group were significantly lower than those in the TDGR group (p < 0.05). The increase in spinal height in the HT group was significantly greater than that in the TDGR group (3.83 ± 0.45 cm vs. 1.85 ± 0.72 cm, p < 0.001). Compared with TDGR, HT significantly decreased rod strain (p < 0.05). Conclusions: Compared with TDGR, HT can significantly improve correction outcomes and maintain spinal growth. Apical anchors can effectively disperse stress on the spine and instrumentation, which may reduce the risk of complications and potentially delay intervertebral disc degeneration, although clinical validation is required. Full article

Background/Objectives: Adult degenerative lumbar deformity is a heterogeneous condition in which outcome depends on radiographic correction, patient-related risk factors, and surgical burden. This study evaluated spinopelvic realignment, clinical outcomes, complications, and predictors of unfavorable postoperative course after surgical treatment of adult degenerative lumbar deformity. Methods: This three-center retrospective cohort study included adult patients who underwent posterior decompression and instrumented fusion, with or without interbody fusion, for adult degenerative lumbar deformity between January 2021 and December 2024. Of 136 screened patients, 113 completed final follow-up and were included in the analysis. The mean follow-up duration was 31.0 ± 12.9 months. Radiographic parameters were assessed preoperatively, immediately postoperatively, and at final follow-up. Patient-reported outcome measures were analyzed using available paired data. Unfavorable postoperative course was defined as persistent or worsened pain with functional limitation, symptomatic mechanical complication, deep infection requiring surgical treatment, or revision/reoperation. Results: Surgery produced significant immediate improvement in coronal and sagittal alignment. Cobb angle improved from 29.8 ± 13.1° to 13.7 ± 6.7°, lumbar lordosis increased from 28.8 ± 15.5° to 40.3 ± 16.0°, PI–LL mismatch decreased from 21.7 ± 10.0° to 10.1 ± 11.5°, and SVA decreased from 58.8 ± 31.4 mm to 32.5 ± 36.0 mm. Partial loss of correction was observed at final follow-up, although alignment generally remained improved compared with baseline. ODI improved from 57.8 ± 12.6 to 34.7 ± 8.7 in patients with available paired data. Any postoperative complication occurred in 42.5% (n = 48) of patients, revision/reoperation in 23.9% (n = 27), and unfavorable postoperative course in 35.4% (n = 40). In multivariable analysis, osteoporosis, greater fusion length, and residual immediate postoperative PI–LL mismatch were independently associated with unfavorable postoperative course. Conclusions: In this three-center retrospective cohort, surgery for adult degenerative lumbar deformity was associated with significant radiographic correction and meaningful clinical improvement in patients with available paired outcome data. However, the substantial complication and revision/reoperation burden highlights the morbidity of adult degenerative lumbar deformity surgery. Osteoporosis, fusion length, and residual immediate postoperative PI–LL mismatch may help identify patients at higher risk for unfavorable postoperative course. Full article

Background: Three-level anterior cervical discectomy and fusion (ACDF) is widely used for multilevel cervical degenerative disc disease; however, the relationship between postoperative alignment trajectories, adjacent segment degeneration (ASD), and late patient-reported outcomes remains incompletely defined. This study evaluated plane-specific radiological alignment changes, MRI-based ASD, and late functional outcomes in a homogeneous three-level ACDF cohort. Methods: This single-center observational cohort included 29 patients who underwent three-level ACDF between January 2018 and December 2023 and had complete radiographic follow-up. Radiological data were collected retrospectively from institutional records and imaging archives. Cervical sagittal and coronal alignment were assessed using Cobb angles on radiographs obtained preoperatively and at 6 months, 1 year, and 2 years postoperatively. ASD was evaluated at the superior adjacent segment on 2-year MRI. Late patient-reported clinical outcomes were assessed at a mean follow-up of 42.6 ± 6.8 months using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Nottingham Health Profile (NHP). Results: Sagittal Cobb angle changed significantly over time (χ²(3) = 12.60, p = 0.006; Kendall’s W = 0.145), whereas coronal Cobb angle showed a statistically significant reduction over time, although the absolute magnitude of change was small (χ²(3) = 28.74, p < 0.001; Kendall’s W = 0.330). Lower sagittal Cobb angle correlated with worse NDI (r = −0.46, p = 0.004), and greater coronal Cobb angle correlated with worse physical activity scores (r = 0.52, p = 0.006). Higher Pfirrmann grade correlated with worse NDI (r = 0.49, p = 0.004) and pain scores (r = 0.44, p = 0.021). In exploratory regression analysis, sagittal Cobb angle and Pfirrmann grade were retained in the model for NDI, but these findings should be interpreted as hypothesis-generating. Conclusions: After three-level ACDF, sagittal and coronal alignment followed different postoperative trajectories. Lower sagittal alignment and greater adjacent disc degeneration were associated with worse late neck-related disability. However, given the modest sample size and exploratory nature of the regression analysis, these findings should be interpreted as hypothesis-generating. Larger prospective studies are needed to confirm whether sagittal alignment and MRI-based adjacent segment degeneration independently contribute to late functional outcomes. Full article

Background: This study aimed to determine the prevalence of DXA-detected lumbar scoliosis in postmenopausal women based on dual-energy X-ray absorptiometry (DXA) scans and identify associated risk factors. Methods: A total of 261 postmenopausal women aged ≥50 years who underwent lumbar spine DXA before June 2021 were included. Lumbar scoliosis was defined as a Cobb angle ≥ 10° measured from DXA images. Logistic regression analysis was performed to evaluate associated risk factors. Diagnostic performance of DXA-based Cobb angle measurements was assessed in the radiographic validation subgroup using radiography as the reference standard. Results: The prevalence of DXA-detected lumbar scoliosis was 14.9% (39/261; 95% CI, 10.8–19.9%). Increasing age was significantly associated with scoliosis, while body mass index, bone mineral density, and T-scores at the lumbar spine, hip, and femoral neck were not. DXA and radiographic Cobb angle measurements demonstrated strong agreement (ICC = 0.91, 95% CI 0.73–0.96), with a mean difference of −2.63°. Diagnostic accuracy was 82.1%, with sensitivity 62.1%, specificity 97.4%, PPV 94.7%, and NPV 77.0%. ROC analysis demonstrated good discriminative performance (AUC = 0.88, 95% CI, 0.79–0.98); an exploratory cutoff of 6.5° yielded the highest Youden index. Conclusions: DXA-detected lumbar scoliosis was identified in 14.9% of postmenopausal women undergoing DXA. DXA-based Cobb angle measurements demonstrated strong agreement with radiographic assessment and may facilitate opportunistic case detection of likely lumbar scoliosis during routine BMD assessment. Full article

Abnormal vertebral column curvature is sporadically reported in koalas of the Mount Lofty Ranges, South Australia. This study evaluates the imaging features of 23 koalas from the Mount Lofty Ranges presenting with abnormal vertebral column curvature between 2015 and 2023 using digital radiography and computed tomography (CT). All images were evaluated by four reviewers to assess curve morphology, severity and Cobb angles for both scoliosis and kyphosis. For Cobb angle measurement, radiography performed similarly to CT with good agreement as measured by intraclass correlation coefficient (0.835 and 0.825 respectively) and Lin’s concordance correlation coefficient (>0.85). The apex vertebra was always located between T7 and L6. For both scoliosis and kyphosis apex vertebrae, the thoracolumbar region was the most common location (8/22 and 9/19, respectively). For scoliosis, the caudal thoracic and lumbar regions were equally common (7/22 each), whereas for kyphosis, the caudal thoracic region (7/19) was more frequent than the lumbar region (3/19). Vertebral body rotation was a common component particularly in severely affected individuals, in which complex or ‘S’ shaped curves also occurred. Severity ranged from minimal or mild (6/23) to moderate (5/23) and severe (12/23), with simultaneous kyphosis and scoliosis present most frequently (21/23). As a result, the term, kyphoscoliosis is the most appropriate morphological description for abnormal vertebral curvature in koalas and may have pathophysiologic commonalities with human idiopathic scoliosis. This study is the first to describe imaging features of abnormal vertebral column curvature in koalas and evaluate inter-modality and interobserver agreement between radiography and CT. Full article

Clinical evaluation of scoliosis primarily relies on the Cobb angle measured on standing whole-spine radiographs. However, manual measurement is affected by intra- and inter-observer variability caused by differences in end-vertebra selection, endplate definition, and vertebral boundary interpretation. In addition, low radiographic contrast and anatomical overlap can hinder accurate identification of the spinal contour. In clinical screening, rapid three-level severity classification with reduced false negatives serves as a complementary function to precise quantitative measurement, supporting case triage and missed-detection prevention. This study proposes a boundary-enhanced YOLO-based instance segmentation framework—where ‘boundary-enhanced’ refers to the reinforcement of spinal contour boundary representation through the DeepLabV3+-based segmentation head—for three-level scoliosis severity screening using clinician-assigned severity labels derived from Cobb angle measurements. Unlike semantic segmentation, which may cause class fragmentation within a single spine, the proposed method defines the entire spine as one anatomical instance and predicts a single severity label based on the global contour structure. Class-balanced offline augmentation, background-only negative samples, attention modules, and segmentation heads were comparatively evaluated. Results showed that background-only negative samples reduced false negatives, and CBAM improved accuracy while maintaining a practical model size and near-real-time inference speed under the tested environment. DeepLabV3+ provided the most stable contour reconstruction. The final model improved both contour extraction and three-level severity screening performance, suggesting that the proposed framework may be potentially useful for assisting scoliosis screening. However, further external validation and prospective evaluation are required before clinical deployment. Full article

Background and Objectives: Idiopathic scoliosis (IS) has been conceptualized as a structural spinal deformity; emerging evidence suggests that postural control and vestibular mechanisms may contribute to curve development and functional severity. This study investigated the relationship between radiological parameters, postural stability, and vestibular dysfunction in adolescents with IS. Materials and Methods: A retrospective cohort of 177 patients aged 8–22 years was analyzed between 2022 and 2024. Standard radiography was performed on 135 participants to evaluate the major curve as established by the Cobb method, Nash–Moe classification, and Risser stage. Peripheral vestibular syndrome (PVS) was investigated using the Fukuda (FST), video-nystagmography (VNG), and instrumental Romberg tests on a stable and unstable platform. Associations between vestibular variables and radiographic parameters were explored using Mann–Whitney U and Kruskal–Wallis tests, supported by non-parametric correlations. Results: Female participants (63%) exhibited significantly higher initial major curve angle value compared with males (median 14° vs. 10.5°, p = 0.004). Positive FTS findings and the presence of peripheral vestibular syndrome were strongly associated with higher baseline and final major curve angles (both p < 0.001). Romberg performance showed significant correlations with major curve angle across stable and unstable conditions (r = 0.298–0.396, all p < 0.001). VNG identified multi-canal vestibular involvement, particularly anterior–horizontal combinations on the right ear, as being associated with substantially greater curve magnitude; left-ear impairment demonstrated similar non-significant trends. Curve localization did not differ by vestibular involvement. Conclusions: Patients with idiopathic scoliosis (IS) display consistent associations between vestibular dysfunction, impaired postural control, and greater curve severity. These findings support the clinical relevance of vestibular assessment in scoliosis evaluation and suggest a potential role for sensorimotor rehabilitation strategies. Integrating vestibular screening into standard care may enhance risk stratification and inform the clinician on individualized conservative management. Full article

Background: Congenital spinal deformities associated with multiple vertebral anomalies often require surgical correction during growth; however, the relationship between age at initial surgery and cumulative treatment burden remains insufficiently characterized. Objective: To evaluate whether age at first surgery is associated with surgical burden and radiographic outcomes in children with congenital spinal deformity treated with conventional posterior instrumented fusion. Methods: In this retrospective single-center cohort study, 32 children treated between 2019 and 2024 were stratified by age at initial surgery into two groups: ≤6 years (n = 13) and 7–12 years (n = 19). Planned staged procedures and growth-friendly techniques were excluded. Surgical burden was assessed as the total number of procedures, procedures per patient-year, and high surgical burden, defined as ≥3 procedures. Radiographic outcomes included postoperative Cobb angle and correction percentage. Adjusted analyses were performed using Poisson regression with log follow-up as an offset term, logistic regression, and linear regression. Results: Baseline deformity severity was similar between groups (mean preoperative Cobb angle, 45.2 ± 19.0° vs. 43.1 ± 21.6°; p = 0.61). Both groups showed significant within-group improvement after surgery (p < 0.001), with no significant between-group difference in correction percentage (61.5 ± 35.2% vs. 64.8 ± 30.6%; p = 0.78). The total number of procedures and procedures per patient-year were also comparable between groups (p = 0.21 and p = 0.58, respectively). However, high surgical burden was more frequent in the younger group (38.5% vs. 10.5%; p = 0.048). In adjusted analysis, older age at first surgery was associated with lower odds of high surgical burden (OR = 0.78; 95% CI: 0.61–0.99; p = 0.042), whereas no variable independently predicted correction percentage. Conclusions: Younger age at initial surgery was associated with a greater likelihood of high surgical burden, whereas the time-adjusted operation rate and early coronal correction were similar between groups. Full article

Background/Objectives: Scoliosis is a three-dimensional deformity involving coronal curvature, axial rotation, and sagittal imbalance, which may alter thoracic geometry and reduce ventilatory capacity. Traditional two-dimensional radiographic measures incompletely represent the complexity of axial rotation, and the apical vertebra is not always the most rotated vertebra. We aimed to determine whether computed tomography (CT)-derived three-dimensional vertebral rotation indices, particularly global rotational asymmetry between main and compensatory curves, are associated with pulmonary function impairment in a large heterogeneous scoliosis cohort. Methods: We retrospectively reviewed 250 patients with scoliosis who underwent full-spine CT and spirometry within a 1-year interval (2013–2023). Vertebral rotation was measured using the Aaro–Dahlborn method. Rotation indices included apical rotation (R(Apex)), averaged apical rotation across the apical vertebra and adjacent levels (R(Avg)), and rotational asymmetry defined as the absolute difference between rotation in the main and compensatory curves (ΔR(M–C)). Pulmonary function outcomes were FVC (L), FEV1 (L), FVC% and FEV1%. Pearson correlation and multivariate linear regression, adjusted for age, sex, height, and weight, were performed; sensitivity analyses, additionally adjusted for upright Cobb angle and thoracic kyphosis (TK) to evaluate whether ΔR(M–C) provided independent explanatory information, and subgroup analyses by etiology were performed. Results: The cohort had a mean age of 15.6 ± 5.7 years; 49.6% were female. All rotation indices showed significant negative correlations with pulmonary function in the overall cohort. ΔR(M–C) showed the strongest associations with FVC% (r = −0.66) and FEV1% (r = −0.64), as well as with absolute volumes (FVC, r = −0.59; FEV1, r = −0.58). In adjusted multivariate analyses, models incorporating ΔR(M–C) consistently demonstrated the highest explanatory performance compared with models based on R(Apex) or R(Avg). Subgroup analysis revealed the strongest associations in neurofibromatosis-related scoliosis (r = −0.87) and congenital scoliosis (r = −0.71). Associations were attenuated in neuromuscular subtypes and did not reach statistical significance in SMA. In sensitivity analyses adjusting for Cobb angle and thoracic kyphosis, ΔR(M–C) retained a robust independent association with FVC% (unstandardized B = −0.82 percentage points per 1°, 95% CI −0.98 to −0.66; p < 0.001; partial F = 103, p < 0.001), while neither Cobb angle nor TK remained statistically significant after adjustment for ΔR(M–C); comparable patterns were observed across FEV1%, FVC, and FEV1. Conclusions: CT-derived global rotational asymmetry between the main and compensatory curves is strongly associated with pulmonary function impairment in scoliosis and demonstrates superior explanatory performance to single-level rotation indices and retains independent explanatory value after adjustment for conventional 2D radiographic parameters (Cobb angle and thoracic kyphosis). Incorporating a CT-derived metric may complement traditional two-dimensional assessments for functional risk stratification. Full article

Background/Objectives: The prevalence of developmental dysplasia of the hip (DDH) in adolescent idiopathic scoliosis (AIS) remains unclear, partly because of differences in diagnostic criteria and measurement accuracy. Additionally, spinopelvic alignment and skeletal maturation may affect radiographic assessment of acetabular morphology in patients with AIS. This study aimed to clarify the prevalence of DDH in Japanese patients with AIS using standardized radiographic assessment and to compare conventional and age-adjusted diagnostic criteria for DDH. Methods: This cross-sectional study included 602 Japanese patients aged 10–18 years with AIS. Patients with inadequate radiographs, including those with pelvic rotation and lateral inclination, were excluded to improve measurement accuracy. DDH was defined using two criteria: (1) conventional (lateral center-edge angle <20°) and (2) age-adjusted thresholds (<15° for <15 years and <18° for ≥15 years). Radiographic parameters were compared between patients with and without DDH. A multivariate logistic regression analysis was performed to identify factors independently associated with DDH. Results: The prevalence of DDH in AIS was 5.6% (34/602) using the conventional criterion and 1.5% (9/602) using the age-adjusted criteria. Patients with DDH showed significantly lower acetabular coverage, with a lower lateral center-edge angle and acetabular head index and higher Sharp and Tönnis angles than those without DDH (all p < 0.01). No significant difference in the main curve Cobb angle was observed between the groups. A younger age was independently associated with DDH, whereas sex and the main curve Cobb angle were not. Conclusions: The prevalence of DDH in Japanese patients with AIS varies substantially depending on the diagnostic criteria. Standardized radiographic evaluation with exclusion of pelvic rotation provides a reliable estimate. These findings highlight the importance of evaluating acetabular morphology on standing whole-spine radiographs in patients with AIS while considering skeletal maturation and spinopelvic alignment. Full article

The increasing demand for personalized conservative treatment of idiopathic scoliosis (IS) highlights the need for objective and continuous monitoring of corrective forces during brace therapy. This study aims to evaluate the feasibility and clinical relevance of a smart orthopedic brace equipped with integrated force sensors for long-term biomechanical assessment. Three female patients with different types of idiopathic scoliosis were treated using a custom-designed thoracolumbosacral orthosis incorporating four flexible pressure sensors, enabling real-time and long-term recording of corrective forces at key anatomical locations. Sensor data were analyzed in relation to brace-wearing adherence, patient activity, and radiological outcomes assessed using Cobb angle measurements. The results demonstrated substantial variability in force distribution and wearing patterns among patients, which was associated with differences in treatment effectiveness. Higher and more stable corrective forces near curve apices were generally accompanied by improved radiological outcomes, whereas irregular brace use and uneven pressure distribution limited therapeutic effects. Long-term monitoring enabled identification of insufficient correction zones and adherence issues. In conclusion, the proposed sensor-based orthotic system provides clinically relevant information on force distribution and brace use, supporting individualized therapy optimization. These findings indicate that smart braces can enhance clinical decision-making and contribute to more effective and personalized scoliosis management. Full article

Background and Objectives: Adolescent idiopathic scoliosis (AIS) may influence pelvic orientation and lower-limb alignment; however, data on coronal lower-limb alignment after completion of spinal treatment remain limited. This study aimed to evaluate lower-limb radiographic alignment in AIS patients after spinal treatment and to determine whether these parameters differ according to main curve location. Materials and Methods: In this retrospective study, 70 AIS patients treated surgically (n = 52) or with brace therapy (n = 18) between 2010 and 2020 were analyzed. Patients were grouped according to main curve location as thoracic (n = 28), lumbar (n = 21), or thoracolumbar (n = 21). Pre-treatment standing full-spine radiographs were used to assess Cobb angle, coronal balance, and pelvic coronal obliquity angle (PCOA). After completion of spinal treatment, full-length weight-bearing lower-limb radiographs were evaluated for femoral and tibial lengths, mechanical axis deviation (MAD), femoral neck–shaft angle (NSA), anatomical lateral distal femoral angle (aLDFA), and mechanical lateral distal femoral angle (mLDFA). Additional treatment-stratified, treatment-adjusted, and threshold-based analyses were performed. Results: PCOA, coronal balance, bilateral MAD, right aLDFA, and right mLDFA differed significantly among the three curve-location groups. The lumbar group demonstrated more negative MAD values than the thoracic group, indicating a tendency toward valgus alignment (right MAD: −5.88 ± 8.8 mm vs. 3.65 ± 7.9 mm, p = 0.004; left MAD: −3.5 ± 7.5 mm vs. 3.75 ± 7.0 mm, p = 0.005). After adjustment for treatment modality, age, and main Cobb angle, curve location remained significantly associated with right MAD, left MAD, right aLDFA, and right mLDFA. However, the proportion of patients with clinically relevant malalignment, defined as MAD exceeding ±10 mm in at least one limb, did not differ significantly among the groups. Conclusions: AIS patients show subtle but measurable differences in coronal lower-limb alignment after completion of spinal treatment. Lumbar and thoracolumbar curves are associated with greater pelvic obliquity and a tendency toward more valgus mechanical-axis alignment, whereas limb lengths and NSA remain comparable among curve-location groups. These findings appear to represent mainly radiographic or biomechanical variations rather than overt clinically relevant deformity in most patients. Full article

Background: To investigate the risk factors for and prognostic implications of massive blood loss during posterior spinal instrumentation and fusion (PSIF) in pediatric patients with scoliosis. Methods: We retrospectively analyzed the electronic medical records of 460 children who underwent scheduled PSIF under general anesthesia between June 2021 and January 2024. Patients were grouped based on intraoperative blood loss: massive (estimated blood loss [EBL]/estimated blood volume [EBV] ≥ 30%) and nonmassive (EBL/EBV < 30%). Perioperative parameters were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for massive intraoperative blood loss. Results: Among the 460 patients with scoliosis who underwent PSIF, 188 were male and 272 were female (mean age 9.4 ± 4.1 years). Massive intraoperative blood loss occurred in 126 (27%) patients. Factors associated with massive blood loss included age, preoperative Cobb angle, history of heart disease or neurofibromatosis, number of previous scoliosis surgeries, operative time, number of fused levels, number of pedicle screws inserted, and whether osteotomy was performed. Multivariate analysis identified younger age (odds ratios [OR] = 0.829, 95% confidence interval [CI], 0.751–0.914, p < 0.001), history of heart disease (OR = 4.338, 95% CI: 1.637–11.498, p = 0.003), greater number of fused levels (OR = 1.118, 95% CI: 1.014–1.233, p = 0.025), and longer operative time (OR = 1.008, 95% CI: 1.005–1.012, p < 0.001) as independent risk factors. Additionally, the massive blood loss group had a longer postoperative hospital stay (p = 0.008) and a higher rate of postoperative allogeneic blood transfusion (7.1% vs. 1.2%, p = 0.002) than the nonmassive blood loss group. Conclusions: Younger age, preexisting heart disease, a greater number of fused levels, and longer operation duration are independent risk factors for massive intraoperative blood loss in children undergoing PSIF for scoliosis. Full article

Background: Posterior spinal fusion is the mainstay of treatment for Cobb angle over 50 degrees with satisfactory long-term results. In the surgical management of scoliosis, surgeons usually focus on the amount of coronal curvature correction because it can determine the surgical outcome. Nevertheless, there are many factors that contribute to patients’ satisfaction after surgery, and achieving shoulder balance is one of the most vital factors of a successful surgery. Our objective is to study the differences in managing idiopathic scoliosis with pedicle screws versus hybrid fixation with regard to shoulder imbalance postoperatively. Methods: Continuous variables were described using mean and standard deviation, whereas categorical variables were described using frequencies. The association between predictor independent variables with the analyzed outcomes were expressed as (beta coefficients) with their associated 95% confidence intervals. The Alpha significance level was considered at 0.050 level. Results: The mean angle of the clavicle measured a significant drop post-surgery compared to their pre-surgical measured mean clavicular angle, p-value < 0.001, and so did the coracoid height difference: p-value < 0.001. Furthermore, the participants had measured a significantly lower mean angle of the clavicle compared to their baseline; p-value = 0.029, regardless of their surgery type. The participants mean measured coracoid height difference score had correlated positively with their mean angle of the clavicle: beta coefficient = 1.654, p-value < 0.001; when the coracoid height difference increased, so did the mean angle of the clavicle. Conclusions: Posterior spinal fusion is effective in correcting coronal curvature and improving radiographic shoulder asymmetry in AIS. Significant improvements were observed in Cobb angle, clavicle angle, and coracoid height difference, with pedicle screw constructs providing superior curve correction. These findings reinforce the value of individualized surgical planning that considers coronal, sagittal, and cosmetic alignment goals. Full article