Search Results (92)

Background/Objectives: Poor bone quality significantly increases the risk of mechanical complications after adult spinal deformity (ASD) surgery, including proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Although teriparatide enhances bone quality, its effectiveness in preventing junctional complications after extensive correction remains unclear. This study investigated whether preoperative teriparatide administration reduces the incidence of PJK and PJF in patients with compromised bone quality undergoing ASD surgery. Methods: This retrospective cohort study reviewed 292 patients (T-score < −1.0) who underwent ASD surgery between 2015 and 2023. Patients were divided into teriparatide (n = 59) and non-teriparatide (n = 233) groups. Propensity score matching (1:2 ratio) was performed using six covariates: age, preoperative pelvic incidence minus lumbar lordosis, preoperative T1 pelvic angle, upper instrumented vertebra (UIV) cementing, UIV screw angle, and fusion length, yielding 153 matched patients (52 teriparatide, 101 non-teriparatide). Results: After matching, all baseline characteristics were statistically similar, with no significant differences. The incidence of PJK and PJF did not differ significantly between the teriparatide and non-teriparatide groups (44.2% vs. 52.5%, p = 0.426; 9.6% vs. 9.9%, p = 1.000), nor did PJK subtype distribution (bony vs. soft-tissue). Multivariate analysis identified older age (odds ratio [OR] = 1.058), higher American Society of Anesthesiologists score (OR = 2.603, p = 0.002), UIV at the thoracolumbar junction (OR = 2.786), and greater postoperative thoracic kyphosis (OR = 1.044) as independent risk factors for PJK. Teriparatide use was not an independent predictor (OR = 0.872). Conclusions: Preoperative teriparatide did not significantly reduce the incidence of PJK or PJF after long-segment fusion for ASD. These findings suggest that improving bone quality alone is insufficient to prevent junctional complications, which are driven by complex biomechanical and patient-related factors inherent to extensive deformity correction. Full article

Intrabody cage augmentation has emerged as a minimally invasive technique for anterior column reconstruction in Kümmell disease and osteoporotic burst fractures. These osteoporotic conditions lead to progressive vertebral collapse, kyphosis, and instability. While cement augmentation provides rapid pain relief, it often fails to reliably restore sagittal balance or ensure biological integration in advanced stages of collapse. Although conventional anterior corpectomy with long-segment posterior fusion can achieve satisfactory deformity correction, these procedures are associated with substantial surgical morbidity. In contrast, screw fixation alone often fails to withstand anterior loading, resulting in loss of correction or hardware failure. By adapting standard interbody devices for off-label intravertebral use, this technique utilizes the intravertebral cleft as a natural cavity to restore vertebral height and sagittal alignment while preserving adjacent intervertebral discs and reducing stress on posterior instrumentation. The surgical technique involves transpedicular access, meticulous curettage of necrotic tissue, and insertion of a cage packed with osteoinductive material. This approach minimizes surgical trauma and operative time compared with conventional corpectomy procedures. Reported outcomes from retrospective series suggest promising pain relief, maintenance of correction, and low complication rates. Collectively, current evidence suggests that intrabody cage augmentation may serve as a potential, less invasive surgical option, acting as an intermediate approach between cement augmentation and corpectomy. However, as the existing evidence remains preliminary, high-quality prospective comparative studies are required to establish definitive indications and long-term efficacy. Full article

Background/Objectives: Vertebral body stenting (VBS) and balloon kyphoplasty (BKP) are widely used for the treatment of osteoporotic vertebral fractures (OVFs). However, it remains unclear whether the theoretical biomechanical advantages of VBS translate to superior clinical or radiographic outcomes. This study aimed to compare VBS and BKP with respect to clinical outcomes, radiographic parameters, and complications. Methods: In this multicenter retrospective comparative cohort study, 123 patients with OVF treated with VBS (n = 24) or BKP (n = 99) were analyzed. VBS was indicated for complex fracture patterns, including severe endplate injury, split-type fractures, and absence of interbody sclerosis; other fractures were treated with BKP. Pain outcomes, operative parameters, cement volume and leakage, and radiographic measures of vertebral kyphosis angle (VKA) and local kyphosis angle (LKA) were assessed. For group comparisons, we used independent-samples t tests or Mann–Whitney U tests for continuous variables and chi-squared or Fisher’s exact tests for categorical variables. Results: Baseline demographics and bone mineral density were comparable between groups. Surgical time was longer for VBS (39 ± 6 vs. 35 ± 9 min, p = 0.007). Both procedures produced significant pain reductions (p < 0.001), and postoperative VAS did not differ between VBS and BKP (18 ± 11 vs. 13 ± 12 mm, p = 0.06). Although VKA immediately after surgery was lower for VBS (4.8 ± 4.4° vs. 7.0 ± 4.9°, p = 0.03), the magnitude of correction, VKA, and LKA at final follow-up were comparable. Cement volume was similar (6.4 ± 1.4 vs. 6.7 ± 1.9 mL, p = 0.45), but cement leakage occurred more frequently with VBS (54% vs. 24%, p = 0.005). Rates of adjacent vertebral fracture (13% vs. 26%, p = 0.12) and revision surgery (4% vs. 8%, p = 0.44) were comparable between groups. Conclusions: Despite VBS being reserved for more complex fracture morphologies with split-type fractures and severe endplate defects, while BKP was generally used for uncomplicated OVF cases, VBS provided pain relief and radiographic correction comparable to BKP. Full article

Background: Achondroplasia, the most common genetic dwarfism caused by the FGFR3 mutation (autosomal dominant, 80% de novo), results in a disproportionately short stature. Thoracolumbar kyphosis (TLK), combined with characteristic spinal canal stenosis, increases the risk of symptomatic compression, yet the literature lacks clear thresholds for symptom onset or progressive deformity angles. Methods: A 16-year-old female with achondroplasia presented with rapidly progressive kyphosis despite conservative management (bracing and therapy). Over six months, she developed neurogenic claudication; bilateral leg pain; weakness; and paresthesia that worsened with standing/walking, which was relieved by flexion/sitting. Imaging demonstrated surgical-threshold kyphosis with progressive spinal misalignment. Her symptoms indicated compressive myeloradiculopathy from lumbar stenosis, critical given achondroplasia’s congenitally narrowed canal and heightened neurologic vulnerability. Results: Staged surgery planned: Posterior fusion T6-L4 with pedicle screws and then extensive decompression (laminectomy/foraminotomy T11-L3), L1 corpectomy with expandable titanium cage, and Ponte osteotomies. Intraoperative complications included a malpositioned left T10 screw breaching the anterior/lateral cortex near the aorta, requiring urgent revision. Postoperatively: Neurogenic bladder, wound leakage, and E. coli urinary tract infection (UTI) with fever (treated with IV antibiotics). After infection resolution, definitive surgery removed the malpositioned screw and completed decompression, corpectomy, cage placement, bone grafting, and osteotomies, successfully resolving neurological symptoms. However, 13 cm trunk lengthening caused severe functional impairment—disproportionately short arms prevented independent toileting and dressing. Left arm lengthening via external fixation restored partial function. At 2.5-year follow-up, there was solid fusion, no neurological deficits, and improved quality of life. Conclusions: Surgery addresses severe TLK, vertebral wedging, and neurogenic claudication in achondroplasia. Vertebral column resection effectively corrects TLK and neurological deficits but carries a high complication risk. This should be reserved for severe TLK with hypoplastic vertebrae, performed by experienced surgeons. Critically, correction magnitude must preserve limb–trunk proportions to prevent functional disability, as excessive lengthening may necessitate additional limb procedures for independence restoration. Full article

Management of unstable upper lumbar fractures with corpectomy and posterior fixation is technically demanding, and conventional workflows may require intraoperative repositioning, increasing operative complexity. Lateral mini-open upper lumbar corpectomy (LMULC) paired with robotic-assisted (RA) posterior percutaneous pedicle screw fixation (PPPSF) can be performed in a single position to facilitate ventral spinal decompression and stabilization in the anatomically constrained upper lumbar spine. In this study, we describe the operative technique and report four illustrative cases of unstable L1 or L2 fractures treated with single-position LMULC, RA-PPPSF, and short-segment fusion. Clinical, radiological, intraoperative variables and postoperative outcomes were evaluated. The mean age was 52.3 ± 17.7 years. The median operation time was 314 min (range 268–361 min); the median estimated blood loss (EBL) was 225 mL (range 100–400 mL). The median preoperative kyphosis was 10.15° (range 8.4–14.6°), the median postoperative kyphosis measured 6.65° (range 1.7–10.8°) and the median correction achieved was 3.5° (range −2.4–12.9°). The median visual analog scale (VAS) pain score reduced from 7 (range 7–9) preoperatively to 4.5 (range 2–6) postoperatively at discharge. At a median follow-up of 12 months (range 6–15 months), all patients had uncomplicated recoveries, demonstrated solid fusion on imaging, and reported favorable MacNab outcomes. Single-position LMULC with RA-PPPSF was technically feasible in this preliminary illustrative series and resulted in favorable clinical and radiographic outcomes. However, further studies in larger cohorts are warranted to help confirm these findings and better define the potential advantages and limitations of this technique. Full article

Background: Short-segment posterior fixation with intermediate pedicle screws is widely used for thoracolumbar junction (TLJ) burst fractures. However, the optimal penetration depth of intermediate screws remains controversial. The aim of this study was to evaluate whether intermediate screw penetration depth influences radiographic alignment and functional outcomes at 12 months following short-segment posterior fixation of AO Spine A3–A4 thoracolumbar burst fractures. Methods: This retrospective cohort study included 105 patients with AO Spine A3–A4 TLJ burst fractures treated between 1 January 2019 and 31 December 2022. All patients underwent short-segment posterior stabilization with intermediate screws at the fracture level. Penetration depth was categorized as either <50% (Group A) or ≥50% (Group B) of vertebral body depth. Radiographic parameters (kyphotic deformity, segmental kyphosis, sagittal index, anterior vertebral body height) and clinical outcomes (Visual Analog Scale and Oswestry Disability Index) were evaluated preoperatively and at 12 months. Results: Both groups demonstrated significant postoperative improvement in radiographic alignment and clinical outcomes. No statistically significant differences were detected between groups in kyphotic correction, loss of correction, pain reduction, disability scores, operative time, length of stay, or complication rates at 12 months. Conclusions: Within the limitations of this retrospective study, intermediate screw penetration depth did not significantly influence radiographic or clinical outcomes at 12 months. Screw length selection may therefore depend on anatomical considerations and surgeon preference rather than expected differences in clinical performance. Full article

Background and Objectives: Long spinal fusion terminating at L5 remains controversial because of the risk of postoperative junctional failure. Although degeneration of the residual L5–S1 disc has been suggested as a contributing factor, the relative impact of disc degeneration versus sagittal spinopelvic alignment on different junctional failure patterns has not been fully clarified. Materials and Methods: This retrospective cohort study included 47 patients aged ≥60 years who underwent ≥5-level thoracolumbar fusion ending at L5 with a minimum follow-up of 2 years. Junctional failures were classified as proximal junctional failure (PJF) or distal junctional failure (DJF). Preoperative L5–S1 disc degeneration was assessed using modified Weiner and Pfirrmann classifications. Spinopelvic parameters were measured preoperatively, postoperatively, and at final follow-up. Junctional failure–free survival was analyzed using the Kaplan–Meier method, and risk factors were explored using Cox proportional hazards models. Results: Junctional failures occurred in 28 patients (59.6%), including 16 PJFs (34.0%) and 10 DJFs (21.3%). Lower grades of L5–S1 disc degeneration (Weiner grades 0–1) were more frequently associated with PJFs, whereas higher grades (≥2) were predominantly associated with DJFs (p = 0.024). Multivariate analysis showed that preoperative thoracolumbar kyphosis (hazard ratio [HR] = 1.164), preoperative T1 pelvic angle (HR = 1.269), and postoperative pelvic incidence–lumbar lordosis mismatch (HR = 0.877) as significant risk factors for PJF. Postoperative proximal junctional angle (HR = 0.899) and lumbar lordosis (HR = 0.920) were independently associated with DJF. Conclusions: Sagittal spinopelvic alignment parameters appear to have a greater influence on junctional failure patterns than residual L5–S1 disc degeneration in long fusions terminating at L5. Adequate sagittal correction should be prioritized to reduce the risk of both proximal and distal junctional failures. Full article

Background: Conservative treatment for adolescent idiopathic scoliosis (AIS) includes physiotherapeutic scoliosis-specific exercises (PSSE) and bracing. One PSSE-based approach is the Rigo Concept, which emphasizes three-dimensional (3D) postural correction, expansion techniques, muscle activation, and postural integration. Recently, increasing interest has been directed toward incorporating whole-body vibration (WBV) into physiotherapy. WBV is a reflex-based neuromuscular training method shown to improve muscle strength and power and enhance proprioception, which may be beneficial in the treatment of AIS. Objectives: This study aimed to assess the effects of physiotherapy based on the Rigo Concept combined with WBV on sagittal spinal curvatures, trunk symmetry, and the angle of trunk rotation (ATR) in girls with AIS. Methods: This prospective controlled experimental study included 45 girls (12.8 ± 1.7 years) with AIS who participated in a 5-day physiotherapy session based on the Rigo Concept. Of these, 22 participants additionally received WBV using a Galileo Med 35 platform (3 × 3 min/day, frequency 25 Hz, peak-to-peak displacement 2 mm), forming the Rigo–WBV group. The remaining participants received the Rigo Concept alone (Rigo–ONLY). Participants were allocated to the study groups using a quasi-random method based on the order of enrollment. ATR was defined as the primary endpoint, while thoracic kyphosis, lumbar lordosis, sacral slope, coronal balance, and scapular position were considered secondary outcomes. All outcomes were assessed before and after the intervention. Results: Neither the Rigo–WBV nor the Rigo–ONLY intervention affected sagittal spinal curvatures (p > 0.05). Coronal balance improved in both the Rigo–WBV (Δ 0.5 cm, p < 0.001) and Rigo–ONLY groups (Δ 0.4 cm, p = 0.005). In the Rigo–ONLY group, an improvement in scapular height asymmetry was observed (Δ 1.1°, p = 0.010). Following the Rigo–WBV intervention, ATR decreased in the main thoracic (Δ 1.9°, p < 0.001), thoracolumbar (Δ 1.9°, p < 0.001), lumbar curve (Δ 2.1°, p < 0.001), and pelvis (Δ 1.0°, p < 0.001). In the Rigo–ONLY group, a reduction in ATR was observed only in the thoracolumbar curve (Δ 1.9°, p < 0.001). Conclusions: In terms of clinical and postural changes, five-day physiotherapy based on the Rigo Concept, with or without WBV, does not influence sagittal spinal curvatures in girls with AIS. Both interventions may improve coronal balance. Moreover, the Rigo Concept combined with WBV may reduce ATR. Full article

Background: Anterior cervical discectomy and fusion (ACDF) is a widely performed procedure for treating degenerative cervical spine conditions. While it effectively addresses neural decompression and restores segmental alignment, the interplay of baseline alignment and implant-specific factors on postoperative segmental alignment remains underexplored. This study evaluates the influence of preoperative cervical alignment and interbody cage design on segmental alignment changes following 1- to 3-level ACDF. Methods: Following institutional review board approval, we identified 258 patients undergoing ACDF for degenerative pathology between 1 January 2010 and 31 December 2023. Preoperative and postoperative radiographs were analyzed for cervical alignment, disc height, and segmental lordosis. Cage dimensions, lordosis, and positioning relative to vertebral landmarks were recorded. Multivariable linear regression models evaluated predictors of postoperative disc height, segmental lordosis, and their respective changes. Results: Postoperative disc height was positively associated with greater cage height (β = 1.13 mm per mm, p < 0.001) and negatively associated with greater cage lordosis (β = −0.10 mm per °, p = 0.001). Segmental lordosis was positively influenced by cage height (β = 0.78° per mm, p = 0.002) and lordosis (β = 0.42° per °, p = 0.002) but was negatively correlated with the distance of the cage from the anterior edge of the cranial vertebra (β = −1.76° per mm, p = 0.004). Greater preoperative segmental kyphosis predicted more significant postoperative lordosis correction (β = −1.07° per °, p < 0.001). Conclusions: This study underscores the importance of preoperative alignment and interbody cage design in achieving optimal segmental correction following ACDF. While cage height primarily drives disc height restoration, surgical technique, particularly anterior placement of the cage, is pivotal for enhancing segmental lordosis. These findings support personalized surgical planning to optimize alignment and patient outcomes. Full article

Background: In adult spinal deformity (ASD) surgery, appropriate rod length determination is crucial, as excessive cranial rod length can lead to skin problems, especially in thin elderly patients if proximal junctional kyphosis (PJK) develops. In adolescent idiopathic scoliosis (AIS), correction is primarily performed in the coronal plane, and rod length changes are relatively predictable. Moreover, PJK is uncommon in AIS, making excess rod length rarely a clinical concern. In contrast, ASD correction involves more complex three-dimensional realignment, including restoration of lumbar lordosis (LL), which makes it challenging to predict postoperative changes in rod trace length (RTL). Furthermore, because PJK occurs more frequently in ASD surgery, appropriate rod length selection becomes clinically important. This study aimed to quantitatively evaluate changes in RTL before and after posterior correction. Method: Thirty patients with ASD who underwent staged lateral lumbar interbody fusion (LLIF) followed by posterior corrective fusion from T9 to the pelvis were retrospectively analyzed. RTL before posterior correction (Pre-RTL) was estimated from the planned screw insertional point on axial CT after LLIF, and postoperative RTL (Post-RTL) was measured from screw head centers on post-operative CT. LL and Cobb angle were assessed before and after posterior correction. Correlations between RTL change and alignment change were evaluated. Results: Postoperative RTL was shortened in all patients, with an average reduction of approximately 16–17 mm. RTL shortening demonstrated significant correlations with LL correction (R = 0.51, p = 0.003) and Cobb angle correction (R = 0.70, p = 0.00001). Greater shortening of RTL was observed on the convex side in patients with preoperative Cobb angle ≥ 10° (p = 0.04). Conclusions: Greater coronal deformity, particularly on the convex side, was associated with increased RTL shortening. These findings suggest that routine preparation of excessively long rods may be unnecessary. Consideration of anticipated RTL shortening may help avoid excessive cranial rod length and potentially reduce the risk of skin complications associated with PJK, particularly in thin elderly patients. Full article

Background: Pediatric craniocervical junction (CCJ) anomalies consist of a unique subset of anatomically complex spine conditions. The aims of intervention are to achieve long-term stability, correct existing deformity, and prevent neurological compromise. However, surgery is challenging due to critical neurovascular and musculoskeletal structures in the limited operative space of a young child. Recently, the use of three-dimensional (3D) printed models has been demonstrated to be valuable neurosurgical adjuncts. We therein report the application of a 3D-printed model for a pediatric case with a complex CCJ condition. A systematic review of the related literature is concurrently performed. Case description: A 10-year-old male presented with torticollis associated with neck pain and progressive thoracic kyphosis. Neuroimaging reported an unfused os odontoideum inferior to the basion and anterior half of the C2 vertebral body and anteriorly angulated with the C1 anterior arch. Of note, there was a large vertebral vein coursing over the left C2 lamina that was predominantly draining into the CCJ venous plexus. A radiologically derived 3D model of the patient’s CCJ was printed and used for pre-operative planning, multi-disciplinary team discussion, and detailed counseling with the patient and caregivers. The patient underwent an uneventful C1–C2 posterior screw fixation and has recovered well since. Separately, we observed there is a paucity of publications specific to this topic. Conclusions: As demonstrated, a custom-made 3D model was useful for clinicians work through technical difficulties and improve the perioperative discussion process in an otherwise difficult case. Full article

Background: The COVID-19 pandemic has been associated with increased sedentary behavior in children, raising concerns about posture and spinal health. This study compared standardized measures of sitting spinal alignment in two independent cohorts assessed before (2017) and after (2024) the pandemic and examined correlations among alignment parameters across different sitting postures. Methods: This cross-sectional study included healthy children aged 9–13 years. The sternal angle, sacral angle, lumbar lordosis, thoracic kyphosis, trunk tilt, and lateral deviation were measured using a Saunders digital inclinometer and a DIERS Formetric 4D rasterstereographic system in passive, forced, and corrected sitting postures. Results: No statistically significant differences were observed between the 2017 and 2024 cohorts (p > 0.05). Within each cohort, significant posture-related differences were found for the sternal and sacral angles, lumbar lordosis, and lateral deviation (p < 0.05), while thoracic kyphosis and trunk inclination differed between passive and corrected sitting (p < 0.05). The sternal angle correlated moderately to strongly with thoracic kyphosis (r = 0.657–0.695, p < 0.001), and the sacral angle correlated with lumbar lordosis (r = 0.679–0.743, p < 0.001). Conclusions: Similar alignment parameters across time-separated cohorts suggest no major cohort-level shifts in standardized sitting posture; however, behavioral factors were not directly assessed. Strong correlations among sagittal angles emphasize the consistent geometric relationship between the sternum, sacrum, and spinal curvatures. A sternal angle of approximately 65° was consistently associated with physiologically favorable spinal alignment and may serve as a practical reference value for posture assessment and education. Full article

Three-dimensional surface topography offers a noninvasive alternative to radiographic imaging for evaluating trunk morphology and posture. This study aimed to establish normative values of trunk cross-sectional geometry and to examine their associations with spinal alignment in healthy young adults. A cross-sectional sample of 108 participants (62 women, 46 men; 19–23 years, normal BMI) underwent assessment using two complementary techniques: TorsoScan, which reconstructed 360° trunk cross-sections at thoracic levels T1, T4, T8, and T12, and DIERS Formetric 4D, which quantified spinal posture parameters. For each cross-section, sagittal and coronal diameters and cross-sectional areas were calculated; sex differences were analyzed using Welch’s t tests and effect sizes, and associations with posture were examined by Pearson correlations with false discovery rate correction and regression modeling. Trunk geometry followed a regular thoracic profile, with the largest coronal diameter at T4 and the maximal area at T8. Men showed consistently larger diameters and areas than women, with large effect sizes at T4–T12. Four associations remained significant: reduced mid-thoracic breadth and area were linked to greater lumbar lordosis, while upper thoracic depth correlated positively with thoracic kyphosis. Predictive models based on posture explained limited variance (R² ≤ 0.19). These findings provide sex-specific reference values and demonstrate that TorsoScan and DIERS Formetric yield complementary, partly convergent measures that may support radiation-free evaluation of trunk morphology in clinical and rehabilitative settings. Full article

We present the findings of a case showing an improvement in severe, chronic mid-back pain (MBP) and disability following sagittal correction of the thoracic spine using Chiropractic BioPhysics^® (CBP^®) spinal rehabilitation with a nine-month long-term follow-up. A 40-year-old female had suffered for years and was referred for spinal rehabilitation by her physicians and physical therapist to treat her severe, chronic MBP. The symptoms had not improved despite several months of physical therapy, traditional chiropractic spinal manipulation, and pain management trigger point injections. The pain was reported as severe and rated as 8/10 at worst on the numerical rating scale. The pain was severe enough to interfere with her normal activities including martial arts training. Postural analysis revealed increased thoracic flexion and spine hyperkyphosis. Lateral thoracic radiography showed a previously undiagnosed wedged vertebral body at T6. Mensuration of the radiograph found an increase in overall posterior tangent angulation from T3–T10 measuring 66.2°. Negative sagittal balance measured from a vertical of T3 above T10 was −16.3 mm. Treatment included Chiropractic Biophysics^® (CBP^®) orthopedic rehabilitation protocols including postural and radiographic based Mirror Image^® (MI^®) exercises, spinal manipulation, and traction. The patient was treated in-office 37 times over the course of 3 months and all initial subjective and objective outcomes were re-assessed. It was reported that the initial average pain of 8/10 for the mid-back had nearly resolved and was rated as 2/10. All ADLs were reported as pain free, including intense exercise and martial arts. Post-treatment radiography was taken following a 24 h “rest-period” and found reduction in the overall hyperkyphosis from T3–T10 now measured 45.2°. Due to the presence of the wedge vertebra, it was recommended that the patient continue home traction and exercises, and long-term follow-up was assessed at 9 months including a repeat of all initial examinations, for subjective and objective outcomes. Thoracic kyphosis was maintained at 47.7° and VAS was 0/10 at 9-month follow-up and symptoms remained nearly resolved. Full article

Background/Objectives: Early-onset scoliosis (EOS) is often treated with growing rods, which use distraction-based correction to control deformity while allowing spinal growth. Although effective in the coronal plane, this technique may adversely affect sagittal alignment, particularly thoracic kyphosis and lumbar lordosis. Whether final fusion surgery is necessary after the growing rod treatment remains controversial. This study compared radiographic outcomes, including coronal and sagittal parameters, between patients with and without final fusion to clarify the value of final fusion. Methods: We retrospectively reviewed 19 EOS patients treated with growing rods between 2015 and 2019. Patients undergoing posterior spinal fusion after lengthening were classified as the final fusion group (n = 9), while those with more than 12 months of follow-up without fusion formed the graduated group (n = 10). Demographics, surgical variables, and radiographic parameters (Cobb angle, correction rate, coronal balance, clavicular angle, thoracic kyphosis, lumbar lordosis, sagittal vertical axis) were compared. Results: Baseline characteristics were similar. At final follow-up, the final fusion group had significantly better outcomes in Cobb angle (24.2° vs. 34.9°, p = 0.002), correction rate (66.6% vs. 40.1%, p = 0.001), and coronal balance (−1.5 mm vs. 19.7 mm, p = 0.004). Sagittal alignment did not differ significantly, but preservation of thoracic kyphosis tended to favor the fusion group. Conclusions: Final fusion surgery after growing rod treatment achieved superior coronal correction and balance compared with observation alone. Although sagittal alignment was not statistically different, a trend toward better thoracic kyphosis preservation was observed. Final fusion should be considered for larger residual curves or coronal imbalance, while observation may suffice in well-corrected cases. Full article