Search Results (426)

Background: Vertebral column resection (VCR) has historically been recognized as the most efficacious corrective intervention for severe rigid spinal deformities. Nevertheless, advancements in preoperative optimization, staged corrective methodologies, osteotomies, and contemporary instrumentation have broadened the spectrum of therapeutic options available. The definitive role of VCR in the modern management of rigid congenital spinal deformities remains a topic of ongoing scholarly discourse. Methods: This study presents two illustrative cases of severe congenital spinal deformities that were addressed employing various surgical methodologies, alongside a comprehensive review of the current literature pertaining to VCR and less invasive alternatives, including halo-gravity traction (HGT), temporary internal distraction techniques, pedicle subtraction osteotomy (PSO), asymmetric pedicle subtraction osteotomy (APSO), and multi-rod constructs. Results: The cases elucidated herein underscore the necessity for treatment strategies to be tailored specifically to the characteristics of the deformity, its flexibility, the neurological risks involved, and the individual patient’s specific attributes. In one case, significant deformity correction achieved via preoperative HGT facilitated successful management through multilevel Ponte osteotomies and posterior spinal fusion, thereby obviating the need for VCR. In other patient suffering from severe rigid congenital kyphotic deformity with pronounced anterior column deficiencies, VCR was deemed essential to realize adequate correction and neural decompression. All patients exhibited substantial radiographic correction, enhancements in health-related quality-of-life metrics, diminished disability and pain, while maintaining correction without neurological complications or implant failure at the final follow-up evaluation. Conclusions: VCR continues to be a vital element within the surgical repertoire for the treatment of severe rigid spinal deformities; however, it should not be deemed obligatory in every instance. Diligent preoperative evaluation, staged correction methodologies, and less invasive osteotomy techniques may permit satisfactory correction while mitigating surgical morbidity in suitably selected patients. Treatment approaches should be customized, favoring the least invasive procedure capable of achieving safe and lasting correction whenever practicable. Full article

Background: Cervical osteochondromas invading the vertebral canal are rare but may cause spinal cord compression requiring surgical resection. Conventional open laminectomy may disrupt posterior stabilizing structures and potentially increase the risk of postoperative cervical deformity. This technical note describes a contralateral-structure-preserving endoscopic technique for cervical osteochondroma resection. Methods: A 25-year-old man with multiple hereditary exostosis presented with neck pain, mild numbness, and a positive Lhermitte’s sign. Computed tomography and magnetic resonance imaging revealed a 9 × 6 × 10 mm osteochondroma originating from the base of the C3 spinous process and extending into the vertebral canal with spinal cord compression and cord signal change. Preoperative clinical assessment included a Visual Analog Scale (VAS) for neck pain of 6/10, a modified Japanese Orthopedic Association (mJOA) score of 16/18, a Neck Disability Index (NDI) of 30%, and Nurick grade 1. The lesion was treated using unilateral biportal endoscopic spine surgery through a partial unilateral laminectomy and sublaminar endoscopic corridor, aiming for en bloc resection while preserving the contralateral lamina, posterior ligamentous complex, and posterior tension band. Continuous intraoperative neurophysiological monitoring (SSEP and MEP) was used throughout the procedure. Results: The osteochondroma was completely resected en bloc using a diamond burr and Kerrison rongeur. Histopathological examination confirmed osteochondroma, and negative margins were identified without residual tumor. The patient’s symptoms resolved completely without postoperative complications, and he was discharged on postoperative day 3. At the 18-month clinical and radiological follow-up, the patient remained symptom-free, with VAS improved to 1–2/10, mJOA improved to 18/18, NDI improved to 4%, and Nurick grade improved to 0, with partial regression of the cord signal change and no evidence of tumor recurrence on follow-up imaging. Cervical lordosis was maintained at the immediate postoperative timepoint. Conclusions: Contralateral-structure-preserving endoscopic resection may represent a potential minimally invasive alternative to conventional wide laminectomy or fusion-based approaches in carefully selected cases of benign cervical osteochondroma. Larger comparative studies with long-term follow-up are required to confirm the potential biomechanical and clinical benefits of this approach. Full article

Background/Objectives: Presynaptic terminals (PTs) in the neuromuscular junction (NMJ) are essential regulators of skeletal muscle function and are responsible for the translation of electrical impulses from motor neurons into muscle contraction. The present exploratory study aimed to compare PT adaptations in spinalis muscle samples from the concave and convex regions of the spine in three cases of advanced scoliosis, which exhibited marked asymmetry in muscle development. Methods: Spinalis muscle sample pairs were retrieved after surgical procedures and subjected to immunofluorescence (IF)-based spatial analysis of PTs, histological assessment of muscle fibers, and expression analyses of inflammatory and neurotrophic proteins. Results: IF images revealed distinct differences in PT parameters between spinalis samples obtained from the corresponding concave and convex sides of spinal deformities. Advanced statistical models revealed a consistent tendency for concave spinalis muscles to develop lower PT numbers, along with decreased expression of relevant components, neurofilament M, and synaptic vesicle glycoprotein 2. Moreover, these impairments were accompanied by increased expression levels of IFN alpha, which has been previously implicated in NMJ disorders, neuropathies, and myopathies. Conclusions: In the concave regions of spinal deformities, continuously compressed spinalis muscles may be particularly susceptible to PT alteration and denervation. However, comprehensive multicenter validation studies are required to better define the relationships among PT alterations, IFN alpha expression, and muscle tissue compression. Full article

Background/Objectives: Optimal trajectories for S2-alar-iliac (S2AI) screw placement have been widely studied; however, in fluoroscopy-assisted free-hand techniques, exact reproduction is rarely achievable. This study aimed to quantify direction-specific safety margins around patient-specific optimal trajectories and to determine their relationship with pelvic parameters. Methods: We retrospectively analyzed patients who underwent S2AI screw fixation with available preoperative and postoperative CT imaging. Pelvic parameters, including pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI), were measured. Optimal transverse and sagittal screw angles were determined using CT-based planning. Postoperative CT was used to assess actual screw trajectories and cortical violations. Direction-specific generalized estimating equation models were used to evaluate associations between trajectory deviation and screw malposition. Receiver operating characteristic (ROC) analysis was performed to determine cutoff values for safe deviation. Results: A total of 62 patients (105 screws) were included in axial analysis and 41 patients (76 screws) in sagittal analysis. PT and PI showed significant inverse correlations with both optimal transverse and sagittal angles (all p < 0.001). Greater lateral and medial deviations were significantly associated with corresponding cortical violations (OR 2.33, 95% CI 1.51–3.59; and OR 2.10, 95% CI 1.40–3.15 per degree, respectively; both p < 0.001). Inferior deviation was significantly associated with violation in the sagittal plane (OR 1.39, 95% CI 1.18–1.65 per degree; p < 0.001), whereas superior deviation was not significant. ROC analysis demonstrated asymmetric safety margins: 1.5° lateral (AUC = 0.972), 8.1° medial (AUC = 0.965), and 18.5° inferior (AUC = 0.897). Conclusions: S2AI screw placement may be conceptualized as a tolerance-based process centered on a patient-specific optimal trajectory. Safety margins are direction-dependent and asymmetric, with a narrow tolerance for lateral deviation. These findings provide practical guidance for intraoperative trajectory adjustment in free-hand techniques. Full article

Objective: To describe the surgical technique and early clinical outcomes of prone-transpsoas single-position corpectomy (PTP-corpectomy) for the management of complex thoracolumbar spinal pathology. Background: PTP-corpectomy is an emerging technique for providing simultaneous lateral and posterior spinal access without patient repositioning. The previous literature describes the PTP approach for interbody fusions; however, evaluation of its use for corpectomy is limited. This case series reports our experience with the PTP-corpectomy procedure at our institution. Methods: We retrospectively reviewed seven patients who underwent PTP-corpectomy surgery for complex spinal pathologies, including severe kyphoscoliosis, traumatic burst fractures, and revision in 2022–2025. Collected variables included demographics, comorbidities, surgical history, perioperative details, radiographic imaging, and clinical outcomes. Results: All seven patients successfully underwent PTP-corpectomy. The average operative time was 460.6 ± 147.1 min, and the estimated blood loss (EBL) was 892.9 ± 898.3 mL. Average length of stay (LOS) postoperatively was 6.7 ± 3.0 days. One case required revision of a preexisting construct and complex wound closure with plastic surgery, which had significantly increased operative time and blood loss (767 min, 2700 mL). Excluding this complicated case, the average time was 409 ± 63.7 min, and EBL was 591.7 ± 454.3 mL. All seven patients maintained clinical stability postoperatively, demonstrating improvements in pain and functional status at latest follow-up. Follow-up time ranged from 41 to 375 days. Conclusions: Our experience adds to the limited body of evidence that the PTP approach is well suited for corpectomy procedures, and that it is feasible, safe, and effective at improving clinical outcomes for complex spinal pathologies. This series adds to the limited case volume describing this technique in the current literature. Future studies with larger patient populations are warranted to further validate these findings. Full article

Adolescent idiopathic scoliosis (AIS) is a multifactorial spinal deformity with variable progression patterns, making early risk stratification challenging. Circulating and tissue biomarkers, including inflammatory, metabolic, endocrine, epigenetic, and bone-related markers, have recently been investigated as potential predictors of disease severity and progression. This systematic review evaluated the current evidence on circulating and tissue biomarkers associated with AIS severity and progression. PubMed, Scopus, and Web of Science were searched for studies published between April 2016 and April 2026. Studies assessing circulating or tissue-based inflammatory, metabolic, epigenetic, and bone-related biomarkers in AIS patients were included. Data on study design, biomarker type, analytical methods, and associations with curve severity or progression were extracted. Twenty-nine studies involving more than 4000 participants were included. Biomarkers identified included inflammatory cytokines, microRNAs, metabolic hormones, and bone metabolism markers. Most studies reported significant associations between biomarkers and curve severity, particularly for inflammatory mediators, epigenetic regulators, and bone-related markers. However, few studies evaluated longitudinal progression, and only a limited number of studies identified predictive biomarkers, including circulating miRNA panels and spermidine levels. ROBINS-I assessment showed substantial risk of bias, mainly related to confounding and selective reporting. Heterogeneity was observed across study designs and outcome definitions. Current evidence supports associations between biomarkers and AIS severity, but predictive value for progression remains limited. Full article

Background: Spinal deformities in children represent a relevant public health issue, with possible long-term consequences. Timely identification of their determinants is essential for adequate prevention. Methods: This study was a secondary analysis of data from the 2019 Serbian National Health Survey, including 1309 children aged 5–14 years. Logistic regression with LASSO regularization and multiple ML algorithms were tested, with XGBoost selected as the optimal model. Class imbalance was addressed using class weighting and SMOTE. Model interpretability was achieved using SHAP analysis. Results: The prevalence of spinal deformities was 8.6%. Univariable analyses showed that age, poorer self-rated health, chronic illness, recent injuries, and pes planus were significantly associated with spinal deformities. Family-related variables showed no significant associations. Among the evaluated models, XGBoost demonstrated the most stable performance across the applied evaluation metrics and the best balance between predictive performance and interpretability. SHapley Additive exPlanations (SHAP) analysis showed that pes planus was the strongest determinant, followed by age and chronic illness, while socio-demographic and family factors had minimal influence. Conclusion: Explainable machine learning models, particularly XGBoost combined with SHAP, can allow for the identification and interpretation of key determinants of spinal deformities in children. Pes planus was shown to be modifiable and relevant associated determinant, supporting its importance in early screening and preventive strategies. Full article

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. 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 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: This study evaluated the performance of a commercial offline adaptive radiotherapy system for systematic monitoring of breast cancer treatment with nodal irradiation using helical tomotherapy. Methods: Thirty patients treated for invasive unilateral breast carcinoma were analysed. For each patient, three megavoltage CT scans acquired at the first, middle, and last treatment sessions were processed through the PreciseART (Accuray, US) offline ART workflow. Automatically deformed structures were compared with manually delineated reference structures. Geometric accuracy was assessed using the Dice similarity coefficient (DSC), Hausdorff distance (HD95), mean distance to agreement (MDA), and barycentre distance (BD). The dosimetric parameters included D2% and V95% for targets and Dmean/Dmax/V20Gy for organs at risk. Results: Median DSCs exceeded 0.9 for the CTVbreast, PTVbreast, heart, and ipsilateral lung and were above 0.8 for the remaining structures, except the CTVn and oesophagus. Dosimetric differences between deformed and reference structures were within 5% for D2% across all targets and for V95% of the CTVbreast and PTVbreast in 90% of the sessions. The ipsilateral lung V20Gy differed by less than 5% in more than 90% of the sessions. Larger deviations (up to 10%) were observed for the nodal PTVs and mean heart dose, while the greatest inconsistencies were found for the oesophagus and spinal canal. Conclusions: The evaluated offline ART system demonstrates sufficient accuracy for automated monitoring of breast and lung structures. However, cautious interpretation remains necessary for nodal targets, heart, and oesophagus dosimetry prior to clinical implementation. Full article

Scoliosis is a three-dimensional spinal deformity that may affect musculoskeletal alignment, respiratory mechanics, and neuromotor control. Rigid thoraco-lumbo-sacral orthoses (TLSOs) remain the primary conservative treatment during skeletal growth. Most brace systems rely on three-point pressure mechanisms that primarily generate lateral compression forces, while the contribution of shear components to corrective biomechanics has been insufficiently quantified. This study presents the experimental and analytical validation of the Canali Front-Push Orthopedic Brace, a rigid orthotic system designed to generate controlled compressive and shear forces through a frontal thrust mechanism and anterior rib cage engagement. By applying anterior force, the device reduces the frontal-plane lever arm, thereby limiting the mechanical moment that contributes to transverse plane rotation. An instrumented four-segment torso model derived from the internal CAD geometry of the brace was developed to independently measure upper compression, lower compression, and intersegmental shear forces. Controlled misalignment conditions (0 mm, 2 mm, and 4 mm) were introduced to simulate asymmetric engagement of the orthosis. Three load cell configurations (200 N and 500 N capacity) were tested. Mechanical endurance of the rack–latch fastening system was also evaluated. A predictive shear–misalignment relationship was derived and experimentally validated. Peak compressive forces reached approximately 370 N, while shear forces increased from less than 40 N under symmetric alignment (D0) to approximately 170 N under maximal misalignment (D4). Shear activation demonstrated near-linear proportionality to imposed geometric asymmetry (R² > 0.94). Following cyclic loading, the fastening system stabilized mechanically around 300 N. Measurement repeatability showed a coefficient of variation below 5%. These findings demonstrate that the brace produces predictable and controllable shear activation while maintaining high mechanical repeatability. The results provide a quantitative biomechanical framework for understanding shear-induced corrective mechanics in scoliosis bracing and support future studies integrating computational modeling and clinical validation. The proposed mechanical framework may contribute to the development of next-generation orthotic strategies aimed at controlling spinal rotation through vector modulation rather than purely compressive correction. 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

Background and Objectives: Enhanced Recovery After Surgery (ERAS) pathways are increasingly used in spine surgery, but uptake in adolescent idiopathic scoliosis (AIS) remains heterogeneous across institutions. Evidence in pediatric deformity surgery supports shorter recovery with protocolized care, yet real-world comparative data combining ERAS and the erector spinae plane block (ESPB) remain limited. This study aimed to compare early postoperative outcomes between a historical standard-care pathway and a structured ERAS+ESPB pathway in adolescents undergoing posterior spinal fusion for AIS. Materials and Methods: A single-center retrospective time-based comparative cohort study design included consecutive AIS patients (<18 years) treated between 1 January 2024 and 31 December 2025. The standard-care pathway was applied to patients operated on before 1 June 2025 (n = 34), whereas the ERAS+ESPB pathway was applied to those operated on from 1 June 2025 onward (n = 35), following formal institutional implementation. Outcomes included postoperative pain assessed using the visual analog scale under two functional conditions—at rest in the supine position and during standing/mobilization—at POD0, POD1, POD2, POD3, discharge, and 2-week follow-up; postoperative nausea at POD0–POD3; and length of stay (LOS). Between-group pain comparisons used Welch’s t-test; nausea used Fisher’s exact test; LOS used the Wilcoxon rank-sum test. Results: At POD0, supine pain was lower in ERAS+ESPB (1.50 ± 0.55) than in standard care (3.20 ± 1.50; p < 0.001). From POD1 onward, supine pain did not differ significantly between groups. Among assessable patients, standing pain was lower in ERAS+ESPB at POD2 (3.05 ± 1.53 vs. 4.50 ± 1.05; p = 0.020), POD3 (2.82 ± 1.62 vs. 4.17 ± 1.03; p = 0.006), and 2-week follow-up (1.45 ± 0.80 vs. 2.26 ± 0.93; p = 0.006). Nausea was lower in ERAS+ESPB at POD0 (11.4% vs. 35.3%; p = 0.024) and POD2 (8.6% vs. 32.4%; p = 0.018), with no significant differences at POD1 or POD3. LOS was shorter in ERAS+ESPB (5.41 ± 1.10 vs. 8.32 ± 2.06 nights; p < 0.001). Conclusions: In adolescents undergoing posterior spinal fusion for AIS, an ERAS-based perioperative pathway incorporating ESPB was associated with improved early postoperative recovery, particularly in terms of immediate postoperative pain, pain during mobilization, early postoperative nausea at selected time points, and length of hospital stay. Prospective multicenter studies are needed to confirm these findings and clarify the independent contribution of individual pathway components. Full article