Objective To determine the role of dynamic hip joint coverage in maintaining postoperative sagittal balance in adult spinal deformity (ASD) patients following S2-alar-iliac (S2AI) fixation.
Methods A total of 224 ASD patients who underwent S2AI fixation were enrolled. Patients were stratified into 2 groups based on pre-to-post (from preoperative to postoperative) changes in femoral head coverage (ΔFHC): change group (group C) and noncoverage change group (group NC). Group C was further subdivided according to FHC recovery during follow-up into rebound (group C-R) and nonrebound (group C-NR) groups. Clinical outcomes and radiographic parameters of hip and spinopelvic alignment were assessed preoperatively, at the initial postoperative standing, and at the 2-year follow-up.
Results Compared to group C, patients in group NC demonstrated a higher incidence of sagittal imbalance-related mechanical complications at 2-year follow-up, with a greater tendency for sagittal imbalance progression (p=0.013), a larger post-to-follow-up change in sagittal vertical axis (ΔSVA) (p=0.029), and a higher incidence of proximal junctional kyphosis (PJK) (p=0.031). Although there was no significant difference in PJK incidence between group C-NR and group C-R (p=0.845), group C-NR showed a greater tendency for postoperative sagittal imbalance aggravation (p=0.025), with a significantly larger ΔSVA during follow-up (p=0.002). The optimal cutoff values for predicting postoperative sagittal imbalance aggravation were 3.5% for pre-to-post ΔFHC (area under the curve [AUC]=0.694) and 1.8% for post-to-follow-up ΔFHC (AUC=0.713).
Conclusion Dynamic postoperative changes in hip joint coverage, characterized by the FHC, are associated with postoperative sagittal balance maintenance. Patients with limited pre-to-post and post-to-follow-up changes in the FHC demonstrate compromised hip joint compensatory capacity, thereby increasing the risk of postoperative sagittal imbalance-related mechanical complications.
Objective To compare perioperative and complication outcomes, focusing on the prevention of sagittal translation (ST), between a novel “prioritized correction with multiple-rod construct” (PC-MRC) technique and traditional multiple-rod constructs (M-RC) in adult spinal deformity (ASD) patients undergoing 3-column osteotomies (3-COs).
Methods In this retrospective study, 101 ASD patients with a minimum 2-year follow-up after 3-COs were divided into 2 groups: PC-MRC (n=65) and M-RC (n=36). The PC-MRC technique involved initial osteotomy closure with short rods followed by global alignment correction with long rods. Radiographic and clinical parameters were assessed preoperatively, postoperatively, and at final follow-up.
Results The PC-MRC group had significantly shorter operation time and lower estimated blood loss (p=0.045 and p=0.007, respectively). Major coronal and kyphotic deformity correction rates were similar between groups. No significant correction loss occurred at the final follow-up. Crucially, the incidence of ST was significantly lower in the PC-MRC group (1.5% vs. 25.0%, p<0.001). Correspondingly, the overall rate of neurological injury was lower in the PC-MRC group (7.7% vs. 22.2%, p=0.037).
Conclusion The PC-MRC technique offers a versatile and rigid fixation for 3-COs in ASD patients, facilitating significant correction of global deformity. This straightforward technique effectively prevents massive blood loss and ST caused by 3-COs, while minimizing the risk of neurological complication.
Objective To evaluate the correlation between lumbar degenerative spondylolisthesis (LDS) and facet joint orientation, and to examine the factors influencing facet joint orientation in patients with double-level LDS (dLDS).
Methods A total of 40 patients with L3–5 dLDS (mean age, 64.1 years) and 106 patients with L4–5 single-level LDS (sLDS; mean age, 63.5 years) were included. Besides, 100 age-matched healthy participants were recruited as the control group. Facet joint angles at each level from L2–3 to L5–S1 were measured on axial computed tomogrpahy images. Slippage and spinopelvic sagittal parameters were measured using lateral full-spine x-rays.
Results Both dLDS and sLDS groups had significantly larger facet joint angles from L2–3 to L5–S1 than those in the control group, except for left L5–S1. In patients with spondylolisthesis, the facet joint angles at the L2–3 and L3–4 levels in the dLDS group were significantly greater than those in the sLDS group, while the angles at the L4–5 and L5–S1 levels showed no significant differences. In contrast to the sLDS group, the dLDS group had significantly greater pelvic tilt, sagittal vertical axis, L3 slope, and L4 slope, as well as smaller sacral slope, lumbar lordosis, L3–4 disc height, L4–5 disc height, L4–5 slippage angle, and L3–S1 height. Age and dLDS were identified as independent factors influencing the changes in the L3–4 facet joint angles between the 2 LDS groups.
Conclusion Spondylolisthesis and aging are associated with facet joint sagittalization. The present study provides evidence that the combined effects of preexisting degeneration and spondylolisthesis alter the morphology of the facet joints.
Objective To investigate the correlation between paraspinal sarcopenia (PS) and sagittal imbalance (SI) in degenerative kyphosis (DK), and to explore the correlation between paraspinal muscle (PSM) function loss and morphology change in DK.
Methods One hundred thirty-eight patients with DK and 204 with lumbar spinal stenosis (LSS) were enrolled. The spinopelvic parameters and sagittal vertical axis (SVA) were measured. Patients were divided into the sagittal balance (SB, SVA ≤ 5 cm, n = 61) and SI (SVA > 5 cm, n = 77) groups. Sagittal balanced LSS patients were served as control group. PSM function was evaluated by measuring the maximal voluntary exertion (MVE) and endurance time (ET). Magnetic resonance imaging-derived cross-sectional area (CSA) and fat infiltration rate (FI%) of PSM at T10–L5 were normalized to intervertebral disc CSA. Psoas CSA and FI% were calculated at L3–4 disc level. The correlation assessment using Spearman rank correlation coefficient and multiple linear regression. Logistic regression was used to identify the risk factors of SI.
Results Significantly lower ET, MVE, relative CSA (rCSA) and higher rFI% was found in the SI group than in the SB and control. The PS were correlated with spinopelvic parameters and regional kyphosis, while lack of correlation was found between the rFI% and MVE. Logistic regression and Youden index analysis showed ET < 15.5 seconds, MVE < 1.3 N/kg, and rCSA (L1–5) atrophy to be potential risk factors for SI in DK.
Conclusion DK patients with SI demonstrate acerbated PS that indicated by significant PSM dysfunction and morphological alterations. We highlight the significance of PSM combined evaluation and revealed that PS plays an indispensable role in the progression of SI, providing novel insights into the underlying sagittal compensatory mechanisms.
Objective To assess the effectiveness of vertebral cement augmentation (VCA) at upper instrumented vertebra (UIV) and UIV+1 in preventing proximal junction complications in correction surgery for adult spinal deformity patients.
Methods A literature search was conducted on Web of Science, PubMed, and Cochrane Library databases for comparative studies published before December 30th, 2024. Two reviewers independently screened eligible articles based on the inclusion and exclusion criteria, assessed study quality with Newcastle-Ottawa scale, and extracted data like study characteristics, surgical details, primary and secondary outcomes. Data analysis was performed using Review Manager 5.4 and Stata software.
Results Of all 513 papers screened, a meta-analysis was conducted on 7 articles, which included 333 cases in the VCA group and 827 cases in the control group. Patients in the VCA group had significantly older age and lower T score than patients in the control group. Although there was no statistically significant difference in the incidence of proximal junctional failure between the 2 groups, the results of the meta-analysis showed that the incidence of proximal junctional failure and the need for revision surgery were reduced by 36% and 71%, respectively, in the VCA group. One study reported 2 clinically silent pulmonary cement embolism and 1 patient requiring surgical decompression for cement leak into the spinal canal.
Conclusion This meta-analysis supported the use of VCA in corrective surgery for spinal deformities patients, especially in patients with advanced age and osteoporosis.
Citations
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Proximal Junctional Kyphosis Prevention in Adult Spinal Deformity Surgery: A Technical Review of Tethering and Adjunctive Strategies Paritash Tahmasebpour, Pawel P. Jankowski, Jason Liang, Joshua Lin, Kyriakos D. Chatzis, Peter S. Tretiakov, Spencer Matthews, Louis Boissiere, John F. Burke, Christopher I. Shaffrey, Aaron Hockley, Peter Passias Operative Neurosurgery.2026;[Epub] CrossRef
Vertebral Cement Augmentation is Associated With Reduced Rates of Proximal Junctional Failure in Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis of 1211 Patients Stavros Matsoukas, Shaan Patel, Pavlos Texakalidis, Teleale F. Gebeyehu, Joshua E. Heller, Jack Jallo, James S. Harrop, Srinivas K. Prasad Operative Neurosurgery.2025;[Epub] CrossRef
Revisiting Cement Augmentation in Osteoporotic Vertebral Fractures: A Narrative Review Gilbert Bungay Dimacali, Byung Ho Lee Journal of Korean Society of Spine Surgery.2025; 32(4): 144. CrossRef
Objective To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making.
Methods One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up.
Results Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively).
Conclusion Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C.
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Objective To establish a novel classification system for predicting the risk of intraoperative neurophysiological monitoring (IONM) events in surgically-treated patients with kyphotic deformity.
Methods Patients with kyphotic deformity who underwent surgical correction of cervicothoracic, thoracic, or thoracolumbar kyphosis in our center from July 2005 to December 2020 were recruited. We proposed a classification system to describe the morphology of the spinal cord on T2-weighted sagittal magnetic resonance imaging: type A, circular/symmetric cord with visible cerebrospinal fluid (CSF) between the cord and vertebral body; type B, circular/oval/symmetric cord with no visible CSF between the cord and vertebral body; type C, spinal cord that is fattened/deformed by the vertebral body, with no visible CSF between the cord and vertebral body. Furthermore, based on type C, the spinal cord compression ratio (CR) < 50% was defined as the subtype C-, while the spinal cord CR ≥ 50% was defined as the subtype C+. IONM event was documented, and a comparative analysis was made to evaluate the prevalence of IONM events among patients with diverse spinal cord types.
Results A total of 294 patients were reviewed, including 73 in type A; 153 in type B; 53 in subtype C- and 15 in subtype C+. Lower extremity transcranial motor-evoked potentials and/or somatosensory evoked potentials were lost intraoperatively in 41 cases (13.9%), among which 4 patients with type C showed no return of spinal cord monitoring data. The 14 subtype C+ patients (93.3%) had IONM events. Univariate logistic regression analysis showed that patients with a type C spinal cord (subtype C-: odds ratio [OR], 10.390; 95% confidence interval [CI], 2.215–48.735; p = 0.003; subtype C+, OR, 497.000; 95% CI, 42.126– 5,863.611; p < 0.001) are at significantly higher risk of a positive IONM event during deformity correction compared to those with a type A. In further multiple logistic regression analysis, the spinal cord classification (OR, 5.371; 95% CI, 2.966–9.727; p < 0.001) was confirmed as an independent risk factor for IONM events.
Conclusion We presented a new spinal cord classification system based on the relative position of the spinal cord and vertebrae to predict the risk of IONM events in patients with kyphotic deformity. In patients with type C spinal cord, especially those in C+ cases, it is essential to be aware of potential IONM events, and adopt standard operating procedures to facilitate neurological recovery.
Citations
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Deformity angular distance ratio independently predicts intraoperative neuromonitoring alerts in spinal deformity correction Jiajun Ni, Xinhu Guo, Zhuoran Sun, Chunwei Zhao, Zhongqiang Chen, Yan Zeng Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef
Neurological Evaluation of Severe Congenital Kyphosis With Compressive Myelopathy in 39 Patients With a Minimum 1‐Year Follow‐Up Jiaqi Zhang, Yan Zeng, Weishi Li Orthopaedic Surgery.2025; 17(7): 2004. CrossRef
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