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To define subaxial cervical spine vertebral body and canal dimensions in a paediatric cohort and to assess the influence of age and ethnicity. Retrospective radiological observational study. Single-centre tertiary level trauma care setting in New Zealand. CT scans of children under 18 years of age were reviewed. A total of 111 participants were included (63 New Zealand European (NZE) and 48 Māori). Patients with cervical spine pathology or deformity were excluded. Not applicable. Primary outcomes were anteroposterior and transverse vertebral body and spinal canal dimensions measured at the mid-pedicle level from C3 to C7. Secondary outcomes included canal-to-vertebral body (canal:VB) ratios. Associations with age and ethnicity were assessed using correlation analysis and analysis of covariance (ANCOVA). Absolute vertebral body and canal dimensions were larger in NZE children compared with Māori. Canal:VB ratios were smaller in NZE children, reaching statistical significance at C7 (p=0.011). Age demonstrated a strong positive correlation with mean vertebral body anteroposterior diameter and a moderate correlation with canal:VB ratio. ANCOVA showed ethnicity (NZE) to be a significant predictor of vertebral body dimensions, particularly transverse diameter at C4-C6, while age had a lesser effect. Canal:VB ratios decreased with increasing age from C3 to C7, with low coefficients of determination indicating additional influencing factors. In this paediatric cohort, vertebral body dimensions were more strongly associated with age than spinal canal dimensions. Ethnicity was associated with modest differences in cervical spine morphology, particularly transverse vertebral body diameter. These findings suggest cervical spine development is multifactorial and may have implications for trauma assessment and spinal cord injury risk evaluation in adolescents. Further studies incorporating anthropometric and sex-specific variables are warranted.
To explore the understanding of osteoporosis in the context of adult spinal deformity (ASD) surgery with a focus on diagnosis, surgical risks, non-operative, and operative treatment techniques. A comprehensive literature search was performed. Articles were identified using the search terms "osteoporosis," "adult spinal deformity," "scoliosis," and "spine surgery." Relevant studies were selected based on their focus on the intersection of these topics with an emphasis on utility in spine surgery. This review discusses osteoporosis diagnosis, surgical risks, and non-operative, and surgical treatments in the context of ASD surgery with a focus on clinical applications. Areas for future growth are highlighted. As adult spinal deformity (ASD) patients increase globally, the Scoliosis Research Society (SRS) formed a task force to improve understanding of osteoporosis and its impact on this vulnerable population. This review brings together the latest research on the topic and highlights this area as one of critical importance and growth in the field.
Spinal deformity correction is technically demanding and often associated with extended operative time, substantial blood loss, and elevated complication rates. Dual-attending surgeon (DS) models have emerged as a strategy to enhance operative efficiency and patient safety, though published outcomes remain inconsistent. To evaluate the impact of a DS approach compared with a traditional single-attending surgeon (SS) strategy on perioperative and postoperative outcomes in spinal deformity surgery. Meta-analysis of comparative studies assessing DS versus SS procedures for spinal deformity correction. A systematic literature search was performed across PubMed, Scopus, the Cochrane Library, and Google Scholar through November 6, 2025. Seventeen studies met inclusion criteria. DS cases were defined as procedures performed by two attending surgeons; SS cases involved one attending assisted by non-attending personnel. Extracted outcomes included operative time, blood loss, transfusion requirements, hospital length of stay, radiographic correction (Cobb angle), complications, readmission, and revision rates. The DS approach was associated with significantly reduced operative time (MD - 109.69 min; 95% CI - 145.04 to - 74.34; p < 0.00001), intraoperative blood loss (MD - 308.90 mL; 95% CI - 454.96 to - 162.83; p < 0.00001), and hospital length of stay (MD - 0.99 days; 95% CI - 1.46 to - 0.52; p < 0.00001). Transfusion risk was also lower in DS cases (RR 0.11; 95% CI 0.03-0.45; p = 0.002). No significant differences were observed in Cobb angle correction (p = 0.84), readmission rates (p = 0.11), revision rates (p = 0.54), or overall complication rates (p = 0.07). Follow-up durations were similar within individual studies but varied across the included literature. A DS strategy improves operative efficiency and reduces perioperative blood loss and transfusion requirements, while maintaining equivalent radiographic correction and comparable postoperative outcomes versus the SS model. These findings support selective use of DS approaches, particularly for complex or high-risk deformity cases. Further prospective studies with standardized follow-up and economic analyses are needed to clarify long-term value and cost-effectiveness.
Spastic foot deformity after central nervous system lesions is clinically heterogeneous and often combines equinus, varus, claw toes, pain, and gait limitation. Selective tibial neurotomy (STN) is a peripheral neurosurgical option for focal lower-limb spasticity, but data from low- and middle-income settings remain limited. What are the long-term clinical and functional outcomes of STN for spastic foot deformity, and are these outcomes influenced by the extent of motor fascicle resection? We conducted a retrospective study of 31 patients (36 feet) who underwent STN. Deformity, clonus, ankle dorsiflexion, pain, gait performance, orthotic comfort, and patient satisfaction were assessed preoperatively and at long-term follow-up. The relationship between fascicle resection extent and outcomes was analysed. Significant improvements were observed in equinus, varus, and claw-toe deformities, ankle dorsiflexion, and clonus (all p < 0.001). Pain resolved in all symptomatic patients, and toe-tip skin lesions markedly decreased. Walking distance increased significantly, and 10-m walking time improved. Orthotic comfort and patient satisfaction were high. Resection of more than two-thirds of fascicles was associated with better clonus and varus control. STN provides sustained clinical and functional benefits for spastic foot deformity. Greater fascicle resection may enhance outcomes in selected patients. This technique is feasible and effective in a Vietnamese neurosurgical setting.
Prospective, multicenter study. To compare and characterize complications in adult spinal deformity (ASD) patients with and without 3-column osteotomy (3CO). Although 3CO is associated with increased risk of neurologic adverse events, no study has, to our knowledge, compared and characterized sensory and motor neurologic complications in ASD patients with vs. without 3CO. Demographics, surgical characteristics, and neurologic complications were collected for 553 ASD patients. Lower extremity motor scores (LEMSs) were compared at baseline and postoperatively. Multivariate analysis was performed to identify risk factors associated with neurologic adverse events. Among 553 ASD patients, 130 (23.5%) underwent 3CO. More patients with 3CO were revision patients (67.7% vs. 35.0%; P<0.001), presented with sagittal deformity (43.9% vs. 31.0%; P=0.008), and had longer operative times (455.6 vs. 407.3 min; P=0.001) and greater estimated blood loss (EBL) (1,650 vs. 1,000 mL; P<0.001) than patients without 3CO. The incidence of neurologic adverse events was greater among patients with vs. without 3CO (23.1% vs. 15.4%; P=0.04). Multivariate analysis revealed that older age (odds ratio [OR] 1.288 per 10-year increase, 95% confidence interval [CI] 1.060-1.565, P=0.01) and longer operative time (OR 1.088, 95% CI 1.001-1.004, P=0.01) were significant predictors of neurologic adverse events. No between-group difference in LEMS was observed at 6-week (49.0 vs. 49.0; P=0.90) or 1-year (49.4 vs. 49.3; P=0.71) follow-up. By 1-year follow-up, 20.5% of 3CO patients and 21.6% of patients without 3CO had residual motor deficit. Compared with patients who did not undergo 3CO, more patients with 3CO had prior instrumentation, presented with sagittal deformity, had longer operative time and greater EBL, and were more likely to have a neurologic adverse event. At 1-year follow-up, there was no significant difference in LEMS between the two groups. III.
To compare the degree of kyphosis among patients with old thoracolumbar fracture kyphosis (OTFK) in various positions and to assess kyphosis flexibility. A total of 32 patients with OTFK who met the inclusion criteria were retrospectively included between February 2017 and August 2022. The cohort consisted of 4 males and 28 females with a mean age of 66.47 years (range, 55-88 years). All patients underwent preoperative standing full-length spine x-ray, prone full-length spine CT scout view (FLS-CT), and supine MRI. Among them, 29 patients had single-segment fractures and 3 had double-segment fractures. The local kyphosis Cobb angle (LKCA) was measured on all imaging modalities. The LKCA measured on standing x-ray and FLS-CT were recorded as LKCAX and LKCAFLSCT, respectively. On MRI, LKCA was measured on three sagittal slices (left parasagittal, midsagittal, and right parasagittal), recorded as LKCALMR, LKCAMMR, and LKCARMR, respectively. Kyphosis flexibility (KF) was calculated based on these measurements. Pairwise comparisons were performed using the Wilcoxon signed-rank test with Bonferroni correction after an overall Friedman test. Equivalence analysis between prone FLS-CT and supine MRI was performed using a prespecified margin of ±5°. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC). The mean standing LKCA was 39.58 ± 9.00°. The LKCA measured on prone FLS-CT was 29.61 ± 6.96°. On supine MRI, the LKCA values were 28.34 ± 6.37° (LKCALMR), 27.64 ± 6.18° (LKCAMMR), and 28.97 ± 5.92° (LKCARMR). The mean LKCA of the three MRI planes was 28.32 ± 5.91°. The corresponding KF values were 24.45% ± 10.86% for prone FLS-CT, 27.36% ± 11.08% for the left parasagittal slice, 29.16% ± 10.89% for the midsagittal slice, 25.52% ± 11.20% for the right parasagittal slice, and 27.35% ± 10.16% for the mean of the three MRI planes. LKCA was significantly lower in the prone and supine positions than in the standing position (all adjusted p < 0.001). No significant differences were found between prone FLS-CT and any supine MRI measurement (all adjusted p > 0.05). In equivalence analysis, all 95% confidence intervals of the paired mean differences between prone FLS-CT and supine MRI measurements were entirely within the prespecified equivalence margin of ±5°. Interobserver reliability was excellent across all imaging modalities, with ICC values ranging from 0.985 to 0.992. Kyphosis severity was significantly reduced in the preoperative recumbent position in patients with OTFK. Prone FLS-CT and supine MRI provided clinically comparable estimates of positional kyphosis correction, suggesting that both modalities may be useful for preoperative assessment of kyphosis flexibility in OTFK.
Existing surgical alignment goals derived from populations with a high pelvic incidence (PI) are not applicable for patients with adult spinal deformity (ASD) and a low PI, who account for a high proportion of Asian populations. The surgical treatment for patients with a low PI is challenging because of their limited pelvic compensation capacity and because there are no criteria to guide corrective spinal deformity surgery in this population. To develop and validate a tailored sagittal correction strategy for patients with ASD and a low PI. Cross-sectional normative analysis and retrospective cohort study. Stage I included 852 asymptomatic Chinese adults (age 50-79 years). Stage II included 103 patients with ASD and a PI of ≤41° who underwent posterior long-segment fusion and follow-up evaluation for ≥2 years, stratified by kyphotic apex into a TL group (kyphotic apex at L1 or above; n = 59) and an L group (kyphotic apex at L2 or below; n = 44). Mechanical complications (MCs) and health-related quality of life (HRQOL), as measured by the Oswestry Disability Index and a visual analog scale for back and leg pain. Normative spinopelvic parameters were used to define a low-PI subgroup (PI ≤ 41°) and to derive the sufficient sacral slope-lumbar lordosis matched correction (SSS-LLMC) strategy. The 25th percentile sacral slope (SS) in asymptomatic adults with a low PI (41°) was adopted as the minimal SS target (SS ≥ 21°). Patients with ASD and a low PI were divided into sufficient sacral slope (SSS, postoperative SS ≥ 21°) or an insufficient sacral slope (ISS, postoperative SS < 21°). According to the linear sacral slope-lumbar lordosis (SS-LL) relationship (LL = 1.122 × SS + 10.84) established in asymptomatic adults with a low PI, the group of patients with an SSS was further stratified into lumbar lordosis matched correction (LLMC), lumbar lordosis undercorrection (LLUC), and lumbar lordosis overcorrection (LLOC). MCs and HRQOL over a minimum 2-year follow-up period were compared across these subgroups within the TL and L groups, and multivariate logistic regression identified independent predictors of MCs in the overall and apex-stratified cohorts. In addition, this strategy was compared with conventional alignment goals, such as the Scoliosis Research Society-Schwab modification of the pelvic incidence to lumbar lordosis (PI-LL) mismatch and the global alignment and proportion (GAP) score, to evaluate the ability of these approaches to reduce MCs. A low PI (≤ 41°) accounted for 32.2% (274/852) of the asymptomatic cohort. Among 103 patients with ASD and a low PI, 36 (35.0%) developed MCs. MCs occurred in 56.8% (20/34) of patients with an ISS versus 23.2% (16/69) of patients with a SSS (P < 0.001). Within the SSS group, MC rates were 47.4% (9/19) in LLUC, 8.6% (3/35) in LLMC, and 26.7% (4/15) in LLOC (P = 0.004). In the TL group, SSS-LLMC had the lowest MC rate (12.5%), whereas in the L group no MCs occurred in SSS-LLMC (0/10) and the MC rate in SSS-LLOC (14.3%; 2/14) was lower than in SSS-LLUC (57.6%; 19/33). Preoperative SVA was an independent risk factor for MCs (odds ratio [OR] = 1.224; 95% confidence interval [CI], 1.088-1.377; P < 0.001), and SSS-LLMC was independently protective (OR, 0.116; 95% CI, 0.031-0.435; P = 0.001). In the L group, SSS alone was independently protective (OR, 0.187; 95% CI, 0.047-0.753; P = 0.018). At the final follow-up evaluation, the ODI were similar between the ISS and the SSS groups. In the TL group, the SSS group showed a lower mean VAS for the back compared to ISS group (2.7 ± 1.0 vs 3.4 ± 1.0; P = 0.028), while all other between-group comparisons yielded no statistically significant results. Patients with ASD and a low PI who require posterior long-segment fusion treatment represent a distinct anatomic subtype requiring individualized correction targets. The SSS-LLMC strategy prioritizes restoring SS as a foundation before precisely matching LL to this established orientation. In addition, the target for LL reconstruction should take into account the different locations of the kyphotic apex.
Recently, functional evaluation using 3D gait analysis (3DGA) proved to predict health-related quality-of-life (HRQOL) scores better than static radiographic evaluation in adult spinal deformity (ASD). However, 3DGA provides multiple parameters that can be a burden to interpret by non-experts. A recent study showed that the dynamic pelvic tilt (dPT), the forward projection of the head and thorax (dODHA) and walking step length (SL) are the most representative gait kinematics in ASD patients. To determine whether reducing kinematic parameters to only these 3 key parameters would still predict HRQOL outcomes in ASD based on machine learning (ML) random forest regression model. Single-center prospective study. 197 patients with ASD and 57 control subjects OUTCOME MEASURES: Self-report measures: SF36 with the physical and mental components (PCS & MCS), Oswetry Disability Index (ODI), Beck's depression inventory (BDI) and Visual analogue scale (VAS) for pain. Physiologic measures: low-dose full-body biplanar Xrays with 3D skeletal reconstructions. Functional measures: full-body 3D gait analysis during walking. Prediction accuracy: random forest regression ML model. All subjects underwent low-dose full-body biplanar Xrays with 3D skeletal reconstructions (with the calculation of spino-pelvic and global alignment parameters), full-body 3DGA during walking (with the calculation of full-body joint kinematic parameters), and completed HRQOL questionnaires: SF36 with the physical and mental components (PCS&MCS), ODI, BDI and VAS for pain. A random forest regression machine learning model was used to predict HRQOL scores in 4 simulations: (Sim-1) X-ray parameters (spinopelvic and global alignment); (Sim-2) Key-kinematic parameters (dPT, dODHA and SL); (Sim-3) X-ray parameters and dPT, dODHA and SL; (Sim-4) All-kinematic parameters. The prediction accuracy and root mean squared error (RMSE) were evaluated using a 10-fold cross-validation and compared between simulations. The same methodology was applied on a subset of 30 ASD patients followed (6 months to 2 years) after medical, orthopedic and surgical treatment. Simulations 1, 2, 3 and 4 had a median accuracy of 82, 85, 86 and 86%, respectively. Simulations 2, 3 and 4 had comparable accuracies of prediction for all HRQOL scores and higher predictions compared to Simulation 1 (i.e., accuracy for PCS=86±3 vs 90±2, 91±3% and 91±3% for simulations 1, 2, 3 and 4 respectively, p<0.05). Similar results were obtained for the 30 follwed-up ASD patients. Head and pelvis kinematics and step length are sufficient to predict HRQOL scores, even postoperatively, with higher accuracies than classic spinopelvic and global alignment parameters. While the latter play an integrating role in the surgical planning of ASD patients, coupling radiographic to only 3 key functional parameters would be optimal to provide a complete assessment and postoperative follow-up. Future technologies should focus on capturing these 3 parameters alone to allow surgeons to easily access functional assessment, bypassing the complexity of the complete gait analysis process.
Intraoperative neurophysiological monitoring (IONM) is a tool that can improve safety during spinal surgery. Patients with neuromuscular scoliosis (NMS) have inherent neural axis or primary muscle pathology that may present challenges to neuromonitoring. An understanding of IONM event rates, patterns, and outcomes would better prepare surgeons to counsel patients and families. IONM data from pediatric spine deformity correction procedures in patients with neuromuscular scoliosis at a single quaternary care center between 2012 and 2022 were reviewed to determine cases with monitorable IONM data as well as cases with IONM events. Surgical data and radiographic measures were compared between cases with and without lower extremity IONM events. 443 surgical cases were reviewed with 404 (91.2%) monitorable. Of monitorable cases, 37 (9.2%) cases had an IONM event. There were 363 (82.0%) cases were monitorable from the lower extremities, and of these, there were 27 (7.4%) cases had IONM events. One case (1/363 = 0.3%) had clinically identifiable post-surgical neurological complications. Statistical comparisons revealed more blood loss (p = 0.0473) and a trend toward more severe deformity angular ratio (p = 0.07) in cases with lower extremity intraoperative IONM events than those without. This study provides an estimate of IONM events and clinically identifiable neurological injury for children with neuromuscular scoliosis. These rates were similar to those reported in studies of other populations of children with spine deformity which supports the feasibility of IONM. Our data suggest that lower extremity IONM events tend to happen in more severe spine deformity cases.
VPAs quantify the spatial relationship of each vertebra to the pelvis and are independent of patient positioning, making them a valuable tool for preoperative planning and intraoperative assessment of sagittal alignment. Given the biomechanical relevance of vertebral pelvic angles (VPAs), their role in predicting proximal junctional kyphosis (PJK) warrants further investigation. We hypothesized that malalignment of VPAs is associated with an increased risk of developing PJK following long-segment fusion for adult spinal deformity (ASD). ASD patients ≥ 18 years undergoing ≥ 5-level posterior spinal instrumentation and fusion (PSIF) to the pelvis from 2015 to 2022 were included. VPAs (C2PA, T1PA, T4PA, T10PA, L1PA) were measured on standardized radiographs preoperatively and immediately postoperatively. PJK was defined radiographically by two criteria: (1) a postoperative proximal junctional sagittal Cobb angle ≥ 10°, and (2) an increase of ≥ 10° compared to the preoperative angle between the UIV and UIV + 2. Associations between VPA changes, published alignment thresholds (L1PA = PI × 0.5 - 19° ± 2°; T4-L1PA mismatch = - 3° to + 1°), and PJK were assessed using ROC analysis and logistic regression. A total of 266 patients (mean age: 57.5 ± 12.5 years; 74.8% female; mean follow-up: 24.6 ± 13.7 months) were included. Forty-five patients (16.9%) developed PJK, of which 37.8% were symptomatic. VPAs correlated most strongly with pelvic tilt (r up to 0.766). In the overall cohort, mean postoperative VPA values and changes were not significantly different between PJK and no-PJK groups. However, in a subgroup with UIV ≥ T5 (n = 174), patients with PJK demonstrated greater corrections in C2PA (14.3° vs. 8.0°, p < 0.001), T1PA (14.6° vs. 9.0°, p = 0.005), T4PA (12.9° vs. 8.3°, p = 0.016), T10PA (10.1° vs. 6.2°, p = 0.004), and L1PA (8.3° vs. 5.4°, p = 0.006). ROC demonstrated C2PA change held the highest predictive value for PJK (AUC = 0.64), followed by L1PA change (AUC = 0.62). Adherence to the published L1PA threshold and optimizing T4-L1PA mismatch to near neutral was protective against PJK in this cohort. Our results demonstrate that greater magnitude correction of VPAs from baseline, particularly C2PA and L1PA, was associated with an increased risk of PJK in longer constructs with a UIV proximal to T5. Furthermore, this study is consistent with prior work suggesting that L1PA and T4-L1 mismatch may be useful parameters when assessing sagittal alignment in relation to PJK risk.
To investigate the clinical efficacy and safety of modified bone-disc-bone osteotomy (BDBO) in the treatment of kyphosis caused by old thoracolumbar vertebral fractures. A retrospective analysis was performed on 22 consecutive patients (mean age 65.1 ± 5.9 years) who underwent posterior-only modified BDBO combined with internal fixation and fusion between September 2020 and December 2023. Radiological parameters, including global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), were measured on standing full-spine lateral X-rays. Clinical outcomes were evaluated using the Scoliosis Research Society-22 (SRS-22) questionnaire. All indicators were assessed preoperatively, on the 5th postoperative day, and at the final follow-up (minimum 24 months, mean 25.45 ± 2.24 months). Surgical data and complications were also recorded. Modified BDBO significantly corrected global kyphosis. For GK, the preoperative mean value was 45.32 ± 10.76°, which decreased to 10.51 ± 4.08° on the 5th postoperative day (significant difference, t = 15.82, p < 0.001) and 11.15 ± 4.25° at the final follow-up (compared with preoperative: t = 15.4, p < 0.001; compared with 5th postoperative day: t = - 10.88, p = 0.031). For TK, the preoperative mean value of 40.21 ± 11.24° significantly decreased to 24.5 ± 2.17° on the 5th postoperative day (t = 8.1, p < 0.001) and 24.82 ± 2.31° at the final follow-up (t = 8.01, p < 0.001), with a slight difference between the 5th postoperative day and final follow-up (t = - 6.25, p = 0.049). For LL, it decreased from 47.62 ± 14.74° preoperatively to 42.73 ± 6.58° on the 5th postoperative day (t = 2.79, p = 0.011) and 39.59 ± 7.18° at the final follow-up (t = 4.92, p = 0.006), with continuous adjustment between the 5th postoperative day and final follow-up (t = 23.1, p = 0.010). For SVA (a marker of spinal balance), the preoperative mean value of 37.95 ± 8.02 mm drastically decreased to 12.11 ± 3.92 mm on the 5th postoperative day (t = 29.06, p < 0.001) and 13.39 ± 4.07 mm at the final follow-up (t = 28.36, p < 0.001), with no significant drift. PI, PT, and SS also showed significant improvements and remained stable. No major neurological injury occurred. One patient had a superficial wound infection cured before discharge, and one had a pulmonary infection resolved with anti-infection treatment. All patients achieved solid fusion without internal fixation failure or pseudarthrosis. SRS-22 scores in Function (3.0 ± 0.3 vs. 3.8 ± 0.2, p < 0.001), Appearance (2.8 ± 0.2 vs. 4.0 ± 0.2, p< 0.001), and Pain (2.8 ± 0.2 vs. 3.6 ± 0.1, p < 0.001) domains improved significantly, with a mean satisfaction score of 4.1 ± 0.23. Modified BDBO is an effective and relatively safe surgical technique for kyphosis secondary to old thoracolumbar vertebral fractures. It provides powerful sagittal correction, sustains improved spinal alignment, and enhances patient-reported pain relief and function.
Anterior column realignment (ACR) can increase segmental lordosis through anterior longitudinal ligament release and hyperlordotic cage placement, but its additive value when combined with Smith-Petersen osteotomy (SPO)-based constructs is not fully clear. We compared outcomes of ACR + SPO vs SPO-only in thoracolumbar adult spinal deformity (ASD). We performed a retrospective cohort study of adults undergoing multilevel thoracolumbar fusion with pelvic fixation for ASD (2022-2024). All patients had ≥1 SPO and ≥1 instrumented interbody fusion and were grouped by whether ACR was performed (ACR + SPO vs SPO-only). Primary outcomes were changes in Oswestry Disability Index and visual analogue scale (VAS) scores (axial and radicular pain) at ≥6-month follow-up. Secondary outcomes included lumbar lordosis, pelvic tilt, sagittal vertical axis, length of hospital stay, and complications. Sixty-six patients met criteria (ACR + SPO n = 27; SPO-only n = 39). Improvements in Oswestry Disability Index and radicular VAS were clinically meaningful in both cohorts without clear between-group differences. Radiographic alignment improved in both cohorts; lumbar lordosis correction per interbody level was similar (5.7° vs 5.4°). Length of stay was significantly longer with ACR (P-value .003). Residual postoperative axial pain was higher with ACR (VAS mean difference 1.0; P-value .009), and axial pain improvement favored SPO-only (ΔVAS mean difference 1.2; P-value .019). Mechanical complications, proximal junctional complications, major medical events, and reoperation rates were not meaningfully different between groups. In thoracolumbar ASD reconstruction built on posterior column osteotomies, ACR did not provide superior correction of global sagittal alignment or greater improvement in disability or radicular pain, but it increased hospitalization and was associated with worse residual axial pain, supporting selective, indication-driven use.
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The increased use of hybrid spinal implants combining dissimilar metals raises concerns for galvanic corrosion, which can affect metal ion release and implant longevity. This study examines the variation in post-fusion metal ion concentrations among different hybrid implant constructs. In this prospective multicenter observational study, patients undergoing elective surgery for idiopathic or neuromuscular scoliosis received either cobalt-chromium (CoCr/Ti) or stainless steel (SS/Ti) rods with titanium screw implants. Blood metal ion concentrations were measured preoperatively and at 3, 12 and 24 months. Longitudinal data were analyzed using linear mixed-effects models adjusted for repeated measures. A total of 37 patients were enrolled in the CoCr/Ti group and 35 in the SS/Ti group, with a majority of females (68% in CoCr/Ti vs. 71% in SS/Ti). There were no significant differences between the groups in age, BMI, number of rod attachments or rod surface area. Chromium (Cr) levels initially increased then plateaued, remaining consistently higher in the SS/Ti group, and significantly above baseline at 24 months. Cobalt (Co) concentrations also initially increased in both groups, but were higher in CoCr/Ti. Titanium (Ti) levels increased in both groups but continued to show a positive trajectory in CoCr/Ti at 24 months. Higher titanium concentrations also correlated with the number of rod attachments and instrument-related complications in CoCr/Ti but not the SS/Ti group. With consideration of the different material properties in hybrid implant components, our findings suggest that differences in surface hardness appear to be more pertinent to metallic wear than galvanic corrosion.
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