Spine Research

Abstract

Growth modulation is an established technique for limb deformity correction and is increasingly applied to spinal deformities. While distraction-based posterior and anterior compressive methods have been explored, spinal growth modulation through fixation across vertebral growth centers remains unstudied. We hypothesized that unilateral trans-endplate screws-spinal epiphysiodesis trajectory (SET) screws-could induce partial anterior growth arrest and promote scoliotic deformity in a porcine model.Four male piglets (two experimental, two control) underwent unilateral posterior spinal instrumentation at four lower thoracic levels at eight weeks of age. Experimental animals received trans-endplate SET screws; controls received pedicle screws. Radiographs obtained three months postoperatively assessed vertebral height and Cobb angles. MRI and CT were also used to evaluate vertebral wedging, disc and facet health, physeal bars, and endplate changes.After three months, no significant differences in coronal or sagittal Cobb angles were observed between SET and pedicle screw groups (p > 0.05). No vertebral wedging or restriction of vertical growth was seen in either group. Disc and facet health remained unchanged by Pfirrmann and Fujiwara grading. No physeal bars were identified; one SET specimen showed endplate irregularities.In this pilot porcine model, SET screws did not produce scoliotic or kyphotic deformity. Further research is necessary to clarify the mechanisms and timing required for effective anterior spinal growth modulation.IV.

View details for DOI 10.1007/s43390-026-01313-1

View details for PubMedID 41910710

View details for PubMedCentralID 5686794

Abstract

Bone graft use for pediatric posterior spinal fusion (PSF) is highly variable and can lead to additional cost and risk. Biological failures of fusion are rare in children, suggesting that higher-risk grafts used for their perceived efficacy in adults may be unnecessary. This study aims to assess current expert perspectives on graft choice for pediatric PSF to provide guidance in this unique population, thus aiding risk and cost minimization.We conducted an institutional review board-approved Research Electronic Data Capture (REDCap) survey of surgeon members from an international spine deformity study group. Participants were asked about their graft choices for a routine adolescent idiopathic scoliosis case.Of the 49 invited surgeons, 35 (71%) completed the survey. Most respondents (57%) had over 20 years of experience and performed more than 75 pediatric spine deformity surgeries annually (63%). The majority (83%) used local autograft and cancellous allograft, with 51% using this combination without additional graft products. Surgeons cited side-effect profile, clinical evidence, cost, and training as primary factors influencing graft choice. Notably, 42% of participants acknowledged that iliac crest bone graft (ICBG) and bone morphogenic protein (BMP)-2 may promote better bone formation but were not routinely used due to costs and potential side effects.This expert survey suggests that local autograft combined with allograft represents the prevailing graft strategy among experienced surgeons. However, there is considerable variability in the adjunct use of other graft types/additives indicating a need for further research to establish the value of these adjuncts in pediatric PSF relative to risks and costs.(1)Bone graft choices vary widely among pediatric spine surgeons, with some using higher-risk grafts that lack evidence in children, even though fusion success rates are similar regardless of graft type.(2)An international survey of experienced pediatric spine deformity surgeons identified local autograft combined with cancellous allograft as the prevailing baseline strategy, with most surgeons avoiding additional graft products.(3)This choice is primarily influenced by side-effect profile, available clinical evidence, cost considerations, and training.(4)Among surgeons who do use adjunct grafts, the specific products selected vary considerably, reflecting heterogeneous practice patterns.(5)Given the low rate of biologic fusion failure in children, further research is needed to clarify when additional graft products provide value beyond the baseline strategy.V, Expert opinion.

View details for DOI 10.1016/j.jposna.2025.100290

View details for PubMedID 41552646

View details for PubMedCentralID PMC12809750

View details for DOI 10.1016/j.jposna.2025.100290

View details for Web of Science ID 001660481800001

Abstract

STUDY DESIGN: Retrospective cohort from a multicenter registry.OBJECTIVE: Characterize the variability of the last substantially touched vertebra (LSTV) in Lenke 1- and 2-AR curves and evaluate whether clinical or radiographic factors permit fusion short of the LSTV without increased adding-on risk.SUMMARY OF BACKGROUND DATA: Lenke 1 and 2A curves with an R modifier based on L4 tilt in adolescent idiopathic scoliosis (AIS) are associated with a higher risk of adding-on after posterior spinal fusion (PSF). Fusion to the LSTV may reduce this risk but often requires extending into the distal lumbar spine, compromising motion. The safety of terminating fusion proximal to the LSTV in select patients, without increasing adding-on risk, remains uncertain.METHODS: Patients with Lenke 1- or 2-AR curves undergoing PSF with minimum 2-year follow-up were identified. Radiographs were reviewed to determine LSTV level and assess for adding-on. Patients were stratified based on whether the lowest instrumented vertebra (LIV) was proximal to or at the level of/distal to the LSTV. Among those fused proximal, univariate and multivariate analyses were used to identify protective factors. Subgroup analyses were performed by LSTV level.RESULTS: Of 324 patients, 144 (44.4%) were instrumented proximal to the LSTV. Adding-on occurred in 16.0% of all patients, more frequently in short fusions (21.5% vs. 11.7%, P=0.016). Multivariate analysis identified higher Risser (OR=1.62, P=0.006) and greater main thoracic correction (OR=1.09, P<0.001) as protective. Adding-on was rare (4.0%) when the LSTV was L4, even when fused short.CONCLUSIONS: In skeletally mature patients with adequate thoracic correction, fusion proximal to the LSTV in Lenke 1- and 2-AR curves may be performed safely. When the LSTV is L4, fusion to that level may be unnecessary, offering an opportunity for lumbar motion preservation without increased risk of adding-on.LEVEL OF EVIDENCE: IV.

View details for DOI 10.1097/BRS.0000000000005602

View details for PubMedID 41400008

Abstract

INTRODUCTION: Distal radius fractures are the most common fractures seen in the emergency department in children in the USA. However, no established or standardised guidelines exist for the optimal management of completely displaced fractures in younger children. The proposed multicentre randomised trial will compare functional outcomes between children treated with fracture reduction under sedation versus children treated with simple immobilisation.METHODS AND ANALYSIS: Participants aged 4-10 years presenting to the emergency department with 100% dorsally translated metaphyseal fractures of the radius less than 5cm from the distal radial physis will be recruited for the study. Those patients with open fractures, other ipsilateral arm fractures (excluding ulna), pathologic fractures, bone diseases, or neuromuscular or metabolic conditions will be excluded. Participants who agree to enrol in the trial will be randomly assigned via a minimal sufficient balance algorithm to either sedated reduction or in situ immobilisation. A sample size of 167 participants per arm will provide at least 90% power to detect a difference in the primary outcome of Patient-Reported Outcomes Measurement Information System Upper Extremity computer adaptive test scores of 4 points at 1 year from treatment. Primary analyses will employ a linear mixed model to estimate the treatment effect at 1 year. Secondary outcomes include additional measures of perceived pain, complications, radiographic angulation, satisfaction and additional procedures (revisions, refractures, reductions and reoperations).ETHICS AND DISSEMINATION: Ethical approval was obtained from the following local Institutional Review Boards: Advarra, serving as the single Institutional Review Board, approved the study (Pro00062090) in April 2022. The Hospital for Sick Children (Toronto, ON, Canada) did not rely on Advarra and received separate approval from their local Research Ethics Board (REB; REB number: 1000079992) on 19 July 2023. Results will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings.TRIAL REGISTRATION NUMBER: NCT05131685.

View details for DOI 10.1136/bmjopen-2024-088273

View details for PubMedID 41161832

Abstract

BACKGROUND: Understanding outcomes of spinal fusion (SF) in children with cerebral palsy (CP) beyond the short term is important to determine efficacy and durability. This study examined complications, unplanned returns to the operating room (UPROR), and radiographic and clinical outcomes after SF in children with CP.METHODS: Patients with GMFCS IV or V CP who had been followed for a minimum of 5 years after SF were identified in a prospective multicenter database and analyzed. The major Cobb angle and pelvic obliquity (PO) were recorded. Data regarding complications and any UPROR were collected prospectively. The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire was completed preoperatively and at 2 and 5 years postoperatively. Data were analyzed using a generalized estimating equation (GEE), repeated-measures analysis of variance (RM-ANOVA), and the Kaplan-Meier method.RESULTS: One hundred and eighty-nine patients (mean age, 13.4 ± 2.7 years; 94 male and 95 female; 45% White, 24% Hispanic, 16% Black, and 4% Asian as self-reported) were included in the study. The preoperative Cobb angle (82.8° ± 23.0°) was improved at 2 years (29.9° ± 16.2°; p < 0.001), and the improvement was maintained at 5 years (30.2° ± 17.0°; p = 0.284). The preoperative PO (27.4° ± 15.6°) was improved at 2 years (9.7° ± 9.1°; p < 0.001), and the improvement was maintained at 5 years (9.9° ± 9.8°; p = 0.997). There were 46 patients (24.3%) with major complications and 25 patients (13.2%) who required UPROR, mostly within the first year. The probability of remaining free of major complications and of having no UPROR at 5 years was >75% and >87%, respectively. Improvements in CPCHILD scores were observed at 2 years and remained improved at 5 years compared with baseline. RM-ANOVA demonstrated no significant differences in the change in scores over time in patients with complications or UPROR compared with those who did not. Those with complications or UPROR showed no evidence of a major decline in CPCHILD scores.CONCLUSIONS: SF resulted in durable radiographic correction and sustained improvements in caregiver-reported quality of life over a minimum of 5 years. Patients with major complications or UPROR showed no deterioration in CPCHILD scores. These findings support SF as an effective treatment option for appropriately selected patients with GMFCSIV or V CP.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

View details for DOI 10.2106/JBJS.25.00186

View details for PubMedID 40956877

Abstract

Background: Artificial intelligence (AI) large language models (LLMs) are becoming increasingly popular, with patients and families more likely to utilize LLM when conducting internet-based research about scoliosis. For this reason, it is vital to understand the abilities and limitations of this technology in disseminating accurate medical information. We used an expert panel to compare LLM-generated and professional society-authored answers to frequently asked questions about pediatric scoliosis.Methods: We used three publicly available LLMs to generate answers to 15 frequently asked questions (FAQs) regarding pediatric scoliosis. The FAQs were derived from the Scoliosis Research Society, the American Academy of Orthopaedic Surgeons, and the Pediatric Spine Foundation. We gave minimal training to the LLM other than specifying the response length and requesting answers at a 5th-grade reading level. A 15-question survey was distributed to an expert panel composed of pediatric spine surgeons. To determine readability, responses were inputted into an open-source calculator. The panel members were presented with an AI and a physician-generated response to a FAQ and asked to select which they preferred. They were then asked to individually grade the accuracy of responses on a Likert scale.Results: The panel members had a mean of 8.9 years of experience post-fellowship (range: 3-23 years). The panel reported nearly equivalent agreement between AI-generated and physician-generated answers. The expert panel favored professional society-written responses for 40% of questions, AI for 40%, ranked responses equally good for 13%, and saw a tie between AI and "equally good" for 7%. For two professional society-generated and three AI-generated responses, the error bars of the expert panel mean score for accuracy and appropriateness fell below neutral, indicating a lack of consensus and mixed opinions with the response.Conclusions: Based on the expert panel review, AI delivered accurate and appropriate answers as frequently as professional society-authored FAQ answers from professional society websites. AI and professional society websites were equally likely to generate answers with which the expert panel disagreed.Key Concepts: (1)Large language models (LLMs) are increasingly used for generating medical information online, necessitating an evaluation of their accuracy and effectiveness compared with traditional sources.(2)An expert panel of physicians compared artificial intelligence (AI)-generated answers with professional society-authored answers to pediatric scoliosis frequently asked questions, finding that both types of answers were equally favored in terms of accuracy and appropriateness.(3)The panel reported a similar rate of disagreement with AI-generated and professional society-generated answers, indicating that both had areas of controversy.(4)Over half of the expert panel members felt they could distinguish between AI-generated and professional society-generated answers but this did not relate to their preferences.(5)While AI can support medical information dissemination, further research and improvements are needed to address its limitations and ensure high-quality, accessible patient education.Levels of Evidence: IV.

View details for DOI 10.1016/j.jposna.2025.100196

View details for PubMedID 40791971