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Introduction: The management of type A thoracolumbar fractures varies from conservative treatment to multiple level fusion. Indeed, although Magerl defined the type A fracture as a strictly bone injury, several authors suggested associated disc lesions or degeneration after trauma. However, the preservation of mobility of the adjacent discs should be a major issue. This study was conducted to analyze the presence of immediate post-traumatic disc injuries and to know if discs degenerate after receiving treatment. Methods: We retrospectively reviewed the files of 27 patients with an AOspine A fracture, corresponding to 34 fractures (64 discs) with pre and post-operative MRI (mean follow-up: 32.4 months). Based on Pfirrmann’s and Oner’s classifications of disc injuries, two observers analyzed independently the type of lesion in the discs adjacent to the fractured vertebra in immediate post-trauma and at the last follow-up. Results: The immediate post-traumatic analysis according to Pfirrmann’s classification found 97% of the cranial adjacent discs and 100% of the caudal discs classified Pfirrmann 3 or less. The analysis on the secondary MRI revealed that 78% of cranial adjacent discs and 88% of caudal adjacent discs still were classified Pfirrmann 3 or less. Conclusions: Since, the great majority of type A fractures does not cause immediate disc injuries, these fractures are, as described by Magerl, strictly bony injuries. The quality of the body reduction seems to prevent secondary degeneration. These results may encourage surgeons not to perform arthrodesis on type A fractures even for A3 and A4.

Mohamad Khalife,1 Mohamad A Eloubeidi,2 Maen Aboul Hosn11Department of Surgery, 2Department of Internal Medicine, American University of Beirut, Beirut, LebanonAbstract: McKittrick–Wheelock syndrome is a rare disease characterized by a large hypersecretory rectosigmoid villous adenoma resulting in persistent large volume diarrhea, electrolyte abnormalities, and renal dysfunction. We report an unusual presentation of this syndrome in a patient who developed persistent diarrhea along with dermatomyositis and rectal prolapse and was later discovered to have a large rectal villous adenoma along with a smaller sigmoid tubulovillous adenoma. In our literature review, we were able to find one case report of a dermatomyositis occurring in conjunction with a tubulovillous adenoma and few case reports of rectal prolapse in the setting of a secretory villous adenoma. However, there were no reports on both occurring in association with McKittrick–Wheelock syndrome. This report highlights the variable manifestations of colorectal adenomas and the importance of searching for an underlying neoplastic entity in patients with new onset dermatomyositis or rectal prolapse or both.Keywords: villous adenoma, McKittrick–Wheelock syndrome, dermatomyositis, rectal prolapse, secretory adenoma, rectal polyps

Abstract Background In this retrospective study, we evaluated the prognostic effect of positive lymph-node ratio (pLNR) on patients with stage III colorectal cancer (CRC). Our paper is the first analysis, to our knowledge, to deal with such data from the Middle East. Methods We analyzed the clinicopathological data of 535 patients diagnosed with colorectal cancer at our institution between 1983 and 2003. The 164 patients diagnosed with stage III disease were divided into two categories based on lymph-node ratio (LNR) being the ratio of positive lymph nodes over total lymph nodes dissected: LNR ≤0.4 and LNR >0.4. We used Kaplan-Meier and Cox proportional hazard models to evaluate the prognostic effect of pLNR. Results The 10-year survival rate for the patients with stage IIIA, IIIB and IIIC cancers were 76%, 56% and 0% respectively (P = 0.014). Using pLNR of 0.4 as the cutoff point was found to yield clinically and significant results, with a significant difference in the outcomes of patients with pLNR ≤0.4 compared to those with pLNR >0.4 (hazard ratio = 5.25, 95% confidence interval = 1.2 to 22.1, P = 0.02). Conclusion The ratio-based staging (pLNR) of CRC is a more accurate and clinically useful prognostic method than the number of positive LNs resected or the total number of LNs retrieved for predicting the course of patients with stage III CRC.

Abstract We report a rare case of synchronous duodenal carcinoma, colonic carcinoma and renal oncocytoma successfully treated using a one-stage surgical approach. Potential risk factors for multiple primary malignancies associated with duodenal carcinoma are discussed. This case illustrates several practice points for consideration: 1. Patients presenting with small intestinal carcinomas have a higher than average chance of developing second primary tumors in other organs; this should be taken into consideration during staging and follow-up. 2. For full staging of patients presenting with small bowel tumors, upper and lower gastrointestinal endoscopy and PET scanning should be considered. 3. A one-stage surgical procedure can be used safely and successfully for multiple synchronous primary tumors.

Abstract Introduction An abdominal pseudocyst is a rare complication of a ventriculo-peritoneal shunt. Etiological factors include infection, obstruction and dislodgement. This is the first report of a hepatic cerebrospinal fluid pseudocyst mimicking hydatid liver disease. Case presentation We report the case of an 18-year-old Caucasian male patient who presented with a hepatic pseudocyst secondary to a ventriculo-peritoneal shunt, misdiagnosed as hydatid disease of the liver. Conclusion Hepatic pseudocysts, a rare complication of a ventriculo-peritoneal shunt, have similar clinical and radiological characteristics to those of hydatid liver disease. The formation of a pseudocyst should always be considered in patients with ventriculo-peritoneal shunts in situ.

Abstract Inflammatory pseudo-tumor (IPT) of the liver is a rare benign neoplasm and is often mistaken as a malignant entity. Few cases have been reported in the literature and the precise etiology of inflammatory pseudotumor remains unknown. Patients usually present with fever, abdominal pain and jaundice. The proliferation of spindled myofibroblast cells mixed with variable amounts of reactive inflammatory cells is characteristics of IPT. We reviewed the literature regarding possible etiology for IPT with a possible suggested etiology.

Abstract Primary undifferentiated embryonal sarcoma of the liver is a rare tumor with a peak incidence between the ages of 6 and 10 years. We report a case of a primary hepatic undifferentiated embryonal sarcoma arising in a 21-year-old male mistaken for hydatid disease of the liver. The rapid recurrence of this tumor along the site of attempted percutaneous drainage illustrates some important management points regarding this malignancy.

Abstract Background Primary hepatic leiomyosarcoma is a rare disease diagnosed in older aged adults with a median age of 58 and occasionally in children with a history of immunosuppression. Methods From 1998 to 2009, 215 patients were diagnosed with primary hepatic malignancies at our institution, 4 of which were diagnosed with primary hepatic sarcoma (1.8%). Three cases were primary hepatic leiomyosarcomas (LMS) and one case was primary undifferentiated embryonal sarcoma of the liver; median age 30 (range 20-39) years. Results One patient is currently 12 months post-resection with no evidence of recurrence. Two patients passed away at 19 days and 22 months from small for size liver and tumor recurrence respectively. Conclusion We have presented 3 cases of primary hepatic leiomyosarcoma diagnosed at our institution with an unusually young age distribution and no evidence of immunosuppression. These cases highlight the diagnostic and therapeutic challenges of this rare tumour.

Study Design: Multicentric retrospective study of prospectively collected data., Objective: On the basis of normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate., Summary of Background Data: Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account., Patients and Methods: This study included 721 healthy volunteers and 824 ASD surgery patients with two-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2SD. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes' and Lovecchio's definitions for PJK in the ASD population at two years., Results: Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P <0.001). There was 46.2% of PJK according to Glattes' versus 8.7% according to Lovecchio's and 22.9% of kyphotic PJA compared with normative values ( P <0.001)., Conclusion: This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK., Level of Evidence: Level II., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The variation of lumbar lordosis between standing and supine position is poorly explored in literature. This study sought to analyze variation of lumbar regional angulations (RA) in healthy volunteers between standing and supine positions, according to pelvic incidence (PI)., Methods: This study included 171 patients who had an abdominal CT-scan in supine position and 879 healthy volunteers with full-body stereoradiographs. The two populations were matched using a propensity score including age, PI, and sex. PI and RAs for all vertebrae from T12 to L5 (measured between the overlying vertebra's upper endplate of and the underlying vertebra's lower endplate) were assessed. Studied parameters were compared between Supine and Standing groups in the whole cohort and in every PI group. Multivariate analysis was performed to ascertain the effect of position change., Results: The analysis was performed on 314 subjects (157 matched in each group). In the overall cohort, all RAs from L1 to L4 were more lordotic in the Standing group, ranging from 3 to 8° difference (all p < 0.001), while T12 and L5 RAs were comparable in both groups (p = 0.55 and 0.49, respectively). Multivariate analysis confirmed the significant associations between subject's position and all RAs except for L5 and T12. RA variation between positions occurred at more vertebral levels and tended to be greater in higher PI groups., Conclusion: RA values in the lumbar spine are more lordotic in standing position than supine, except for T12 and L5. These results help estimate RA in Standing position in patients with lumbar fractures., Level of Evidence: IV., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Masson SAS.)

Study Design: A multicentric retrospective study., Objective: The study of center of mass (COM) locations (ie, barycentremetry) can help us understand postural alignment. The goal of this study was to determine relationships between COM locations and global postural alignment x-ray parameters in healthy subjects. The second objective was to determine the impact on the spinopelvic alignment of increased distance between the anterior body envelope and spine at the lumbar apex level., Summary of Background Data: Unexplored relationship between COM location and spinopelvic parameters., Methods: This study included healthy volunteers with full-body biplanar radiographs, including body envelope reconstruction, allowing the estimation of COM location. The following parameters were analyzed: lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), pelvic tilt (PT), sacro-femoral angle (SFA), knee flexion angle (KFA), and sagittal odontoid-hip axis angle (ODHA). The following COM in the sagittal plane were located: whole body, at a thoracolumbar inflection point, and body segment above TK apex. The body envelope reconstruction also provided the distance between the anterior skin and the LL apex vertebral body center ("SV-L distance")., Results: This study included 124 volunteers, with a mean age of 44±19.3. Multivariate analysis confirmed the posterior translation of COM above TK apex with increasing LL ( P =0.002) through its proximal component and posterior shift of COM at the inflection point with increasing TK ( P =0.008). Increased SV-L distance was associated with greater ODHA ( r =0.4) and more anterior body COM ( r =0.5), caused by increased TK ( r =0.2) and decreased proximal and distal LL (both r =0.3), resulting in an augmentation in SFA ( r =0.3) (all P <0.01)., Conclusions: Barycentremetry showed that greater LL was associated with a posterior shift of COM above the thoracic apex, while greater TK was correlated with more posterior COM at inflection point. Whole-body COM was strongly correlated with ODHA. This study also exhibited significant alignment disruption associated with increased abdominal volume, with compensatory hip extension., Level of Evidence: Level-II., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Prospective multicentric study., Objective: This study goal was to analyze the clinical and radiographic outcomes of lumbar stenosis and scoliosis (LSS) patients, treated with lumbar decompression (LD), short fusion and decompression (SF) or long fusion with deformity correction (LF)., Hypothesis: Procedures without correction lead to poorer long-term outcomes., Methods: Consecutive patients with two-year minimum follow-up, older than 50, with lumbar scoliosis (Cobb angle>15°), and symptomatic lumbar stenosis were included. Age, gender, Lumbar and Radicular Visual Analog Scale, ODI, SF12 and SRS30 were collected. Main and adjacent curves Cobb angles, C7 coronal tilt (C7CT), spinopelvic parameters, and spino-sacral angle (SSA) were measured preoperatively, at one and two years. Patients were sorted into surgery type groups., Results: In total, 154 patients were included, with respectively 18, 58 and 78 patients in LD, SF and LF groups. Mean age was 69, 85% were women. Clinical scores improved in each group at one year, but only LF group exhibited persistent improvement at 2years. A significant fractional Cobb angle increase was noted in the SF group at 2years (from 12±11° to 18±14°). C7CT significantly increased in the LD group at 2years (from 2.5±1.3° to 5.1±3.5°). LF group presented the highest complication rate (45%, 19% for SF and 0% for LD). The overall revision rate was 14% in SF group and 30% in LF group., Conclusion: LSS is a complex pathology requiring custom-made surgical treatment. LD, SF and LF allow satisfactory clinical outcome, with a better and more sustained clinical improvement for LF despite higher complication and revision rates., Level of Evidence: IV., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Adolescent idiopathic scoliosis (AIS) is a common spinal disease affecting 2% of adolescents, and women in 90% of the cases. When a surgical treatment is opted for, many questions are frequently asked by families and patients about the course of pregnancy and childbirth after the spinal fusion. This subject remains little studied in the literature, especially with modern instrumentation techniques., Hypothesis: The goal was to describe pregnancy and childbirth after AIS surgery in terms of access to epidural analgesia, need for cesarean section (c-section), and low back pain during and after pregnancy. We thus hypothesized that women undergoing spinal surgery for AIS have subsequently uncomplicated pregnancies and childbirths, and have access to epidural analgesia as women without AIS do., Patients and Methods: In this retrospective multicenter study, 198 women who underwent surgery between 1984 and 2014 were reviewed from two university hospitals. Among them, 50 women became pregnant, for a total of 80 pregnancies. Surgical data were collected [approach, uppermost and lowermost instrumented vertebra (UIV, LIV)]. Pregnancy characteristics were evaluated: time between surgery and pregnancy, number of births, mode of analgesia, type of delivery, weight gain. Occurrence of low back pain during pregnancy and at follow-up was recorded using ODI., Results: Of the 50 women, 34 had posterior surgery and 16 had anterior surgery. Deliveries took place from 1988 to 2018. Of the 80 pregnancies, 81% were delivered by vaginal route (n=65/80), and an effective epidural anesthesia was performed for 49% of them (n=39/80). Epidural analgesia failed in 9% of pregnancies (n=7/80), and was denied in 35% of cases (n=28/80), half of the time by anesthesiologists (n=15/80). Patients refused epidural in 13 pregnancies (16%, n=13/80). A general anesthesia was used in six pregnancies (8%, n=6/80), for c-sections only. Back pain was reported in 48% of the pregnancies (n=38/80). The level of fusion was correlated with c-section, and conversely with epidural anesthesia., Discussion: A normal pregnancy with vaginal delivery seems to be the rule for women undergoing spinal fusion for AIS. The c-section rate in AIS women was similar to the general population (19%). Yet, access to epidural anesthesia still seems problematic with only 49% of births in this series, compared with 81% in the French population., Level of Evidence: IV, retrospective cohort., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Study Design: Retrospective study of a multicentric prospective database., Objective: This study aimed to determine, in a cohort of healthy volunteers, the impact of sacralized lumbo-sacral transitional vertebra (LSTV) on spinal alignment according to its grade, particularly regarding lumbar lordosis magnitude and distribution, and the implications for spinopelvic parameters measurement., Summary of Background Data: There is little data regarding spinopelvic alignment assessment in LSTV patients., Methods: This study included healthy volunteers with full-body stereoradiographs in free-standing position aged over 18. Castellvi grade, pelvic parameters (measured on S1 and L5), L1-S1 lumbar lordosis (LL) and segmental lordosis for each disc and vertebral body, thoracic kyphosis, cervical lordosis, lower limb, and global alignment parameters were assessed. Castellvi I and II were considered as Low-grade and Castellvi III and IV as High-grade LSTV. Alignment parameters between No-LSTV, Low- and High-grade LSTV were compared. Propensity score matching was used to match PI in No-LSTV and Low-grades. Spinopelvic parameters measured on S1 in No-LSTV group and on L5 in High-grade were compared., Results: 713 subjects were included, of whom 23 Low-grades and 27 High-grades. Mean pelvic incidence was 51.0±11.0° and mean age was 37.5±16.2 years. LL distribution was different between groups, with an apex and inflexion point significantly higher in High-grade ( P<0.001 ). Kyphosis in the LSTV segment was compensated for by a steeper increase of LL above L5 in the High-grades. Low-grades and PI-matched No-LSTV presented similar alignment parameters. There were minor differences in parameters measured on S1 in No-LSTV and no L5 in High-grades., Conclusion: Subjects with low-grade LSTV present similar alignment as PI-matched No-LSTV subjects, and S1 should be taken as reference to measure spinopelvic parameters. High-grade LSTV subjects have kyphotic L5-S1 segment with more cranial lumbar apex and thoracolumbar inflexion point. In these subjects, spinopelvic parameters should be measured on L5., Competing Interests: Conflicts of interest: The authors have no conflict of interest to declare relatively to this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Previous work comparing ASD to a normative population demonstrated that a large proportion of lumbar lordosis is lost proximally (L1-L4). The current study expands on these findings by collectively investigating regional angles and spinal contours., Methods: 119 asymptomatic volunteers with full-body free-standing radiographs were used to identify age-and-PI models of each Vertebra Pelvic Angle (VPA) from L5 to T10. These formulas were then applied to a cohort of primary surgical ASD patients without coronal malalignment. Loss of lumbar lordosis (LL) was defined as the offset between age-and-PI normative value and pre-operative alignment. Spine shapes defined by VPAs were compared and analyzed using paired t-tests., Results: 362 ASD patients were identified (age = 64.4 ± 13, 57.1% females). Compared to their age-and-PI normative values, patients demonstrated a significant loss in LL of 17 ± 19° in the following distribution: 14.1% had "No loss" (mean = 0.1 ± 2.3), 22.9% with 10°-loss (mean = 9.9 ± 2.9), 22.1% with 20°-loss (mean = 20.0 ± 2.8), and 29.3% with 30°-loss (mean = 33.8 ± 6.0). "No loss" patients' spine was slightly posterior to the normative shape from L4 to T10 (VPA difference of 2°), while superimposed on the normative one from S1 to L2 and became anterior at L1 in the "10°-loss" group. As LL loss increased, ASD and normative shapes offset extended caudally to L3 for the "20°-loss" group and L4 for the "30°-loss" group., Conclusion: As LL loss increases, the difference between ASD and normative shapes first occurs proximally and then progresses incrementally caudally. Understanding spinal contour and LL loss location may be key to achieving sustainable correction by identifying optimal and personalized postoperative shapes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Cosmetic concerns are one of the main complaints of patients with adolescent idiopathic scoliosis (AIS). Several studies have shown a significant improvement in self-image scores after thoracoplasty. However, the effects of thoracoplasty on pulmonary function and clinical outcomes remain debated. The objective was to analyze the benefits and risks of thoracoplasty during AIS surgery using a hybrid construct with sublaminar bands., Material and Methods: In this monocentric prospective cohort study, 68 patients with thoracic AIS were consecutively included between 2016 and 2017. All patients had low-dose 3D radiographs. Surgical correction was performed via the posterior approach, using the posteromedial translation technique with a hybrid construct (thoracic sublaminar band and lumbar pedicle screws). A thoracoplasty was proposed in cases of severe rib hump (more than 3cm). Pulmonary function was assessed by pulmonary function tests (PFT) with forced vital capacity, forced expiratory volume in 1 second and total lung capacity). Radiographic parameters and PFT were compared between patients who had or had not had a thoracoplasty preoperatively and 2 years postoperatively. The SRS-22 score was collected at follow-up., Results: The average age was 15±3 years. Nineteen patients (27%) had a thoracoplasty. The demographic, radiographic and respiratory data of the 2 groups were comparable preoperatively. The correction was similar between the groups on sagittal and coronal views. At 2 years, the PFTs were comparable to those performed preoperatively and no difference was found between the groups. None of the 12 patients who had a pleural effusion had it drained. The total SRS-22 score and the cosmetic subscore were higher in the thoracoplasty group (p<0.03)., Discussion: The association of a thoracoplasty with AIS surgery improves the self-image of patients without altering the PFTs at 2 years postoperatively. Given the low morbidity of thoracoplasty, it seems reasonable to offer it to patients with severe rib hump and high cosmetic demands., Level of Evidence: III., (Copyright © 2022. Published by Elsevier Masson SAS.)

Purpose: Scoliosis surgery is becoming increasingly frequent. Rate of readmission is little discussed in the literature. It is an interesting data for the patient's information and for public authorities to calculate cost-effectiveness. Aim of the study was to evaluate rate and causes of short and long-term readmissions in patients > 45 years old operated on for a scoliosis primary cases, then to look for predictors of these readmissions., Methods: In this monocentric retrospective cohort study, over 45 years-old scoliosis primary cases operated on between 2015 and 2018 and with a minimum of 2 years follow-up were included. The number of readmissions and their causes were analyzed. Rehospitalized patients (RH) were then compared to non-rehospitalized patients (NRH). Risk factors were sought using a multivariate analysis by logistic regression., Results: 105 patients were included (90% female; 64 ± 8 years). 56% were readmitted at least once. Main cause of readmission as pseudarthrosis (70%). Among the RH patients, fifty-eight required at least one revision. We found no significant difference between RH and NRH, apart from the rate of immediate post-operative medical complications which was significantly higher in RH (17% (n = 11) vs. 4% (n = 2), p = 0.04). According to multivariate analysis, BMI and age were found as predictors of readmission of mechanical origin, and BMI for readmissions of septic origin., Conclusion: The readmission rate after scoliosis surgery was 56%. The main cause was pseudarthrosis. Rehospitalized patients had more immediate post-operative medical complications. The elderly and overweight patients are more likely to be readmitted for mechanical or septic reasons., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: Retrospective study of a multicentric prospective database., Objective: This study aimed at describing the relative contribution of vertebral bodies versus discs to lumbar lordosis, and its variation with age and pelvic incidence., Summary of Background Data: While studies sought to determine the physiological magnitude and distribution of lumbar lordosis, data regarding its anatomical composition is lacking., Methods: This study included healthy volunteers with full-body stereoradiographs in free-standing position, without lumbosacral transitional vertebra or age under 18. The following parameters were analyzed: age, sex, pelvic incidence (PI), lumbar lordosis (LL). Posterior heights and sagittal Cobb angles between upper and lower endplate for each lumbar disc and each vertebral body were measured from L1 to S1. Ratios of contribution to LL were calculated for each disc and vertebral body. The cohort was divided into four age groups and four PI groups., Results: 645 subjects were included, mean age was 37.6±16.3, 51% of females. There was a significant decrease in total lumbar disc lordosis with age (-48.9±9.7° to -42.9±10.2°), occurring in lower LL. Vertebral bodies were significantly more kyphotic in Seniors than Youngs (-8.9±8.4° vs. -5.0±9.4°, P=0.03 ), driven by a significant increase in kyphosis of L1 and L2 bodies. Vertebral body contribution to LL significantly increased between groups as PI increased, from a median of 8.0% to 20.5% ( P<0.001 ). This decrease in disc contribution in favor of vertebral bodies mainly took place in lower LL., Conclusion: This study highlights the importance of vertebral contribution to lumbar lordosis, ranging from 8 to 21% among PI groups. Lumbar lordosis decreased with aging through decreased disc lordosis in the lower lumbar spine and increased body kyphosis in the upper lumbar spine. These results may help surgeons in the assessment of sagittal alignment and the selection of operative technique to achieve surgical correction., Competing Interests: Conflicts of interest: The authors have no conflict of interest to declare relatively to this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Knowledge of the growth spurt and remaining growth is essential for managing musculoskeletal diseases in children. Accurate prediction of curve progression and timely interventions are crucial, particularly for conditions like adolescent idiopathic scoliosis (AIS)., Methods: This study conducted a comprehensive review and synthesis of existing literature on spinal growth, skeletal maturity classifications, and the evolution of sagittal alignment parameters during childhood and adolescence. Key anatomical elements involved in spinal development, natural history of spinal growth, and skeletal maturity assessment systems were analyzed., Results: The analysis highlighted that key parameters such as Pelvic incidence (PI), Pelvic tilt (PT), and Lumbar lordosis (LL) increase significantly with growth, especially during the pubertal growth spurt. In contrast, Sacral slope (SS) remains relatively constant, and Thoracic kyphosis (TK) shows a slight increase. Additionally, there is a posterior shift in the center of gravity as children grow, reflecting progressive postural maturation. The study also reviewed and compared various maturity classification systems, noting the reliability and clinical implications of systems like the Sanders Maturity Stage (SMS) and Tanner-Whitehouse III., Conclusions: Reliable maturity classification systems, such as the Sanders Maturity Stage (SMS) and Tanner-Whitehouse III, allow for tailored treatments to individual growth patterns. Integrating these classification systems into clinical practice enables precise prediction of curve progression and timely therapeutic interventions. This includes options from bracing to surgical techniques like growing rods or vertebral body tethering (VBT), with growth modulation being a key factor in achieving successful outcomes., Competing Interests: One or more of the authors declare financial or professional relationships on ICMJE-NASSJ disclosure forms., (© 2024 The Authors.)

Purpose: The goal of this study was to explore sex-related variations of global alignment parameters and their distinct evolution patterns across age groups., Methods: This multicentric retrospective study included healthy volunteers with full-body biplanar radiographs in free-standing position. All radiographic data were collected from 3D reconstructions: global and lower limb parameters, pelvic incidence (PI) and sacral slope (SS). Lumbar lordosis (LL), thoracic kyphosis (TK) and cervical lordosis (CL) were also assessed as well as the lumbar and thoracic apex, and thoracolumbar inflexion point. The population was divided into five 5 age groups: Children, Adolescents, Young, Middle-Aged and Seniors., Results: This study included 861 subjects (53% females) with a mean age of 34 ± 17 years. Mean PI was 49.6 ± 11.1 and mean LL was - 57.1 ± 11.6°. Females demonstrated a PI increase between Young and Middle-Aged groups (49 ± 11° vs. 55 ± 12°, p < 0.001) while it remained stable in males. SS and LL increased with age in females while remaining constant in males between Children and Middle-aged and then significantly decreased for both sexes between Middle-Aged and Seniors. On average, lumbar apex, inflexion point, and thoracic apex were located one vertebra higher in females (p < 0.001). After skeletal maturity, males had greater TK than females (64 ± 11° vs. 60 ± 12°, p = 0.04), with significantly larger CL (-13 ± 10° vs. -8 ± 10°, p = 0.03). All global spinal parameters indicated more anterior alignment in males., Conclusion: Males present more anteriorly tilted spine with age mainly explained by a PI increase in females between Young and Middle-Aged, which may be attributed to childbirth. Consequently, SS and LL increased before decreasing at senior age., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: Retrospective review of a prospectively-collected multicenter database., Objectives: The objective of this study was to determine optimal strategies in terms of focal angular correction and length of proximal extension during revision for PJF., Methods: 134 patients requiring proximal extension for PJF were analyzed in this study. The correlation between amount of proximal junctional angle (PJA) reduction and recurrence of proximal junctional kyphosis (PJK) and/or PJF was investigated. Following stratification by the degree of PJK correction and the numbers of levels extended proximally, rates of radiographic PJK (PJA >28° & ΔPJA >22°), and recurrent surgery for PJF were reported., Results: Before revision, mean PJA was 27.6° ± 14.6°. Mean number of levels extended was 6.0 ± 3.3. Average PJA reduction was 18.8° ± 18.9°. A correlation between the degree of PJA reduction and rate of recurrent PJK was observed (r = -.222). Recurrent radiographic PJK (0%) and clinical PJF (4.5%) were rare in patients undergoing extension ≥8 levels, regardless of angular correction. Patients with small reductions (<5°) and small extensions (<4 levels) experienced moderate rates of recurrent PJK (19.1%) and PJF (9.5%). Patients with large reductions (>30°) and extensions <8 levels had the highest rate of recurrent PJK (31.8%) and PJF (16.0%)., Conclusion: While the degree of focal PJK correction must be determined by the treating surgeon based upon clinical goals, recurrent PJK may be minimized by limiting reduction to <30°. If larger PJA correction is required, more extensive proximal fusion constructs may mitigate recurrent PJK/PJF rates., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.