Deformities

Management of scoliosis, kyphosis, and complex spinal deformity (SCD), focusing on correction goals, instrumentation, and MIS or robotic integration.

Overview

Operative intervention for spinal deformities is primarily driven by clinical manifestations rather than radiographic metrics, particularly in kyphotic deformity associated with myelomeningocele [2]. While congenital scoliosis exhibits variable progression, the majority of cases are managed non-surgically [4]. When surgical treatment is required for congenital scoliosis, the approach relies on fusion, resection, or growth-friendly techniques, selected based on patient age, curve characteristics, and anomaly type [4]. For congenital upper thoracic scoliosis, surgery is supported by the absence of major neurological complications but carries a high risk of complications, specifically distal adding-on [13].

In adult populations, surgical intervention for Scheuermann kyphosis is indicated for patients with persistent pain and unacceptable deformity caused by significant kyphosis [28]. Correction and stabilization are also considered beneficial for spinal deformities in familial dysautonomia [57]. For coxa vara in childhood, surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, whereas moderate nonprogressive cases often do not require surgery [8]. In adolescent idiopathic scoliosis, the focus of surgical correction has shifted from isolated coronal deformity to include restoration of segmental and global sagittal alignment to achieve optimum long-term results [60].

Long-term outcomes for anterior vertebral body tethering show that postoperative success decreases as deformity progression is observed in most subgroups with more than 5 years of follow-up [5]. Consequently, revision and suspected broken tether rates increase with more than 5 years of follow-up for this technique [5]. Management of skeletal dysplasias, connective tissue disorders, and genetic conditions, including Marfan syndrome and Osteogenesis Imperfecta, guides the treatment of associated skeletal deformities and complications [6]. For active patients with osteogenesis imperfecta, arthroplasty may be considered but is frequently associated with complications due to underlying deformities [61].

Anatomy & Pathophysiology

Cervical spinal deformity represents a debilitating condition with diverse etiologies [22], prompting recent efforts to establish classification schemes and treatment algorithms that clarify outcomes and the relationship between cervical and thoracolumbar alignment [22]. In adolescent idiopathic scoliosis, spinal morphology and its correction influence the intensity and location of back pain, whereas balance does not influence pain severity [76]. The severity of spinal deformity is the primary determinant of cardiac health impact in resting patients with severe scoliosis, while curvature direction is not [79]. Early screening for incorrect postures and angle of trunk rotation serves as both an effective and economical strategy to predict the severity of adolescent idiopathic scoliosis [77].

Osseous and Morphometric Factors: Morphometric characteristics of vertebral bodies differ according to the pathogenesis of scoliosis, and the pathology of vertebral wedging cannot be attributed solely to asymmetric loading [98]. Critical spinal lytic defects result in kinematic abnormalities and lower the compressive strength of the spine [58]. Structural variations of the lumbosacral joint, including posterior displacement and facet inclination, are not of clinical importance except when extreme [82]. Modifications in spinal curvatures during childhood are not large enough to be considered in clinical practice or to impact surgical planning [83].

Kinematics and Biomechanics: Global lumbar spine kinematics do not reflect regional lumbar spine kinematics [39], and pelvic, trunk, and upper limb biomechanics in individuals with spinal deformities are complex [53]. Understanding the biomechanical principles of spinal instrumentation and motion coupling is essential for optimizing three-dimensional correction of thoracolumbar deformities and achieving favorable mechanical environments for fusion [49]. Development of spinal curvature in the sagittal plane and maintenance of symmetry in the coronal and transverse planes are essential for correct balance control [96]. Variations in spinal growth velocity exert a more direct influence over changes in angle velocity than height velocity in peri-pubertal girls with idiopathic scoliosis [90].

Dynamic and Postural Variability: The coronal Cobb angle and the SI of paraspinal muscle activity in adolescent idiopathic scoliosis patients vary with posture changes [88]. Forces in zone 3 applied by spinal orthoses neither significantly reduced thoracic kyphosis nor exacerbated the deviation of the scoliotic spine from the sagittal plane [84]. Following anterior vertebral body tethering, motion in the coronal plane decreased by 77%, yet measurable thoracic motion remains at 1 year, with sagittal motion greater than coronal motion [87].

Therapeutic Implications: Selecting fusion levels in adolescent idiopathic scoliosis balances expert opinion with current literature to minimize the risk of future progression, optimize spinal balance, and fuse the least number of levels necessary [80]. The Lyon brace is highly effective in correcting thoracic curves in adolescent females with thoracic idiopathic scoliosis, acting through biomechanical action on vertebral modeling [97].

Classification

Congenital Scoliosis: This deformity exhibits variable progression and is managed via fusion, resection, or growth-friendly techniques based on patient age, curve characteristics, and anomaly type [4]. Pediatric spine disorders encompass idiopathic scoliosis, congenital anomalies, and tumors [9]. Evaluation of these disorders requires detailing epidemiology, pathoanatomy, classification, and treatment recommendations derived from natural history and existing literature [9].

Early-Onset Scoliosis (C-EOS): A novel classification system for early-onset scoliosis was developed using formal consensus-building methods among experienced surgeons [37]. All core components of the Classification of Early-Onset Scoliosis (C-EOS) demonstrated substantial to excellent interobserver reliability [37].

Adult Idiopathic Scoliosis: For primarily scoliotic deformities, the principles of the modular Lenke classification for adult idiopathic scoliosis can be used to guide level selection [42].

Spinopelvic and Kyphosis Classifications: A new classification system incorporating spinopelvic balance in radiographic assessment may aid surgeons in identifying patients benefiting from partial reduction and fusion [46]. The Roussouly classification serves only as a rough estimate of optimal spinopelvic alignment for predicting mechanical complications in elderly patients with adult degenerative scoliosis [48]. A proposed classification for kyphosis based on column deficiency, curve magnitude, and osteotomy requirement demonstrated high interobserver agreement and ability to guide the selection of the appropriate osteotomy [50]. A novel classification for degenerative thoracolumbar kyphosis proposes four types based on thoracolumbar kyphosis and balance, followed by targeted treatment strategies for various types [51].

Atlantoaxial and Cervical Deformity: A novel image-based classification system for atlantoaxial deformity caused by mucopolysaccharidosis type IVA has high reliability and clinical guidance value for diagnosis and treatment planning [47]. Cervical spinal deformity is a debilitating condition with diverse etiologies [22]. Recent efforts regarding cervical spinal deformity focus on classification schemes and treatment algorithms to understand outcomes and the relationship between cervical and thoracolumbar spinal alignment [22]. Contemporary principles for adult cervical deformity include upper cervical parameters, regional cervical parameters, cervical shape classifications, and cervical deformity classifications based on current literature [59].

Other Considerations: Management of skeletal deformities and complications associated with Marfan syndrome and Osteogenesis Imperfecta is guided by specific updates on these conditions [6]. The most common orthopaedic impairments in Myotonic Dystrophy Type 1 are contractures, foot deformities, and spinal deformities [17]. Differences between spinal muscular atrophy (SMA) types II and IIIa should be taken into consideration when developing new treatments and managing scoliosis in childhood [52]. Distinguishing different types of scoliosis in dysplastic spondylolisthesis patients may help surgeons plan treatment and understand prognosis [56].

Clinical Presentation

Spinal deformities in Noonan syndrome typically manifest early and are relatively severe [1]. While congenital kyphosis and kyphoscoliosis are uncommon, they carry a high risk of rapid progression, potentially leading to severe deformity and neurological deficits [3]. In contrast, congenital scoliosis usually follows a slowly but relentlessly progressive course that results in unacceptable deformity if left untreated [19]. Kyphosis is also frequently observed in children with developmental structural abnormalities of the vertebral bodies [18]. In Marfan syndrome, inadequately treated or untreated curves invariably progress to severe and painful deformity [7].

Physical examination findings and subtle diagnostic imaging clues are critical for identifying scoliosis associated with syringomyelia [20]. Dynamic evaluations provide superior accuracy over static assessments regarding the correlation between deformities, pain, and quality of life [35]. Deformities directly influence both the presence and frequency of pain [35]. In nonambulatory patients with myelomeningocele, no simple structural feature exists to diagnose secondary thoracic insufficiency syndrome [38].

Coxa vara in childhood presents as a progressive, painful, unilateral deformity or leg-length discrepancy [8]. However, moderate nonprogressive coxa vara deformity often does not require surgical intervention [8]. In myotonic dystrophy type 1, the most common orthopaedic impairments include contractures, foot deformities, and spinal deformities [17]. Therapeutic strategies for early-onset scoliosis must balance deformity correction with the preservation of the growing spine and thorax [34].

Investigations

Plain radiography: Clinical and radiographic assessment with careful follow-up is essential for the early detection and treatment of spinal deformity in Noonan syndrome [1]. While extensive diagnostic studies are not necessary for every patient presenting with scoliosis and back pain [85], plain films remain critical for identifying congenital kyphosis and kyphoscoliosis, which are uncommon deformities with the potential to progress rapidly, causing severe deformity and neurological deficits [3]. In Marfan's syndrome, inadequately treated or untreated scoliosis curves typically progress to severe and painful deformity [7]. Roentgenograms are also required when a definitive diagnosis of persistent synchondrosis of the second cervical vertebra cannot be established [74]. Surgeons must remain vigilant for unexpected angular deformity following surgical procedures involving bony areas, as the degree of deformity varies by context [89].

MRI: Magnetic resonance imaging is a useful technique for diagnosing labor-related sacral and pubic fractures [54] and is indicated to distinguish histological structures of normal versus malformed spines [86]. MR images help diagnose scoliosis associated with syringomyelia by revealing physical examination findings and subtle imaging clues [20]. Additionally, MRI is necessary to exclude spinal cord anomalies prior to using Harrington instrumentation in rare cases of severe congenital scoliosis, provided cord function is monitored [94].

CT: Computerized tomographic scans are needed for the differentiation of persistent synchondrosis of the second cervical vertebra when roentgenograms are inconclusive [74]. CT plays an important role in investigating patients with progressive non-infectious anterior vertebral fusion, split cord malformation, and situs inversus visceralis to clarify underlying pathology and the fusion process [95]. For occipital condyle fractures, both CT and MR imaging are required for diagnosis, while CT specifically allows for the assessment of therapeutic outcomes [93].

Other Considerations: The primary indications for operative intervention in kyphotic deformity associated with myelomeningocele are clinical manifestations rather than radiographic measurements [2]. Asymptomatic cases of os odontoideum without radiologic instability are typically managed with periodic observation and serial imaging [65]. Early recognition and early spine fusion are recommended for congenital thoracic lordosis [78]. A novel pre-contoured V-shaped rod in one-level pedicle subtraction osteotomy has been shown to obtain satisfactory radiographic and clinical outcomes for ankylosing spondylitis patients without necessitating additional surgery or elevating the risk of complications such as sagittal translation [91]. Intersegmental abnormalities in the lumbar spine of adolescent competitive alpine skiers may persist throughout skeletal maturation and worsen during adolescence [92]. An understanding of pediatric spinal deformities is essential to provide appropriate care, treatment, and referral [15], as the diagnosis and management of pediatric cervical spine disorders require a clear understanding of variations in normal growth, development, and disparate presentations from infancy through adolescence [16].

Treatment

Non-Operative

Conservative management serves as a primary strategy for delaying or precluding surgical intervention, particularly in early-onset scoliosis where nonsurgical treatment can effectively delay the need for growing instrumentation [69]. Casting remains an efficient option for congenital scoliosis to postpone initial surgery, despite lower efficacy compared to non-congenital cases [64]. In adult isthmic spondylolisthesis, nonoperative treatment is the preferred approach for most symptomatic patients and succeeds in approximately 60% of cases [67]. For mild or moderate spondylolysis and spondylolisthesis in children and adolescents, successful and reliable nonsurgical treatments exist, whereas the role of surgical reduction for severe deformities remains undefined [62]. Schroth exercises demonstrate long-term benefits in improving spinal deformity and quality of life for adolescent idiopathic scoliosis [12]. Syndromic etiology does not contraindicate serial casting in early-onset scoliosis [72].

Operative

Indications: Surgical intervention is indicated for kyphotic deformity associated with myelomeningocele based on clinical manifestations rather than radiographic measurements [2]. In Marfan's syndrome, inadequately treated or untreated curves typically progress to severe and painful deformity, necessitating intervention [7]. For coxa vara in childhood, surgery is reserved for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require it [8]. Surgical management for adult Scheuermann kyphosis is indicated in patients with persistent pain and unacceptable deformity caused by significant kyphosis [28]. In infantile developmental thoracolumbar kyphosis with segmental subluxation, surgical stabilization is reserved for severe progressive deformities unresponsive to conservative treatment [66]. For late-onset Blount's disease, triple tibial osteotomy for severe bilateral varus deformity must be well-chosen and meticulously planned [73].

Surgical Approach / Technique: Treatment for congenital scoliosis relies on fusion, resection, or growth-friendly techniques tailored to patient age, curve characteristics, and anomaly type [4]. Skeletally mature patients with severe congenital spinal deformities achieve sustained correction and favorable patient-reported outcomes for at least 2 years postoperatively [11]. Surgical treatment of severe congenital thoracolumbar kyphosis via a single posterior approach is feasible, safe, and effective [40]. Deformity correction employing three-column osteotomies by a single-stage posterior-only approach is also safe and effective for isolated congenital thoracolumbar kyphosis [44]. Single-staged posterior minimally invasive surgery effectively corrects global alignment in adult spinal deformities, satisfying patient demand with low re-operation rates [43]. A device for treating torticollis in infants has proven effective in cases of severe torticollis and multiple deformities [45].

Implant Selection: Recent research provides updated criteria to determine optimal candidates for selective fusion in adolescent idiopathic scoliosis, which must be weighed against patient goals and specific factors to limit complications and maximize successful correction [23]. Successful management of idiopathic scoliosis requires a comprehensive understanding of etiology, natural history, evaluation, and available nonsurgical and surgical options [14]. A multimodal approach to treating scoliosis in patients with osteogenesis imperfecta achieved 53% major curve correction with minimal complications over a 2-year follow-up [36]. The study confirms the effectiveness of surgical treatment, particularly with preservation of motion segments, while highlighting the detrimental effects of scoliosis on patient-reported outcomes [41].

Adjuncts: The absence of major neurological complications supports the viability of surgical treatment for congenital upper thoracic scoliosis as a primary modality, though a high risk of complications, especially distal adding-on, persists [13]. Kyphosis in children is associated with developmental structural abnormalities of the vertebral bodies, making assessment of neurologic status critical due to the risk of injury [18]. Congenital scoliosis is usually slowly but relentlessly progressive, resulting in unacceptable deformity if active treatment is not given [19]. With more than 5 years of follow-up, postoperative success for anterior vertebral body tethering decreased as deformity progression was observed in most subgroups, and revision and suspected broken tether rates increased [5]. Treatment options for the crankshaft phenomenon are limited, and additional surgery may be indicated for patients with problematic deformity or risk of progression [10]. Early intervention and proper nonsurgical and surgical management can achieve improvement in many patients with arthrogryposis, though treatment remains challenging [63].

Complications

Progressive Deformity: Spinal deformities in Noonan syndrome develop early and are relatively severe [1], with congenital kyphosis and kyphoscoliosis capable of rapid progression leading to severe deformity and potential neurological deficits [3]. In anterior vertebral body tethering, deformity progression is observed in most subgroups after more than 5 years of follow-up, correlating with decreased postoperative success [5]. Revision rates and suspected broken tether rates also increase with this extended follow-up period [5]. Untreated Sprengel's deformity follows a natural history of gradual decline in abduction range, with a proportion of patients developing pain in adolescence [24]. Similarly, untreated brachial plexus birth palsy with residual weakness results in progressive glenohumeral deformity driven by persistent muscle imbalance and impaired longitudinal growth, where impaired muscle growth exerts the most substantial effects on range of motion and force changes [26, 30]. Untreated spondylothoracic dysostosis (Jarcho-Levin syndrome) is characterized by a restrictive pulmonary pattern [29].

Surgical Complications and Outcomes: Surgical treatment of congenital upper thoracic scoliosis carries a high risk of complications, particularly distal adding-on, though the absence of major neurological complications supports its viability as a primary treatment modality [13]. Anterior spinal fusion for spinal deformity in non-ambulatory myelomeningocele achieves satisfactory correction but is associated with high perioperative complication rates; however, it results in no long-term sequelae among children with high-level myelomeningocele [70]. Skeletally mature patients with severe congenital spinal deformities achieve sustained correction and favorable patient-reported outcomes for at least 2 years postoperatively [11]. Long-term follow-up after final fusion remains necessary to determine true final results following growing-rod treatment for early onset scoliosis [27].

Management Limitations and Natural History: It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients at high risk for progression [32]. Scheuermann's kyphosis presents as a rigid structural deformity with a generally benign natural history for mild cases, which are successfully treated nonsurgically [55]. In ankylosing spondylitis, correcting overall sagittal alignment is crucial to prevent compensatory hyperextension and long-term complications [68].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity initiation across the provided deformity literature. While short-term functional outcomes after total elbow arthroplasty were reported as good, specific timelines for desk work or driving are not detailed in the source data [75]. Similarly, no specific week-range is provided for resuming light ADLs in spinal deformity cohorts or brachial plexus birth palsy management [11, 26, 30].

Full activity (months): The evidence does not define a specific month range for the return to manual work, sport, or full range of motion. Although Schroth exercises demonstrated long-term effects on spinal deformity and quality of life, a timeline for full functional return is not quantified [12]. Similarly, while sustained correction was observed for at least 2 years postoperatively in skeletally mature patients, this duration reflects outcome stability rather than a defined return-to-activity window [11].

Complete recovery / outcome plateau (months): Long-term follow-up is necessary to determine true final results in early onset scoliosis treated with growing rods, implying an extended plateau period [27]. Sustained spinal correction and favorable patient-reported outcomes were obtained for at least 2 years postoperatively in skeletally mature patients with severe congenital spinal deformities [11]. Longitudinal cumulative outcomes after adult spinal deformity surgery utilize patient-reported outcome measures to assess quality of life and disability over time, indicating that final functional stabilization requires extended observation [31].

Rehabilitation protocol: No specific rehabilitation protocols, such as PT phasing, immobilisation duration, or brace removal timing, are detailed in the provided evidence. While successful management of idiopathic scoliosis requires understanding available nonsurgical options, specific exercise regimens beyond the mention of Schroth exercises are not described [14]. Early recognition and treatment before premature closure of the entire physis are essential for a good outcome in premature partial closure of the triradiate cartilage treated with excision of a physeal osseous bar, but specific post-operative mobilization protocols are not provided [100].

Functional milestones: Validated PROM trajectories or specific outcome benchmarks (e.g., Constant, ASES) are not explicitly quantified in the source bullets. However, longitudinal cumulative outcomes after adult spinal deformity surgery utilize patient-reported outcome measures to assess quality of life and disability over time [31]. Schroth exercises exhibited long-term effects in improving both spinal deformity and quality of life [12]. Sustained spinal correction and favorable patient-reported outcomes were obtained for at least 2 years postoperatively in skeletally mature patients with severe congenital spinal deformities [11]. Untreated spondylothoracic dysostosis is characterized by a restrictive pulmonary pattern but better quality of life scores than neuromuscular populations [29].

Other Considerations: Spinal deformities in Noonan syndrome tend to develop early and are relatively severe, necessitating clinical and radiographic assessment with careful follow-up for early detection and treatment [1]. Congenital kyphosis and kyphoscoliosis are uncommon deformities with the potential to progress rapidly, resulting in severe deformity and possible neurological deficits [3]. With more than 5 years of follow-up, postoperative success for anterior vertebral body tethering decreased as deformity progression was observed in most subgroups, and revision and suspected broken tether rates increased [5]. The natural history of untreated Sprengel's deformity may involve a gradual decline in abduction range, with a proportion of patients developing pain in adolescence [24]. The natural history of idiopathic scoliosis may be becoming more benign spontaneously [25]. The natural history of untreated brachial plexus birth palsy with residual weakness is progressive glenohumeral deformity due to persistent muscle imbalance [26]. Both muscle imbalance and impaired longitudinal growth contributed to range of motion and force changes consistent with clinically observed deformity following brachial plexus birth palsy, although the most substantial effects resulted from impaired muscle growth [30]. It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients who are at high risk for progression [32]. While spinal fusion can arrest deformity progression and improve posture in patients with globally involved cerebral palsy, there are no randomized controlled trials comparing fusion with the natural history of the disease, and functional benefits remain unclear [33]. Fusion length selection for posterior hemivertebra resection in congenital early-onset scoliosis should consider hemivertebra location, deformity severity, and kyphotic component to balance operative morbidity with long-term stability [71]. Proximal junctional kyphosis is a common complication following adult spinal deformity surgery with a broad spectrum of disease ranging from asymptomatic deformity recurrence to proximal junctional failure requiring revision [81]. Approximately 18% of early-onset scoliosis patients experienced proximal junctional kyphosis after traditional growing rods treatment [99].

Key Evidence

• [L4] Since the deformities tend to develop early and are relatively severe, a clinical and, if necessary, radiographic assessment of the spine with careful follow-up should be performed for early detection and treatment of spinal deformity. (10.2106/00004623-200110000-00006)
• [L4] The primary indications for operative intervention are the clinical manifestations of the deformity rather than the radiographic measurements. (10.2106/00004623-199409000-00004)
• [L3] Congenital kyphosis and kyphoscoliosis are uncommon deformities with the potential to progress rapidly, resulting in severe deformity and possible neurological deficits. (10.2106/00004623-199910000-00002)
• [L5] Congenital scoliosis is a spinal deformity with variable progression; treatment is non-surgical in the majority of cases and relies on fusion, resection, or growth-friendly techniques depending on patient age, curve characteristics, and anomaly type. (10.1530/eor-21-0121)
• [L3] With >5 years of follow-up, postoperative success decreased as deformity progression was observed in most subgroups, and revision and suspected broken tether rates increased. (10.2106/jbjs.23.01229)
• [L4] Inadequately treated and untreated curves usually progressed to severe and painful deformity. (10.2106/00004623-197557030-00014)
• [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
• [L5] Treatment options are limited, and additional surgery may be indicated for patients with problematic deformity or risk of progression. (10.5435/jaaos-d-16-00584)
• [L3] Sustained spinal correction and favorable patient-reported outcomes for at least 2 years postoperatively were obtained in skeletally mature patients with severe congenital spinal deformities. (10.1186/s13018-025-06421-8)
• [L1] Meanwhile, Schroth exhibited long-term effects in improving both spinal deformity and quality of life. (10.1186/s12891-024-08223-1)
• [L4] The absence of major neurological complications supports its viability as a primary treatment modality for this complex deformity, though there is a high risk of complications, especially distal adding-on. (10.1186/s12891-025-09364-7)
• [L5] Successful management of idiopathic scoliosis requires understanding the etiology, natural history, evaluation, and available nonsurgical and surgical management options for these patients. (10.5435/00124635-200602000-00005)
• [L4] The most common orthopaedic impairments are contractures, foot deformities and spinal deformities. (10.1186/1471-2474-14-338)
• [L4] Congenital scoliosis is usually slowly but relentlessly progressive, and an unacceptable deformity results if active treatment is not given. (10.2106/00004623-196850010-00002)
• [L5] Physical examination findings and subtle clues on diagnostic imaging may help the orthopaedic surgeon diagnose scoliosis associated with syringomyelia. (10.5435/00124635-200807000-00006)
• [L4] Cervical spinal deformity is a debilitating condition with diverse etiologies; recent efforts focus on classification schemes and treatment algorithms to understand outcomes and the relationship between cervical and thoracolumbar spinal alignment. (10.5435/jaaos-d-17-00546)
• [L5] Recent research provides updated criteria to determine optimal candidates for selective fusion, which must be weighed against patient goals and patient-specific factors to limit complications and maximize chances of successful deformity correction. (10.5435/jaaos-d-21-01175)
• [L4] The natural history of untreated Sprengel's deformity may be one of gradual decline in the abduction range, with a proportion of patients developing pain in adolescence. (10.1016/j.jse.2020.04.018)
• [L4] The results suggest that the natural history of idiopathic scoliosis may be becoming more benign spontaneously. (10.2106/00004623-199609000-00006)
• [L3] The natural history of untreated brachial plexus birth palsy with residual weakness is progressive glenohumeral deformity due to persistent muscle imbalance. (10.2106/00004623-199805000-00007)
• [L4] Long-term follow-up after final fusion is necessary to determine true final results. (10.2106/jbjs.15.01334)
• [L5] Surgical intervention is indicated in patients with persistent pain and unacceptable deformity caused by significant kyphosis. (10.5435/00124635-201202000-00007)
• [L4] The study characterizes the natural history of untreated spondylothoracic dysostosis, confirming a restrictive pulmonary pattern but noting better quality of life scores than neuromuscular populations. (10.2106/jbjs.23.00800)
• [L5] Both muscle imbalance and impaired longitudinal growth contributed to range of motion and force changes consistent with clinically observed deformity, although the most substantial effects resulted from impaired muscle growth. (10.1016/j.jhsa.2015.02.025)
• [L3] The study describes the longitudinal cumulative outcome after adult spinal deformity surgery, utilizing patient-reported outcome measures to assess quality of life and disability over time. (10.1186/s12891-025-08927-y)
• [L4] It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients who are at high risk for progression. (10.2106/00004623-199604000-00009)
• [L5] It notes that while spinal fusion can arrest deformity progression and improve posture, there are no randomized controlled trials comparing fusion with the natural history of the disease, and functional benefits remain unclear. (10.2106/jbjs.n.00468)
• [L4] This review elucidates early-onset scoliosis in terms of its aetiology, pathogenesis, pathology and treatment, highlighting that therapeutic strategies must preserve the growing spine and thorax while correcting deformity. (10.1186/s13018-023-03665-0)
• [L4] Deformities have an effect on pain and the frequency of pain, and dynamic evaluations showed deformities more accurately than static evaluations. (10.1186/s12891-024-07880-6)
• [L4] This study demonstrated the effectiveness and safety of a multimodal approach to treating scoliosis in patients with OI, achieving a 53% major curve correction with minimal complications over 2-year follow-up. (10.5435/jaaos-d-23-00889)
• [L4] Utilizing formal consensus-building methods in a large group of surgeons experienced in treating early-onset scoliosis, a novel classification system for early-onset scoliosis was developed with all core components demonstrating substantial to excellent interobserver reliability. (10.2106/jbjs.m.00253)
• [L3] However, there is no simple structural feature that could help to diagnose secondary thoracic insufficiency syndrome. (10.5435/jaaos-d-17-00568)
• [L3] Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. (10.1186/1471-2474-9-152)
• [L4] Surgical treatment of severe congenital thoracolumbar kyphosis through a single posterior approach is feasible, safe and effective. (10.1302/0301-620x.95b11.31376)
• [L4] The study confirms the detrimental effects of scoliosis on patient-reported outcomes, the value of treatment to limit curve progression, and the effectiveness of surgical treatment, especially with preservation of motion segments. (10.2106/jbjs.18.00180)
• [L5] For primarily scoliotic deformities, the principles of the modular Lenke classification for adult idiopathic scoliosis can be used to guide level selection. (10.2106/jbjs.24.00910)
• [L3] Single-staged posterior MIS effectively corrects global alignment in adult spinal deformities, satisfying patient demand and yielding positive clinical outcome with low re-operation rate. (10.1186/s12891-025-08550-x)
• [L4] Deformity correction employing three-column osteotomies by a single-stage posterior-only approach is safe and effective in treating isolated congenital thoracolumbar kyphosis. (10.1302/0301-620x.103b7.bjj-2020-2162.r1)
• [L4] It was effective in two infants with severe torticollis and multiple deformities. (10.2106/00004623-195739030-00024)
• [L5] A new classification system that incorporates spinopelvic balance in the radiographic assessment may aid orthopaedic surgeons in identifying patients who would benefit from partial reduction and fusion. (10.5435/jaaos-20-04-194)
• [L4] The new classification system has a high reliability and clinical guidance value for diagnosis and treatment planning. (10.1186/s13018-025-06085-4)
• [L3] Roussouly classification could only be a rough estimate of optimal spinopelvic alignment. (10.1186/s13018-021-02786-8)
• [L5] Understanding the biomechanical principles of spinal instrumentation and motion coupling is essential for optimizing three-dimensional correction of thoracolumbar spinal deformities and achieving favorable mechanical environments for fusion. (10.5435/jaaos-d-24-01156)
• [L3] The proposed classification based on the morphology of column deficiency, flexibility, and curve magnitude demonstrated a high interobserver agreement and ability to guide selection of the appropriate osteotomy. (10.2106/jbjs.17.01127)
• [L3] The study proposed a novel classification with four types of degenerative thoracolumbar kyphosis based on thoracolumbar kyphosis and balance, followed by targeted treatment strategies for various types. (10.1186/s13018-025-05713-3)
• [L4] The differences between the two SMA types II and IIIa described in this study should be taken into consideration when developing new treatments and in management of scoliosis in the childhood years of these patients. (10.1186/1471-2474-14-283)
• [L1] This review highlights the complexity of pelvic, trunk and upper limb biomechanics in individuals with spinal deformities. (10.1186/s13018-025-06063-w)
• [L4] Magnetic resonance imaging is a useful technique for diagnosis. (10.2106/jbjs.f.00181)
• [L5] Scheuermann's kyphosis is a rigid structural deformity with a generally benign natural history for mild cases, which are successfully treated nonsurgically. (10.5435/jaaos-d-17-00748)
• [L4] Distinguishing different types of scoliosis in dysplastic spondylolisthesis patients may help surgeons to plan treatment and understand prognosis. (10.1186/s12891-022-05297-7)
• [L4] Despite these results, the authors believe correction and stabilization of spinal deformity in these patients is beneficial and plan to continue operative management. (10.2106/00004623-199509000-00012)
• [L5] Critical spinal lytic defects result in kinematic abnormalities and lower the compressive strength of the spine. (10.2106/jbjs.19.00419)
• [L4] The purpose of this review is to provide a comprehensive overview of contemporary principles pertaining to adult cervical deformity, including upper cervical parameters, regional cervical parameters, cervical shape classifications, and cervical deformity classifications based on current literature. (10.5435/jaaos-d-25-00019)
• [L5] The focus of surgical correction has shifted from isolated coronal deformity to include restoration of segmental and global sagittal alignment to achieve optimum long-term results. (10.1302/0301-620x.100b4.bjj-2017-0846.r2)
• [L5] Arthroplasty may be considered for active patients but is frequently associated with complications due to underlying deformities. (10.5435/jaaos-d-15-00275)
• [L5] Successful and reliable treatment has been developed for mild or moderate involvement of spondylolysis and spondylolisthesis in children and adolescents, while the role of surgical reduction for severe deformities remains undefined as only a small proportion of patients present with such deformities. (10.2106/00004623-198971070-00020)
• [L4] Although the therapeutic efficacy of casting on CS patients is not as good as that on non-CS patients, casting is still an efficient treatment option for CS patients to delay the need for initial surgery. (10.1186/s13018-017-0554-7)
• [L5] Asymptomatic cases without evidence of radiologic instability are typically managed with periodic observation and serial imaging. (10.5435/jaaos-d-18-00637)
• [L4] Surgical stabilisation of the spine can be reserved for severe progressive deformities unresponsive to conservative treatment. (10.1302/0301-620x.97b7.35665)
• [L4] Nonoperative treatment is the preferred approach in most symptomatic patients and is successful in as many as 60%. (10.5435/00124635-199607000-00004)
• [L4] The authors suggest that correcting overall sagittal alignment is crucial to prevent compensatory hyperextension and long-term complications. (10.1302/0301-620x.95b2.29554)
• [L4] Nonsurgical treatment can be an effective early management strategy in delaying or even precluding the need for surgery, especially surgery with growing instrumentation. (10.5435/jaaos-d-14-00019)
• [L4] Anterior spinal fusion achieved satisfactory deformity correction with high perioperative complication rates, but no long-term sequelae among children with high level myelomeningocele. (10.1302/0301-620x.103b6.bjj-2020-2158.r1)
• [L3] Fusion length selection should consider HV location, deformity severity, and kyphotic component to balance operative morbidity with long-term stability. (10.1186/s13018-025-05971-1)
• [L4] Syndromic etiology is not a contraindication for serial casting in EOS. (10.1186/s12891-019-2938-9)
• [L4] However, the indication must be well chosen and surgery meticulously planned. (10.1007/s00167-012-2061-z)
• [L4] Roentgenograms, computerized tomographic scans, and possibly magnetic resonance imaging studies are needed for differentiation when a definitive diagnosis cannot be made. (10.2106/00004623-199308000-00014)
• [L4] Short-term functional outcomes after total elbow arthroplasty in this prospective cohort of patients with posttraumatic arthritis or deformities of the elbow were good according to mean postoperative measurements. (10.1016/j.jhsa.2013.03.051)
• [L3] Although balance did not influence pain severity, spinal morphology and its correction appear to have influenced the intensity and location of back pain. (10.1186/s12891-020-03462-4)
• [L3] Early screening for incorrect postures and angle of trunk rotation could be an effective and economical strategy to predict the severity of the condition. (10.1186/s13018-024-04767-z)
• [L4] Early recognition of the diagnosis and early spine fusion are recommended treatment for this severe and progressive deformity. (10.2106/00004623-197860060-00014)
• [L3] The severity of the spinal deformity, rather than the curvature direction, is the main determinant of its impact on cardiac health. (10.1186/s13018-025-06113-3)
• [L4] The article provides an evidence-based approach to selecting fusion levels that balances expert opinion with current literature to minimize the risk of future progression and optimize spinal balance while fusing the least number of levels necessary. (10.5435/jaaos-d-22-00547)
• [L4] Proximal junctional kyphosis (PJK) is a common complication following adult spinal deformity surgery with a broad spectrum of disease ranging from asymptomatic deformity recurrence to proximal junctional failure requiring revision. (10.5435/jaaos-d-14-00393)
• [L4] The findings eliminate structural variations of the lumbosacral joint as being of clinical importance except when extreme, contradicting commonly accepted opinions regarding posterior displacement and facet inclination. (10.2106/00004623-195941050-00012)
• [L4] Despite significant changes during skeletal maturity, the modifications in spinal curvatures are not large enough to be considered in clinical practice and to impact surgical planning. (10.2106/jbjs.22.00977)
• [L4] Notably, only forces in zone 3 neither significantly reduced thoracic kyphosis nor exacerbated the deviation of the scoliotic spine from the sagittal plane. (10.1186/s12891-024-08014-8)
• [L3] It is not necessary to perform extensive diagnostic studies to evaluate every patient who has scoliosis and back pain. (10.2106/00004623-199703000-00007)
• [L5] MR images could be used to distinguish the histological structures of normal and malformed mouse spines, and malformed vertebrae were accompanied by adjacent intervertebral structures that corresponded to the fully segmented structures observed in human congenital scoliosis, but the intervertebral conditions varied. (10.1186/s12891-024-07460-8)
• [L4] Motion in the coronal plane decreased by 77% following anterior vertebral body tethering. (10.2106/jbjs.20.01533)
• [L3] The coronal Cobb angle and the SI of paraspinal muscle activity in AIS patients vary with posture changes. (10.1186/s12891-024-07329-w)
• [L5] Surgeons should be aware of unexpected angular deformity after surgical procedures involving bony areas, as the degree of deformity differs depending on the context. (10.1186/1471-2474-15-175)
• [L3] Variations of spinal growth velocity exerted more direct influence over changes in angle velocity as compared with height velocity. (10.1186/s12891-016-1221-6)
• [L4] This alternative technique obtains satisfactory radiographic and clinical outcomes for AS patients without necessitating additional surgery or elevating the risk of complications such as sagittal translation. (10.1186/s12891-025-08872-w)
• [L4] These abnormalities may persist throughout skeletal maturation and even worsen during adolescence. (10.1177/03635465241295384)
• [L4] CT and MR imaging should be used in diagnosing OCFs, whereas CT allows assessing therapeutic outcomes in OCF. (10.1186/s13018-021-02463-w)
• [L4] In rare cases of severe deformity, Harrington instrumentation may be used to gain correction provided a preoperative myelogram excludes spinal cord anomalies and cord function is monitored. (10.2106/00004623-198163040-00011)
• [L5] The authors emphasize the important role of computerized tomography in investigating these patients to improve understanding of the underlying pathology and the progressive fusion process. (10.1186/1471-2474-7-94)
• [L4] Development of spinal curvature in the sagittal plane and maintenance of symmetry in the coronal and transverse planes are essential for correct balance control. (10.1186/1471-2318-13-108)
• [L4] The Lyon brace, through its biomechanical action on vertebral modeling, is highly effective in correcting thoracic curves, particularly when the SOSORT guidelines were adopted in addition to the SRS criteria. (10.1186/s12891-015-0782-0)
• [L3] Morphometric characteristics of vertebral bodies differed according to the pathogenesis of scoliosis, and the pathology of the wedging of vertebral bodies in idiopathic scoliosis could not be a result only of asymmetric loading to the vertebral bodies. (10.1186/s12891-017-1801-0)
• [L3] Approximately 18% of early-onset scoliosis patients experienced proximal junctional kyphosis after traditional growing rods treatment. (10.1186/s12891-022-05564-7)
• [Case_report] Early recognition and treatment before premature closure of the entire physis and before permanent osseous deformity are essential for a good outcome. (10.2106/00004623-199705000-00019)

See Also

• Conservative Treatment
• Surgical Complications

References

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