Clinical, radiological, and Scoliosis Research Society-22 questionnaire data were reviewed pre-operatively and two years post-operatively for patients with thoracolumbar/lumbar adolescent idiopathic scoliosis treated by posterior spinal fusion using a unilateral convex segmental pedicle screw technique. A total of 72 patients were included (67 female, 5 male; mean age at surgery 16.7 years (13 to 23)) and divided into groups: group 1 included 53 patients who underwent fusion between the vertebrae at the limit of the curve (proximal and distal end vertebrae); group 2 included 19 patients who underwent extension of the fusion distally beyond the caudal end vertebra. A mean scoliosis correction of 80% (45% to 100%) was achieved. The mean post-operative lowest instrumented vertebra angle, apical vertebra translation and trunk shift were less than in previous studies. A total of five pre-operative radiological parameters differed significantly between the groups and correlated with the extension of the fusion distally: the size of the thoracolumbar/lumbar curve, the lowest instrumented vertebra angle, apical vertebra translation, the Cobb angle on lumbar convex bending and the size of the compensatory thoracic curve. Regression analysis allowed an equation incorporating these parameters to be developed which had a positive predictive value of 81% in determining whether the lowest instrumented vertebra should be at the caudal end vertebra or one or two levels more distal. There were no differences in the Scoliosis Research Society-22 outcome scores between the two groups (p = 0.17). In conclusion, thoracolumbar/lumbar curves in patients with adolescent idiopathic scoliosis may be effectively treated by posterior spinal fusion using a unilateral segmental pedicle screw technique. Five radiological parameters correlate with the need for distal extension of the fusion, and an equation incorporating these parameters reliably informs selection of the lowest instrumented vertebra. Cite this article: Bone Joint J 2014;96-B:1082–9

Purpose of the study. To investigate the efficacy of pedicle screw instrumentation in correcting thoracolumbar/lumbar idiopathic scoliosis in adolescent patients. Summary of Background Data. Thoracolumbar/lumbar scoliosis has been traditionally treated through an anterior approach and instrumented arthrodesis with the aim to include in the fusion the Cobb-to-Cobb levels and preserve distal mobile spinal segments. Posterior instrumentation has been extensively used for thoracic or thoracic and lumbar scoliosis. In the advent of all-pedicle screw constructs there is debate on whether thoracolumbar/lumbar scoliosis is best treated through an anterior or a posterior instrumented arthrodesis. Methods. We reviewed the medical notes and radiographs of 19 consecutive adolescent patients with Lenke 5C idiopathic scoliosis (17 female-2 male, prospectively collected single surgeon's series). We measured the scoliosis, thoracic kyphosis and lumbar lordosis angles, apical vertebral rotation (AVR) and translation (AVT), trunk shift (TS), as well as the lower instrumented vertebra angle (LIVA) both pre-and post-operatively and at minimum 2-year follow-up. SRS 22 data was available for all patients. Results. All patients underwent posterior spinal arthrodesis of the primary thoracolumbar/lumbar curve using all-pedicle screw constructs. Mean age at surgery was 15.1 years. We identified 3 separate groups: Group 1 (9 patients) had a fusion to include the preoperative Cobb-to-Cobb levels of the curve; in Group 2 (8 patients) the fusion extended 1-2 levels distal (all patients) +/− proximal (4 patients) to the end Cobb vertebrae; in Group 3 (2 patients) the fusion extended to one level proximal to the lower end Cobb vertebra. Eight patients had compensatory thoracic curves. Mean Cobb angle before surgery was 60.3° (range: 43-91°). This was corrected by 79% to mean 13° (p<0.001) with no patient losing >2° correction at follow-up. Mean preoperative Cobb levels of the thoracolumbar/lumbar curve were 6.3; mean levels of instrumented fusion were 7 (mean extent of fusion: preoperative Cobb angle + 0.7 levels). Mean preoperative thoracic kyphosis was 34.7° and lumbar lordosis 45.3°. Mean postoperative thoracic kyphosis was 36.6° and lumbar lordosis 43°. Mean theatre time was 3.8 hours, hospital stay 7.5 days and intraoperative blood loss 0.26 blood volumes. There were no neurological complications other than one temporary brachial plexus neuropraxia (recovered before patient discharge from hospital), no wound infections or detected non-union at follow-up. Mean preoperative SRS 22 score was 3.7; this was improved to 4.5 at 2-year follow-up (p=0.01). Pain and self-image demonstrated significant improvement (p=0.02, p=0.001 respectively) with mean satisfaction rate 4.8. Comparison between Groups 1 and 2 showed similar age at surgery but higher preoperative scoliosis in Group 2 (Group 1: 54°/Group 2: 65°, p=0.05). Preoperative AVR, TS and LIVA were similar between the 2 groups (p>0.05). Preoperative AVT was significantly higher in Group 2 (Group 1: 3.3 cm/Group 2: 5 cm, p=0.01). Conclusion. Pedicle screw instrumentation can achieve excellent correction of Lenke 5C idiopathic scoliosis which is maintained at follow-up. This is associated with high patient satisfaction and low complication rates. Greater preoperative AVT and scoliosis angle predicted the need for longer fusion both distally and proximally beyond the end vertebra of the preoperative Cobb angle

Aim:. To determine radiographic variables that predict the need for distal extension of the fusion beyond Cobb-to-Cobb levels in treating thoracolumbar/lumbar (TL/L) scoliosis (Lenke 5) in adolescent patients. Method:. We reviewed the medical notes and radiographs of the senior author's consecutive series of 53 adolescent patients with TL/L scoliosis treated by posterior instrumented spinal arthrodesis using an all-pedicle screw construct. Our patients were categorised into 2 groups: patients with instrumented fusion between Cobb-to-Cobb levels of the TL/L curve (Group 1), and patients that required distal extension beyond the caudal Cobb level (Group 2). Pearson correlation and binary logistic regression analyses (significance p<0.05) were performed to identify variables that predict the need for distal extension. Results:. Groups 1 and 2 comprised 36 and 17 patients, respectively. The following preoperative parameters significantly correlated with distal extension of the fusion: TL/L scoliosis angle (TL/L), TL/L supine maximum lateral bending angle, TL/L apical vertebral translation (AVT), TL/L flexibility index (FI), lowest instrumented vertebra angle (LIVA), and compensatory thoracic scoliosis angle (TH). Binary logistic regression analysis optimised a predictive equation incorporating TL/L, AVT, FI, LIVA, and TH parameters that provides an 81% accuracy in predicting the need for Cobb-to-Cobb fusion or distal extension. There was no difference in demographic data or SRS-22 scores between the 2 groups. Discussion:. Regression analysis of preoperative radiographic variables can accurately predict the need for distal extension of the fusion beyond the preoperative Cobb-to-Cobb levels during posterior spinal arthrodesis in patients with adolescent idiopathic thoracolumbar/lumbar scoliosis. Conflict Of Interest Statement: No conflict of interest

Methods. In this study of patients who underwent internal fixation without fusion for a burst thoracolumbar or lumbar fracture, we compared the serial changes in the injured disc height (DH), and the fractured vertebral body height (VBH) and kyphotic angle between patients in whom the implants were removed and those in whom they were not. Radiological parameters such as injured DH, fractured VBH and kyphotic angle were measured. Functional outcomes were evaluated using the Greenough low back outcome scale and a VAS scale for pain. Results. Between June 1996 and May 2012, 69 patients were analysed retrospectively; 47 were included in the implant removal group and 22 in the implant retention group. After a mean follow-up of 66 months (48 to 107), eight patients (36.3%) in the implant retention group had screw breakage. There was no screw breakage in the implant removal group. All radiological and functional outcomes were similar between these two groups. Although solid union of the fractured vertebrae was achieved, the kyphotic angle and the anterior third of the injured DH changed significantly with time (p < 0.05). . Discussion. The radiological and functional outcomes of both implant removal and retention were similar. Although screw breakage may occur, the implants may not need to be removed. Take home message: Implant removal may not be needed for patients with burst fractures of the thoracolumbar and lumbar spine after fixation without fusion. However, information should be provided beforehand regarding the possibility of screw breakage. Cite this article: Bone Joint J 2016;98-B:109–16

Aims. Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL. Methods. We reviewed the full medical records and radiological reports of patients referred to our hospital with a scoliosis of childhood between April 1972 and April 1982. Of 129 eligible patients with a juvenile or adolescent idiopathic scoliosis, 91 took part in the study (71%). They were evaluated with full-spine radiographs and HRQoL questionnaires and compared with normative data. We compared the HRQoL between observation (n = 27), bracing (n = 46), and surgical treatment (n = 18), and between thoracic and thoracolumbar/lumbar (TL/L) curves. Results. The mean time to follow-up was 40.8 years (SD 2.6) and the mean age of patients was 54.0 years (SD 2.7). Of the 91 patients, 86 were female (95%) and 51 had a main thoracic curve (53%). We found a significantly lower HRQoL measured on all the Scoliosis Research Society 22r instrument (SRS-22r) subdomains (p < 0.001) with the exception of mental health, than in an age-matched normal population. Incapacity to work was more prevalent in scoliosis patients (21%) than in the normal population (11%). The median SRS-22r subscore was 4.0 (interquartile range (IQR) 3.3 to 4.4) for TL/L curves and 4.1 (IQR 3.8 to 4.4) for thoracic curves (p = 0.300). We found a significantly lower self-image score for braced (median 3.6 (IQR 3.0 to 4.0)) and surgically treated patients (median 3.6 (IQR 3.2 to 4.3)) than for those treated by observation (median 4.0 (IQR 4.1 to 4.8); p = 0.010), but no statistically significant differences were found for the remaining subdomains. Conclusion. In this long-term follow-up study, we found a significantly decreased HRQoL and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis. Cite this article: Bone Joint J 2023;105-B(2):166–171

Aims. A total of 30 patients with thoracolumbar/lumbar adolescent idiopathic scoliosis (AIS) treated between 1989 and 2000 with anterior correction and fusion surgery using dual-rod instrumentation were reviewed. . Patients and Methods. Radiographic parameters and clinical outcomes were compared among patients with lowest instrumented vertebra (LIV) at the lower end vertebra (LEV; EV group) (n = 13) and those treated by short fusion (S group), with LIV one level proximal to EV (n = 17 patients). . Results. The allocation of the surgical technique was determined by the flexibility of the TL/L curves and/or neutral vertebrae located one level above LEV as determined on preoperative radiographs. If these requirements were met a short fusion was performed. The mean follow-up period was 21.4 years (16 to 27). The mean correction rate at final follow-up was significantly lower in the S group (74 . sd. 11%) than in the EV group (88 . sd. 13%) (p = 0.004).Coronal and sagittal balance, thoracic kyphosis, lumbar lordosis, and clinical outcomes evaluated by the Scoliosis Research Society-22 questionnaire scores were equivalent between the two groups. . Conclusion. Short fusion strategy, which uses LIV one level proximal to LEV can be considered as an alternative to the conventional strategy, which includes LEV in the fusion, when highly flexible TL/L curves are confirmed and/or neutral vertebrae are located one level above LEV in patients with thoracolumbar/lumbar AIS curves. Take home message: Short fusion strategy can be considered as an alternative to the conventional strategy in patients with thoracolumbar/lumbar AIS curves undergoing anterior spinal fusion with dual-rod instrumentation. Cite this article: Bone Joint J 2016;98-B:402–9

Aims. The aims of our study were to provide long-term information on the behaviour of the thoracolumbar/lumbar (TL/L) curve after thoracic anterior correction and fusion (ASF) and to determine the impact of ASF on pulmonary function. Patients and Methods. A total of 41 patients (four males, 37 females) with main thoracic (MT) adolescent idiopathic scoliosis (AIS) treated with ASF were included. Mean age at surgery was 15.2 years (11 to 27). Mean follow-up period was 13.5 years (10 to 18). Results. For the TL/L curve, the mean curve flexibility evaluated with supine pre-operative bending radiographs was 78.6% (standard deviation 16.5%), with no significant loss of correction observed. On comparing patients with an increase of the TL/L curve increase (> 4º, n = 9, 22%) to those without, significant differences were observed in the correction rate of the MT curve at the final follow-up (p = 0.011), correction loss of the MT curve (p = 0.003) and the proportion of patients who had semi-rigid instrumentation (p = 0.003). Pre-operative percentage predicted forced vital capacity (%FVC) was 80%, dropping to 72% at final follow-up (p < 0.001). The Scoliosis Research Society questionnaire score was not significantly different between patients with and without a TL/L curve increase (p = 0.606). Spontaneous lumbar curve correction (SLCC) was maintained up to 18 years following selective ASF in most patients and demonstrated significant correlation with maintenance of MT curve correction. Conclusion. Maintenance of MT curve correction using rigid instrumentation provided stable SLCC over time. An observed 8% decrease in %FVC indicates that ASF should be reserved for patients with no or only mild pulmonary impairment. Cite this article: Bone Joint J 2016;98-B:997–1002

Purpose of the study. To compare the effectiveness of unilateral and bilateral pedicle screw techniques in correcting adolescent idiopathic scoliosis. Summary of Background Data. Pedicle screw constructs have been extensively used in the treatment of adolescent patients with idiopathic scoliosis. It has been suggested that greater implant density may achieve better deformity correction. However, this can increase the neurological risk related to pedicle screw placement, prolong surgical time and blood loss and result in higher instrumentation cost. Methods. We reviewed the medical notes and radiographs of 139 consecutive adolescent patients with idiopathic scoliosis (128 female-11 male, prospectively collected single surgeon's series). We measured the scoliosis, thoracic kyphosis (T5-T12), and lumbar lordosis (L1-L5) before and after surgery, as well as at minimum 2-year follow-up. SRS 22 data was available for all patients. Results. All patients underwent posterior spinal arthrodesis using pedicle screw constructs. Mean age at surgery was 14.5 years. We had 2 separate groups: in Group 1 (43 patients) correction was performed over 2 rods using bilateral segmental pedicle screws; in Group 2 (96 patients) correction was performed over 1 rod using unilateral segmental pedicle screws with the 2. nd. rod providing stability of the construct through 2-level screw fixation both proximal and distal. Group 1. Mean Cobb angle before surgery for upper thoracic curves was 37°. This was corrected by 71% to mean 11° (p<0.001). Mean Cobb angle before surgery for main thoracic curves was 65°. This was corrected by 71% to mean 20° (p<0.001). Mean Cobb angle before surgery for thoracolumbar/lumbar curves was 60°. This was corrected by 74% to mean 16° (p<0.001). No patient lost >2° correction at follow-up. Mean preoperative thoracic kyphosis was 24° and lumbar lordosis 52°. Mean postoperative thoracic kyphosis was 21° and lumbar lordosis 50° (p>0.05). Mean theatre time was 5.5 hours, hospital stay 8.2 days and intraoperative blood loss 0.6 blood volumes. Complications: 1 transient IOM loss/no neurological deficit; 1 deep wound infection leading to non-union and requiring revision surgery; 1 rod trimming due to prominent upper end. Mean preoperative SRS 22 score was 3.9; this improved to 4.5 at follow-up (p<0.001). Pain and self-image demonstrated significant improvement (p=0.001, p<0.001 respectively) with mean satisfaction rate 4.9. Group 2. Mean Cobb angle before surgery for upper thoracic curves was 42°. This was corrected by 52% to mean 20° (p<0.001). Mean Cobb angle before surgery for main thoracic curves was 62°. This was corrected by 70% to mean 19° (p<0.001). Mean Cobb angle before surgery for thoracolumbar/lumbar curves was 57°. This was corrected by 72% to mean 16° (p<0.001). No patient lost >2° correction at follow-up. Preoperative scoliosis size for all types of curves correlated with increased surgical time (r=0.6, 0.4). Mean preoperative thoracic kyphosis was 28° and lumbar lordosis 46°. Mean postoperative thoracic kyphosis was 25° and lumbar lordosis 45° (p>0.05). Mean theatre time was 4.2 hours, hospital stay 8.4 days and intraoperative blood loss 0.4 blood volumes. Complications: 1 deep and 1 superficial wound infections treated with debridement; 1 transient brachial plexus neurapraxia; 1 SMA syndrome. Mean preoperative SRS 22 score was 3.7; this improved to 4.5 at follow-up (p<0.001). Pain, function, self-image and mental health demonstrated significant improvement (p<0.001 for all parameters) with mean satisfaction rate 4.8. Comparison between groups showed no significant difference in regard to age at surgery, preoperative and postoperative scoliosis angle for main thoracic and thoracolumbar/lumbar curves, as well as SRS scores and length of hospital stay. Better correction of upper thoracic curves was achieved in Group 1 (p<0.05), but upper thoracic curves in Group 2 were statistically more severe before surgery (p<0.05). Increased surgical time and blood loss was recorded in Group 1 (p<0.05, p=0.05 respectively). The implant cost was reduced by mean 35% in Group 2 due to lesser number of pedicle screws. Conclusion. Unilateral and bilateral pedicle screw instrumentation has achieved excellent deformity correction in adolescent patients with idiopathic scoliosis, which was maintained at follow-up. This has been associated with high patient satisfaction and low complication rates. The unilateral technique using segmental pedicle screw correction has reduced surgical time, intraoperative blood loss and implant cost without compromising surgical outcome for the most common thoracic and thoracolumbar/lumbar curves. The bilateral technique achieved better correction of upper thoracic scoliosis

Aims. To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach. Methods. Hospital records of 27 patients with isolated congenital thoracolumbar kyphosis undergoing surgery at a single centre were retrospectively analyzed. All patients underwent deformity correction which involved a three-column osteotomy by single-stage posterior-only approach. Radiological parameters (local kyphosis angle (KA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 slope, and pelvic incidence minus lumbar lordosis (PI-LL)), functional scores, and clinical details of complications were recorded. Results. The mean age of the study population was 13.9 years (SD 6.4). The apex of deformity was in thoracic, thoracolumbar, and lumbar spine in five, 14, and eight patients, respectively. The mean operating time was 178.4 minutes (SD 38.5) and the mean operative blood loss was 701.8 ml (SD 194.4). KA (preoperative mean 70.8° (SD 21.6°) vs final follow-up mean 24.7° (SD 18.9°); p < 0.001) and TK (preoperative mean -1.48° (SD 41.23°) vs final follow-up mean 24.28° (SD 17.29°); p = 0.005) underwent a significant change with surgery. Mean Scoliosis Research Society (SRS-22r) score improved after surgical correction (preoperative mean 3.24 (SD 0.37) vs final follow-up mean 4.28 (SD 0.47); p < 0.001) with maximum improvement in self-image and mental health domains. The overall complication rate was 26%, including two neurological and five non-neurological complications. Permanent neurological deficit was noted in one patient. Conclusion. Deformity correction employing three-column osteotomies by a single-stage posterior-only approach is safe and effective in treating isolated congenital thoracolumbar kyphosis. Cite this article: Bone Joint J 2021;103-B(7):1309–1316

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To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so.

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This systematic review aims to identify 3D predictors derived from biplanar reconstruction, and to describe current methods for improving curve prediction in patients with mild adolescent idiopathic scoliosis.

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A variety of surgical methods and strategies have been demonstrated for Andersson lesion (AL) therapy. In 2011, we proposed and identified the feasibility of stabilizing the spine without curettaging the vertebral or discovertebral lesion to cure non-kyphotic AL. Additionally, due to the excellent reunion ability of ankylosing spondylitis, we further came up with minimally invasive spinal surgery (MIS) to avoid the need for both bone graft and lesion curettage in AL surgery. However, there is a paucity of research into the comparison between open spinal fusion (OSF) and early MIS in the treatment of AL. The purpose of this study was to investigate and compare the clinical outcomes and radiological evaluation of our early MIS approach and OSF for AL.

Introduction. The potential structural effect of the sacral tilt on the development of disc wedging adjacent to lowest instrumented vertebra (LEV), and consequent postoperative coronal trunk decompensation in the surgical treatment of idiopathic scoliosis are well known. The aim of this study is firstly to establish the possible role of sacral tilt, limb length inequality, and associated pelvic girdle anomalies in the cause of idiopathic scolisosis, and secondly to determine the effect of sacral tilt on adjacent disc wedging below LEV in some idiopathic curves such as thoracolumbar/lumbar curves, and double major curves postoperatively. Methods. Between 2006 and 2008, 159 patients with idiopathic scoliosis from outpatient clinics were included in analyses. In all patients, standing posteroanterior and lateral spinal column and Ferguson radiographs were routinely taken. If direct radiographs suggested iliac bone asymmetry, hemi-pelvis volume measurements were done with CT scan. Curve type, sacral tilt, L5 tilt, iliac asymmetry, and limb-length differences were measured. As a second part of study, 87 surgically treated patients with double major curves were examined retrospectively in terms of adjacent subjacent disc wedging below LEV and sacral tilt. Results. In the first part of the study, the mean age of patients was 14·21 years (range 2–25) and all but 14 were female. The curve types were lumbar in 31 patients, thoracolumbar in 42, double major in 55, thoracic in 27, and triple in four. Sacral tilt towards the convex side of TL/L curve was present in 117 (74%) patients with an average of 8° measured from Ferguson graphs. L5 tilt towards the convex side of TL/L curve, and limb length inequality of less than 5 mm on the convex side of TL/L curve were more prevalent in patients with sacral tilt (57%) than in those without sacral tilt (p=0·021). On hemi-pelvis volume measurement, patients with no sacral tilt (n=42) had no difference in both sides whereas patients with sacral tilt (n=117) showed significant difference, with the convex side being smaller. We noted a correlation between L5 tilt and sacral tilt (p=0·048) and between sacral tilt and hemi-pelvis volume (p=0·024). There was no correlation between sacral tilt and pelvic asymmetry, age, sex, curve type, or amount of limb length inequality. In the second part of the study, disc wedging adjacent to LEV was present in 75 of 87 patients and sacral tilt was present in 72 of 75 (96%) (p=0·008). Six patients had limb length inequality of more than 1 cm, showing the postoperative trunk decompensation, which was corrected by elevating the shorter leg by shoe-lift. Conclusions. This study revealed significant association between sacral tilt and hemi-pelvis hypoplasia independent from age. This association may have a primary role in the cause of this disease. Although LEV is paralel to pelvis, intervertebral disc adjacent to LEV is often wedged and there is lumbosacral hemicurve distally below the instrumentation in patients treated by either anterior or posterior surgery. We believe that lumbosacral hemicurve due to sacral tilt behaves like hemivertebra, which is impossible to detect with preoperative standing anteroposterior radiographs. Ferguson view is necessary to detect the sacral tilt. The postoperative trunk decompensation is greater with presence of sacral tilt and limb length inequality

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The prevalence of scoliosis is not known in patients with idiopathic short stature, and the impact of treatment with recombinant human growth hormone on those with scoliosis remains controversial. We investigated the prevalence of scoliosis radiologically in children with idiopathic short stature, and the impact of treatment with growth hormone in a cross-sectional and retrospective cohort study.

Aims. Patients with multiple myeloma (MM) develop deposits in the spine which may lead to vertebral compression fractures (VCFs). Our aim was to establish which spinopelvic parameters are associated with the greatest disability in patients with spinal myeloma and VCFs. Patients and Methods. We performed a retrospective cross-sectional review of 148 consecutive patients (87 male, 61 female) with spinal myeloma and analysed correlations between spinopelvic parameters and patient-reported outcome scores. The mean age of the patients was 65.5 years (37 to 91) and the mean number of vertebrae involved was 3.7 (1 to 15). Results. The thoracolumbar region was most commonly affected (109 patients, 73.6%), and was the site of most posterior vertebral wall defects (47 patients, 31.8%). Poorer Oswestry Disability Index scores correlated with an increased sagittal vertical axis (p = 0.006), an increased number of VCFs (p = 0.035) and sternal involvement (p = 0.012). Poorer EuroQol visual analogue scale scores correlated with posterior vertebral wall defects in the thoracolumbar region (p = 0.012). The sagittal vertical axis increased with the number of fractures and kyphosis in the thoracolumbar (p = 0.009) and lumbar (p < 0.001) regions. Conclusions. In MM, patients with VCFs have poorer clinical scores at presentation in the presence of sagittal imbalance. Outcome is particularly affected by multiple fractures in the thoracolumbar and lumbar regions and by failure to prevent kyphosis. Patients with MM should be screened for spinal lesions early. Cite this article: Bone Joint J 2016;98-B:1234–9

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To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS).

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The aim of this study was to investigate whether including the stages of ulnar physeal closure in Sanders stage 7 aids in a more accurate assessment for brace weaning in patients with adolescent idiopathic scoliosis (AIS).

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Spinal fusion remains the gold standard in the treatment of idiopathic scoliosis. However, anterior vertebral body tethering (AVBT) is gaining widespread interest, despite the limited data on its efficacy. The aim of our study was to determine the clinical efficacy of AVBT in skeletally immature patients with idiopathic scoliosis.

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To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele.

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We present the results of correcting a double or triple curve adolescent idiopathic scoliosis using a convex segmental pedicle screw technique.