Introduction: There are few reports investigating the actual situation of postoperative sports resumption in patients with adolescent idiopathic scoliosis (AIS), a condition often requiring surgery during the active sports years of middle and high school. The purpose of this study is to investigate the actual situation of postoperative sports resumption in AIS patients and to analyze factors related to returning to sports after surgery.

Methods: A survey on sports activity and postoperative resumption was conducted in 170 AIS patients who underwent posterior correction and fusion surgery before the age of 18 and had a follow-up period of at least 2 years. Various radiographic parameters were measured using whole-spine images taken before surgery and 2 years postoperatively. Clinical evaluation was performed using the SRS-22r questionnaire. Comparisons were made between two groups based on the presence or absence of preoperative sports activity and postoperative sports resumption.

Results: Responses were obtained from 131 of the 170 patients (121 females, 10 males, average age 14.6 years), with a response rate of 77%. Among them, 68 patients (51.9%) had participated in sports preoperatively. The most common sport was tennis, with school clubs being the main venue. Most participants competed at the prefectural or city level, but four patients had competed at the national level. Among the 68 patients, 37 (54.4%) returned to sports postoperatively, with an average time to resumption of 8.3 months. The most common reason for not resuming sports was the conclusion of school club activities, although 11 patients cited surgery as a reason. Among those who resumed sports, 28 (75.8%) returned to the same sport, and 26 (70.3%) were able to maintain their competitive level.

Conclusions: Among AIS surgical patients, 52% engaged in sports preoperatively, and 54% returned to sports postoperatively. Spinal fusion and prolonged postoperative rest may be factors discouraging sports resumption. The results suggest a need for postoperative rehabilitation guidance tailored to facilitate sports resumption.

Introduction: Brace treatment has been widely accepted for the non-operative care of adolescent idiopathic scoliosis (AIS). Many studies have proposed the factors for the timing of brace weaning, but consensus has not been reached. Therefore, we aimed to investigate the timing of brace weaning using the hand skeletal maturity index in patients with AIS.

Methods: Twenty patients with AIS were enrolled for brace treatment in accordance with SRS brace criteria. Mean age, body height, and Cobb angle at the time of initial bracing and brace weaning were measured. Days in-brace period also was counted from initial bracing to brace weaning. Failure of brace treatment was defined as a Cobb angle > 40° or surgery. Chi-square tests and Cramer's V values were utilized to identify the relationship between the skeletal maturity scale (Risser sign, SSMS, and TOCI) and curve progression after brace weaning.

Results: Mean ages at the time of initial bracing and brace weaning were 12.7 and 15.1 years, respectively. Mean heights at those periods were 151.3 cm and 160.0 cm, respectively. The average in-brace period was 913 days. The mean major Cobb angles at the timing of initial bracing, brace weaning, and at 6-months after brace weaning were 29.8°, 30.2°, and 29.2°, respectively. The success rate by brace treatment was 80% in this study. The timing of weaning at TOCI 8 had a significant association with curve progression < 5° of 6 months after brace weaning.

Conclusions: The success of bracing is the precise timing of its brace weaning at skeletal maturity. The accurate identification of skeletal maturity provides a good recommendation for brace weaning in order to avoid the overuse of bracing and minimize the physical and mental burdens in AIS patients. Knowing the timing of brace weaning using TOCI classification allows a prospective prediction of curve progression in AIS.

Introduction: Proximal reciprocal change of global spinal alignment after thoracolumbosacral fixation has been well reported. On the other hand, distal reciprocal change of global spinal alignment after occipitothoracic fusion (OTF) are still unclear, nevertheless difficulty in horizontal gaze can occur depending on the change in thoracolumbosacral alignment since neck mobility is completely lost after OTF. The purpose of this study is to investigate reciprocal change of global spinal alignment and risk factors of horizontal gaze after OTF.

Methods: Sixteen patients who underwent OTF and followed over 1 year were included. We measured cervical and global spinal sagittal alignment on preoperative, postoperative and follow-up radiograms and investigate the chronological changes of the alignments after OTF. In addition, the alignments were compared between the cases with the difficulty in horizontal gaze (group NG) and without it (group G).

Results: T1 slope (T1S) and COG-C7 SVA did not show significant change between pre- and postoperative radiogram, but significantly increased in follow-up (T1S: 29.7 degrees to 36.7 degrees, COG-C7 SVA: 28.4 mm to 43.9 mm) (p<0.01). There were no significant changes in C2-7 angle, TK, LL, SS, C7 SVA during follow-up period. There were six cases of group NG and ten cases of group G at the follow-up. The difference of preoperative radiological parameters was not significant between group NG and group G. However, postoperative COG-C7 SVA in group NG (47.4 mm) was significantly larger than group G (21.3 mm) (p<0.05). The incidence of difficulty in horizontal gaze was significantly higher in the cases with 35 mm or more postoperative COG-C7 SVA (six of eight cases) than the cases with under 35 mm postoperative COG-C7 SVA (no case) (p<0.01).

Conclusion: In the cases after OTF, T1S and COG-C7 SVA increased during follow-up although there had no change of global spinal alignment between before and after surgery. Postoperative COG-C7 SVA of 35 mm or more was risk factor of difficulty in horizontal gaze.

Introduction: We conducted a questionnaire survey among members of Japanese Scoliosis Society because the current situation in Japan is unclear.

Methods: The questionnaire included basic information of respondents, recognition of physiotherapeutic scoliosis specific exercises (PSSE), and status of its implementation at their affiliated institution, and nearby medical institutions/non-medical institutions, etc.

Results: Response rate was 29% (193 of 656 members), of which 95% were physicians. Seventy percent of respondents had more than 20 years of experience and the most common affiliation was university hospital (47%). Regarding the type of treatment that respondents were engaged in (multiple answers allowed), 70% answered surgery, while 15% answered physical therapy. Among the respondents, 77% recognized PSSE. Regarding the effectiveness of PSSE, 22% answered positively, 35% answered negatively, and 43% answered "undecided. " Among the respondents, 12% implemented PSSE. When asked whether they knew of any nearby medical or non-medical institutions that provide exercise therapy (broad definition including PSSE) /PSSE, the percentage of respondents answering "yes" was 31%/16% for medical institutions and 36%/17% for non-medical.

Conclusions: Although PSSE was widely recognized, limited members actually performed it, and evaluation of its effectiveness was mixed. It was suggested that exercise therapy may be as common or more common in non-medical institutions than in medical institutions.

Introduction: Brace treatment is important to prevent curve progression in adolescent idiopathic scoliosis (AIS). We conducted a questionnaire survey of patients regarding Osaka Medical College (OMC) brace (underarm type) and made the following improvement; (1) a frontal pelvic fixation belt, (2) a change in axillary pad material, and (3) a weight reduction of the brace (modified OMC brace). This study aimed to compare the treatment outcome of the modified OMC brace with that of the conventional brace.

Methods: AIS patients treated with brace were included. Patients were divided into two groups: conventional OMC brace group (group C) and modified OMC brace group (group M). Curve progression was defined as a worsening of 6° or more in the Cobb angle at the end of brace treatment, or conversion to surgery before bracing was completed. Demographic data, image evaluation, and information on brace wearing were recorded. Statistical analysis was performed using the χ-square test to compare the rate of prevention of curve progression between the C and M groups. P<0.05 was considered a significant difference.

Results: Of the brace treated AIS patients, 35 in the C group and 27 in the M group were evaluated. The age just before brace was 13.4 years in group C and 12.8 years in group M, younger in group M (P=0.029). On the other hand, there was no difference in bone maturity (Risser+ grade). The duration of brace wear was longer in group M (14 months in group C vs. 20 months in group M, P=0.024). There was no significant difference in the rate of prevention of curve progression (Group C (65.7%): Group M (63%) ).

Conclusion: There was no difference in treatment outcome despite changes in brace shape and material.

Introduction: In adult spinal deformity (ASD), a sagittal vertical axis (SVA) greater than 100 mm is associated with aggravated postural balance. However, quantitative changes of standing balance before and after surgery in ASD patients were only a few studies. The aim of this study was to investigate changes in the sway of the center of gravity (COG) before and after surgery in ASD patients with a preoperative SVA> 100 mm.

Methods: This is a retrospective observational (clinical) study. Thirteen female patients with ASD (66.7±7.1 years) were SVA> 100 mm preoperatively. All patients underwent long segment at corrective fusion surgery from the middle to lower thoracic spine to pelvis. The examination of the sway of the COG was measurement eye-opening, barefoot and closed legs with standing position for 60 seconds on the stabilometry. We used 6 parameters: the enveloped area, total track length, total left and right distance traveled, total anteroposterior distance traveled, coronal plane (X axis) mean deviation, sagittal plane (Y axis) mean deviation. Spinopelvic alignment and the angles of the lower extremity joint were analyzed using EOS system. The results were compared preoperatively and one year postoperatively.

Results: The post-operative SVA was significantly improved than pre-operative (31.2±33.3 mm vs. 158.5±40.0 mm, p<0.01). Total track length, total anteroposterior distance traveled, sagittal plane (Y axis) mean deviation were significantly reduced following surgery (p<0.02). Enveloped area, total left and right distance traveled, coronal plane (X axis) mean deviation showed no significant difference.

Conclusions: Compensatory posture was improved by corrective fusion surgery, affected the sway of the COG.

Introduction: Several studies have analyzed vertebral deformities in adolescent idiopathic scoliosis (AIS) using three-dimensional (3D) techniques. We developed a novel 3D analysis method utilizing a coordinate system based on the caudal endplate of the vertebral body and evaluated its utility.

Methods: Forty cases who underwent surgery for thoracic AIS (Lenke type 1 or 2) were randomly selected. Using preoperative CT images and specialized image analysis software, we measured sagittal tilt (SaT), coronal tilt (CoT), and the angle between the cranial and caudal endplate (endplate angle, EPA) for five vertebrae spanning from two levels above to two levels below the apical vertebra (AP) of the main thoracic curve. These 3D parameters were compared across vertebral levels, and correlations were assessed among the parameters as well as between the parameters and Cobb angles.

Results: CoT and EPA were significantly greater at the AP and AP−1 levels, while SaT was significantly smaller at the AP and AP+1 levels. EPA demonstrated a significant positive correlation with CoT across all measured vertebrae, but not with SaT. Neither CoT and EPA showed significant correlations with the standing Cobb angle; however, both exhibited significant positive correlations with the lateral bending Cobb angle.

Conclusions: Vertebral deformities were most pronounced around the apical vertebra. However, intervertebral disc deformity appeared to contribute more significantly to the standing Cobb angle than vertebral body deformity.

Introduction: It was quantified that perioperative blood loss during surgery to treat adult spinal deformity, and the potential risk factors associated with increased hemorrhagic volume were systematically evaluated.

Methods: A total of 125 cases were retrospectively selected from among 283 adult spinal deformity procedures performed between December 2019 and November 2023, all of which involved spinal fixation extending from the thoracic vertebrae to the ilium.

We assessed the patients' characteristics (age, sex, body mass index [BMI], use of antithrombotic agents, and presence of renal insufficiency, hypertension, and diabetes), as well as operative parameters (total surgical duration, intraoperative blood loss, surgical approach, postoperative drain output, and overall perioperative bleeding volume).

The cases were stratified according to whether perioperative blood loss exceeded the mean value, and the potential risk factors contributing to higher blood loss were analyzed.

Results: The mean patient age was 70.9 years, and seven individuals maintained antithrombotic agents during the perioperative period. The mean operative time, intraoperative blood loss, postoperative drain output, and total perioperative blood loss values were 480.1 min, 971.3 mL, 1,206.8 mL, and 2,178.1 mL, respectively.

Significantly higher BMIs, the performance of osteotomy, and longer operative durations were noted among those with perioperative blood loss ≥2,200 mL. However, continued use of antithrombotic agents was not significantly associated with higher blood loss.

Conclusion: Higher BMI, the performance of osteotomy, and longer surgical time appear to represent significant risk factors for increased perioperative hemorrhage during surgeries to treat adult spinal deformity. The effect of continued use of antithrombotic drugs on perioperative blood loss requires further investigation.

We report a case of pyogenic spondylitis after anterior-posterior spinal fusion surgery for lumbar kyphosis with an incidentally detected giant renal cyst using computed tomography (CT).

A 68-year-old male has presented with low back pain for 10 years. The symptom got worse and the patient was referred to our clinic. Before surgery, CT demonstrated bilateral giant renal cyst, which displaced the descending colon severely and laterally. Several punctures and alcohol sclerotherapy have been performed by a urologist. After the procedure, anterior-posterior spinal fusion surgery underwent for lumbar kyphosis. However, pyogenic spondylitis at L2/3 was found at 6-month postoperatively. Salvage surgery with posterior spinal fixation extension surgery combined with anterior debridement and autogenous iliac bone graft was added. After revision surgery, postoperative course was uneventful and the patient had no low back pain and walked without cane.

This case illustrated that histopathological finding as well as intraoperative specimen culture test was of paramount importance for diagnosing pyogenic spondylitis. In addition, preoperative contrast-enhanced CT was essential to detect the abnormal intra-abdominal organ or vessels for avoiding the LLIF approach-related complications.