Adolescent idiopathic scoliosis (AIS) is treated with various forms of conservative care or surgery, depending on the degree of severity. When AIS is detected early, it can be monitored and initially treated with reduced invasiveness to prevent further progression. AIS manifests itself through deformations of the trunk, which are mostly identified as asymmetries in manual clinical examination. Torsobarography is a new pressure-based surface topographic system for posture analysis and evaluates such associated morphologic asymmetries. The aim of this study is to investigate the diagnostic validity of torsobarography by examining correlation of extracted torsobarographic indices with the Cobb angle and its ability to differentiate between different severities of scoliosis: no scoliosis, mild scoliosis, and moderate scoliosis. A total of 87 subjects (51 females and 36 males) were examined with torsobarography. Six torsobarographic indices were calculated for all subjects: torsobarography angle (TBA), sagittal imbalance index (SII), torso asymmetry index (TAI), shoulder asymmetry angle (SAA), waist asymmetry angle (WAA), and pelvis asymmetry Angle (PAA). These indices were correlated with the Cobb angle, and the differences between severities were statistically analyzed. Three out of six indices (TBA, TAI, and WAA) were able to significantly distinguish between mild and moderate scoliosis. Additionally, those indices showed moderate correlation (ρ = 0.37-0.50) with the Cobb angle measurements. The WAA was the only statistically significant index capable of differentiating between no scoliosis and moderate scoliosis. This study is the first to demonstrate that torsobarography can distinguish between different severities of scoliosis and thus identify a scoliotic deformity that requires bracing over monitoring.

Adult spinal deformity (ASD) is a spectrum of abnormalities of the thoracic and lumbar spine and has an increasing prevalence. It is associated with significant physical and mental disability in symptomatic patients. Given the increased rates and the morbidity associated with this disease, novel innovation in the diagnosis and treatment of such deformity is required. The SRS-Schwab classification system described coronal scoliotic deformity with sagittal modifiers. Other parameters, such as the sagittal vertical axis, pelvic tilt, T1 pelvic angle, pelvic incidence and lumbar lordosis attempted to quantify global sagittal balance. More recently, a focus on more patient specific parameters has been targeted to improve patient outcomes. The Roussouly classification system attempted to predict sagittal alignment parameters based on fixed parameters of the pelvis. Others determined the parameters based on patient age. Technological advances have also enhanced our understanding of ASD. Long cassette films and automated analyses have allowed standardization of these measurements across physicians. 3D printing has been used as an adjunct for both surgical planning and implants, both generic and patient specific, to improve outcomes. With these, advances in minimally invasive approaches have allowed ASD correction with lower complications and blood loss. Intraoperative navigation and the use of robotics has allowed improved accuracy in the care of these patients. Development of complex osteotomies have allowed for correction of advanced deformity. Fusion, however, is the ultimate goal of surgical ASD correction. Advances in biologics such as the use of recombinant Human Bone Morphogenetic Protein-2 have been used to improve fusion rates and combat pseudoarthrosis. Finally, post-operative advances in ASD patient care with emphasis on enhanced recovery after surgery has allowed improvements in hospital length of stay and pain scores. ASD is becoming a more ubiquitous diagnosis for spine surgeons with an increasing aging population. Improvement in the understanding of the diagnosis, spinopelvic parameters, imaging techniques, and post operative care are all aimed toward helping patients in whom care can be extremely difficult. Further study in ASD patient care will target advanced innovation to provide optimal treatment to these patients and allow for best possible outcomes.

Surgical correction of neuromuscular scoliosis is a challenging problem facing spine surgeons. Many patients require long constructs and pelvic fixation to obtain adequate curve correction and pelvic obliquity correction. The aim of this technical note is to describe a technique for sequential pelvic obliquity and scoliotic curve correction in patients with neuromuscular scoliosis using four rods in upper thoracic to pelvis posterior spinal fusion, without the need for intraoperative traction. We present 5 cases of neuromuscular scoliosis that underwent upper thoracic to pelvis posterior spinal fusion using the four-rod technique and demonstrate improvement in major Cobb angle and pelvic obliquity immediately postoperatively and maintained at final follow-up (range: 2-16 years). Preliminary findings from this small case series support the use of four-rod correction technique for correction of neuromuscular scoliosis and pelvic obliquity.

In subjects with scoliotic alterations of the spine, asymmetrical lengths of the lower limbs are frequently observed, a condition commonly referred to as leg length inequality (LLI) or discrepancy (LLD). This asymmetry can induce pelvic misalignments, manifested by an asymmetric height of the iliac crests, and consequently an alteration of the spine's axis. Although correcting this discrepancy might appear to be a straightforward solution, further investigation may reveal other indications. The purpose of this article is to aid clinicians confronted with the decision of whether to compensate for an LLI in individuals with scoliosis, encompassing both adolescents and adults. It presents a literature review on the incidence of LLIs in the general population, distinguishing between structural LLI (sLLI) and functional LLI (fLLI) types of LLIs, and quantifying their magnitude with clinical and instrumental evaluation. Additionally, it links these two types of LLIs to the type of scoliosis (structural or functional). From a clinical perspective, it also examines the compensatory mechanisms employed by the pelvis in the presence of structural or functional LLIs in order to draw useful indications for therapeutic decisions. Moreover, it proposes an additional evaluation parameter in the coronal plane, namely the central sacral vertical line (CSVL), to aid in the decision-making process regarding LLI compensation. Although this parameter has been documented in the literature, it has been little associated with LLIs. The findings indicate that scoliotic discrepancies should be compensated (conservatively or surgically) only when the imbalance of the femoral heads is on the same side as the imbalance of the sacrum and the iliac crests; this corrective action should result in a reduction of the overhang in the coronal plane.

Temporary internal distraction (TID) is a surgical technique that can be utilized to correct severe scoliotic deformities. It allows the correction of severe curves (i.e., exceeding 90° to 100°) while minimizing the risk of neurologic injury associated with large corrections1,2.

Multilevel lateral interbody fusion is an acceptable surgical technique in patients with severe degenerative adult spinal deformity (ASD). The current standard-of-care in spine surgery includes the use of patient reported outcome measures (PROMs) to assess post-operative improvement. Objective activity data during the peri-operative period may provide supplementary information for patients recovering from ASD surgery. In this report, we use smartphone-based activity data as an objective outcome measure for a patient who underwent a two-stage operation for ASD corrective surgery: lateral osteotomy and lumbar interbody fusion with posterior column release. An 82-year-old male presented with intractable back pain secondary to severe thoracolumbar scoliotic deformity (Lenke 5BN). Pre-operative images demonstrated the presence of bridging osteophytes over the left lateral aspect of L2-5 disc spaces and over the apex of the lumbar curvature, with significant neuroforaminal stenosis. Surgical correction was completed in two stages: (1) left-sided lateral osteotomy using anterior-to-psoas approach (ATP) in a right lateral decubitus position, and (2) multilevel Ponte osteotomies and instrumented fusion from T10-pelvis. Post-operative radiography showed correction to scoliotic deformity and sagittal misalignment. The patient had developed seroma and wound dehiscence, which was evacuated on post-operative day 11. At 14-month follow-up, the patient reported significant improvement in pain symptoms, corroborated by patient reported outcome measures. To further quantify and assess patient recovery, smartphone-based patient activity data was collected and analyzed to serve as a proxy for the patient's functional improvement. The patient's walking steps-per-day was compared pre- and post-operatively. The patient's pre-operative baseline was 223 steps/day; the patient's activity during immediate post-operative recovery dropped to 179 steps/day; the patient returned to baseline activity levels approximately 3 months after surgery, reaching an average of 216 steps/day. In conclusion, we found that lateral osteotomy through an ATP approach is a powerful tool to restore normal spine alignment and can be successfully performed using anatomic landmarks. Additionally, smartphone-based mobility data can assess pre-operative activity level and allow for remote patient monitoring beyond routine follow-up schedule.