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A thirteen-year-old girl seemingly destined for a modeling career finds she has a deformation of the spine called scoliosis.

Study design Cadaveric anatomical analysis. Purpose and overview of literature. Oblique Lumbar Interbody Fusion (OLIF) is a minimally invasive surgical technique used to treat various lumbar spine pathologies, including spinal canal stenosis, degenerative scoliosis, and spondylolisthesis. While vascular injury to the approach (left) side is a recognized complication, there is an underappreciated risk of injury to the contralateral lumbar segmental arteries, particularly during discectomy and cage insertion. These vessels lie outside the direct OLIF surgical corridor and are thus at risk due to the \"blind\" nature of instrument manipulation. Understanding the trajectory of these contralateral arteries is essential for minimizing complications such as postoperative bleeding and psoas hematoma. The primary objective of this study is to evaluate the anatomical relationships of lumbar segmental arteries bilaterally and identify reliable predictors of contralateral artery trajectory. Methods A total of 30 intact cadaveric specimens were dissected to assess the anatomical course of both left and right lumbar segmental arteries. Measurements were taken at each lumbar level (L1-L5) to determine the distance between the arteries and defined landmarks along the intervertebral disc--from the most anterior to the most posterior border. Results The analysis revealed a strong correlation between the positions of the left and right lumbar segmental arteries at certain levels. Notably, the anterior position of the left segmental artery demonstrated a high predictive value for the contralateral artery's location at L4 (R = 0.882) and L5 (R = 0.804). In contrast, correlations were weaker at other levels, particularly in the posterior regions of the disc. Conclusion This cadaveric study suggests that identifying the anterior trajectory of the left segmental artery intraoperatively may serve as a reliable predictor for locating the contralateral artery, particularly at the L4 and L5 levels during OLIF procedures. if the left segmental artery is observed overlying the L4 and L5 vertebral bodies--rather than at the L3/4 or L4/5 intervertebral disc levels--surgeons can be reasonably assured that the corresponding right-sided arteries are also not positioned over the disc spaces. Nevertheless, the general surgical principle remains paramount: instrumentation should never extend beyond the contralateral intervertebral disc border, regardless of presumed vascular anatomy. Keywords: Lumbar segmental artery, Oblique lumbar interbody fusion (OLIF), Lateral lumbar interbody fusion (LLIF), Minimally invasive spine surgery, Vascular complication

The authors, one who has major scoliosis and the other the UK's leading Pilates practitioner, explain how Pilates exercises can promote flexibility, posture, and muscle strength for scoliosis sufferers.

When twelve-year-old Rachel learns that her scoliosis has worsened and she'll need to wear a back brace to keep her spine straight, she's devastated, afraid that she won't be able to play soccer, and terrified that she won't be able to hide her condition from her friends and classmates--but her mother's determined to spare her the spinal fusion surgery that she herself had as a teenager.

Background: Anterior vertebral body tethering (AVBT) and posterior dynamic deformity correction (PDDC) are motionsparing procedures for the treatment of idiopathic scoliosis. Currently, comparative data between AVBT and PDDC remain limited. We aim to compare the effects of AVBT and PDDC on perioperative 3D spinopelvic alignment. Methods: Through a single-centre study, patients treated with either AVBT or PDDC were identified. Major scoliosis, minor scoliosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic apical vertebral rotation (AVR thoracic) and thoracic apical vertebral translation (AVT thoracic) were measured pre- and post-operatively using 3D biplanar x-ray imaging and reconstruction. Independent t tests compared correction rates and absolute changes in spinopelvic parameters between groups. Results: Twenty-two patients (9 PDDC, 13 AVBT) with a mean age of 13.7 (10.317.8) years at index surgery were identified. The correction rate of major scoliosis was 50% with PDDC and 40% with AVBT (p = 0.14). The correction rate of minor scoliosis was 48% using PDDC and 29% using AVBT (p = 0.07). The total change of TK was +10° for PDDC and -1° in AVBT (p = 0.007) postoperatively. LL was +5° with PDDC and -8° with AVBT (p = 0.008). SS was +1° with PDDC and -6° with AVBT (p = 0.05). PI and PT were both similarly stable between groups (p = 0.3, p = 0.2). Postoperative AVR thoracic improved by 3.9° for PDDC and 4.9° for AVBT (p = 0.75). AVT thoracic had a postoperative improvement of 3.8 cm for PDDC and 2.2 cm for AVBT (p = 0.04). Conclusion: Fusionless surgeries improved both major and minor scoliosis, as well as thoracic apical rotation. AVBT was less kyphogenic and decreased LL compared with PDDC, whereas PDDC had better correction of coronal vertebral translation.

\"This unusual memoir immerses the reader in the fascinating story of a spirited girl in a remote, undeveloped region of Nepal near the border of Tibet, a place made known to the world in Peter Matthieson's The Snow Leopard. Life above 13,000 feet in northern Dolpo--often called the last paradise because of its breathtaking snow-capped peaks, untouched beauty, and hand-irrigated green pastures--was one of constant risk and harsh survival. In the 1980s, Dolpo had no running water, electricity, motor vehicles, phones, school, or doctors, other than the local lamas, trained in the use of herbs and prayer. Dorje Dolma's life centered around the care of her numerous younger siblings and the family's sheep, goats, and yaks. At age five she began herding, taking the animals high in the mountains, where she fought off predatory wolves and snow leopards. Covering her first ten years, the story takes Dorje from her primitive mountain village to the bewildering city of Kathmandu, and finally to a new home in America, where she receives life-saving medical treatment. With humor, soul, and insightful detail, the author gives us vividly told vignettes of daily life and the practice of centuries-old Tibetan traditions. She details the heartbreaking trials, natural splendors, and familial joys of growing up in this mysterious, faraway part of the world with its vanishing culture. This is the inspiring story of an indomitable spirit conquering all obstacles, a tale of a girl with a disability on her way to becoming a dynamic woman in a new world\"-- Provided by publisher.

IntroductionIn adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition.MethodsThis is an expert’s opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified.ResultsTwo main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers.ConclusionCoronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Background The Cobb angle is proposed as the “disease process” outcome for scoliosis research because therapies aim to correct or stop curve progression. While the Scoliosis Research Society recommends the Cobb angle as the primary outcome, the Society on Scoliosis Orthopaedic and Rehabilitation Treatment prioritises, as a general goal, patient related outcomes over Cobb angle progression. Objective To determine the threshold of change in the Cobb angle in adolescents with idiopathic scoliosis (AIS) who perceive improvement in a 6-months randomized controlled trial comparing a Schroth exercise intervention added to the standard of care to the standard of care alone. Methods This is a secondary analysis of data from a randomized controlled trial of 50 patients with AIS, with curves ranging from 10° to 45°, with or without a brace. Participants with diagnoses other than AIS, surgical candidates or patients who had scoliosis surgery were excluded. The 6-month interventions consisted of Schroth exercises added to standard-of-care (observation or bracing) with daily home exercises and weekly therapy sessions (Schroth) or standard-of-care alone (Control). The anchor method for estimating the minimal important difference (MID) in the largest Cobb angles (LC) was used. Patient-reported change in back status over the 6-month treatment period was measured using the Global Rating of Change (GRC) scale as anchor varying from − 7 (“great deal worse”) to + 7 (“great deal better”). Participants were divided into two groups based on GRC scores: Improved (GRC ≥2) or Stable/Not Improved (GRC ≤1). MID was defined as the change in the LC that most accurately predicted the GRC classification as per the receiver operating characteristic curve (ROC). Results The average age was 13.4 ± 1.6 years and the average LC was 28.5 ± 8.8 °s. The average GRC in the control group was − 0.1 ± 1.6, compared to + 4.4 ± 2.2 in the Schroth group. The correlation between LC and GRC was adequate (r = − 0.34, p  < 0.05). The MID for the LC was 1.0 °. The area under the ROC was 0.69 (0.52–0.86), suggesting a 70% chance to properly classify a patient as perceiving No Improvement/Stable or Improvement based on the change in the LC. Conclusion Patients undergoing Schroth treatment perceived improved status of their backs even if the Cobb angle did not improve beyond the conventionally accepted threshold of 5°. Standard of care aims to slow/stop progression while Schroth exercises aim to improve postural balance, signs and symptoms of scoliosis. Given the very small MID, perceived improvement in back status is likely due to something other than the Cobb angle. This study warrants investigating alternatives to the Cobb angle that might be more relevant to patients. Trial registration ClinicalTrials.gov , NCT01610908 . Retrospectively registered on April 2, 2012 (first posted on June 4, 2012 - https://clinicaltrials.gov/ct2/keydates/NCT01610908 )