New Advances in the Diagnosis and Treatment of Spinal Deformities Based on a review of 2011 reports and publication information, the discussion in this section focuses on idiopathic scoliosis, adult spinal deformities, the growth rod technique, three-column osteotomies, and neuromuscular spinal deformities. Multicenter studies are much larger than they were five years ago because of the establishment of corporate-sponsored research groups and further data collection. Idiopathic scoliosis In-school screening is a priority in the treatment of adolescent idiopathic scoliosis. The results of at least one large-sample retrospective cohort study in Hong Kong have proposed the application of a universal school-based screening methodology that they have authorized. Research on bracing continues, and wearing a brace twelve hours a day has become an important criterion, and it is clear that brace wearing time is negatively correlated with scoliosis progression. The convex lateral vertebral anastomosis is currently an alternative technique to bracing for the treatment of idiopathic scoliosis. The indications for the use of this technique and its efficacy are still unclear, but it has been reported that for thoracolumbar curvatures less than 35°, the efficacy of the convex anastomosis is similar to that of a brace. However, for thoracic curves between 35° and 44°, the efficacy is poor. A Korean study applied the thoracic pedicle nailing technique to treat idiopathic scoliosis for more than 10 years with favorable results. However, the amount of scoliosis angle correction is still controversial. A multicenter study concluded that correction of rotation by pedicle nailing may exacerbate sagittal imbalance and lead to thoracic flat back deformity in the long term. Therefore, maximal correction of the deformity is not the appropriate year. Adult Spinal Deformities A complication of treating adult spinal deformities is proximal junctional kyphosis and surgical failure in the proximal junctional position. At least one study suggests that prophylactic vertebroplasty may improve this. Another study suggests that CT imaging may be more likely than MRI to detect spinal stenosis at the stage of responsibility. Another study suggests that prophylactic placement of lower extremity venous filters may be effective in reducing the incidence of the corresponding complications in people at high risk for deep vein thrombosis and pulmonary embolism during spinal surgery A multicenter study suggests that the poorest postoperative outcomes after spinal deformity surgery in adults are seen in patients with severe preoperative pain symptoms, increased use of anesthetics, a high body mass index, and a high prevalence of anxiety and nervousness. This study concluded that these preoperative factors were more determinative of outcome than the technical aspects of the procedure. Another study concluded that the potential for improvement of symptoms after spinal deformity surgery in adults varies depending on the initial or revision surgery. And at least one study showed that the types of postoperative complications after spinal fusion were very similar between patients who had osteoinductive protein applied and those who did not. The only difference was in anterior cervical fusion, where osteoinductin application may lead to an increased complication rate. In a survey of spine surgeons at the SRS meeting, it was shown that bone graft substitutes are now preferred over iliac bone grafts. Most spine surgeons are no longer using iliac bone graft as the gold standard for spinal fusion surgery, and are turning to bone graft substitutes to minimize donor-area complications and improve fusion rates. Growing Rod Technique The application of deformity-controlling or corrective fixation as an alternative to spinal fusion is now becoming more and more of a focus for patients under the age of ten. One study showed that in most patients with early scoliosis, growth rods need to be removed and fused with internal fixation. Further, fusion spans more segments than growing rods, and the final correction rate of spinal deformity is less than 50% with the growing rod technique. Among patients with early scoliosis, the more difficult to apply the growth rod technique to are those with large angular rigid thoracic kyphosis. However, in this group of patients, pedicle screw internal fixation points were more satisfactory than the peg hook system. The application of this surgical technique appears to be beneficial in improving the overall nutritional status of the child. Three-column osteotomy An experimental study in a porcine model confirmed that it is safe to shorten the thoracolumbar spine by less than 5.1% of the total length of the anterior spinal column (T1-L6). A shortening equal to or greater than 6.3% carries a significant risk of spinal cord injury. When combined spinal cord disease makes it difficult to obtain intraoperative spinal cord monitoring data, it can also be concluded that there is a very high incidence of substantial neurologic complications during surgery. Neuromuscular scoliosis A Canadian study has demonstrated that glucocorticoid (fucoidan) therapy is effective in reducing the incidence of treatable scoliosis caused by duchenne muscular dystrophy. Preliminary data suggests that growth rod technology may have a role in the treatment of spinal muscular dystrophy. Another study confirmed that pre-tethered release is not necessary in the correction of spinal deformities caused by myelodysplasia.