Introduction: Children with spinal deformities cannot undergo anterior column fusion due to the lack of fusion devices tailored to pediatric sizes. This is a significant factor contributing to postoperative complications such as spinal cord folding, non-fusion of the anterior column and internal fixation failure. Customized 3D-printed titanium alloy fusion devices can meet the needs of these patients.
Methods: This manuscript retrospectively collected 1-year follow-up data from 20 patients who underwent 3D-printed titanium alloy fusion device placement in the vertebral body and 110 patients who did not undergo anterior column fusion during the same period. Methods such as t-tests and chi-square tests were used to compare intraoperative data and postoperative follow-up data between the two groups of patients.
Results: There were no statistically significant differences between the two groups of patients in terms of surgical time, intraoperative bleeding, and neurological complications. However, the use of 3D-printed titanium alloy fusion devices significantly improved the restoration of intervertebral height and the rate of interbody fusion at one year.
Conclusion: The use of 3D-printed titanium alloy fusion devices is associated with simplified surgical procedures, without increasing surgical risks, and improves postoperative interbody fusion. It represents one of the surgical strategies for anterior column fusion in pediatric spinal deformity patients.

Introduction: Active apex correction (APC) is posterior tethering technique for correction of early onset scoliosis (EOS) via reverse modulation at the apex. APC has been increasingly used worldwide. This study aimed to assess short-term outcomes of multicenter study with ≥2 years of APC on spine length, curve correction, complications, unplanned surgeries, and proposed low crankshaft phenomena incidence. Methods: Prospective multicenter study including 24 EOS patients treated by APC; involves inserting and compressing pedicle screws on convex side of apex proximal and distal to most wedged vertebra allowing apex modulation according to Hueter-Volkmann law. Excluded patients with <2years follow-up whom APC was not primary surgery. Results: Mean age 85.97 ± 32.43 months, 71% congenital scoliosis, mean follow-up 35.54 ± 12.36 months. At final follow-up, statistically significant improvement in Cobbs angle (Δ=23.96%, p<0.0001), spinal length T1-T12 (Δ=12.83%, p<0.0001), T1-L5 (Δ=13.41%, p<0.0001) but not in apical vertebral translation (AVT) albeit clinical improvement (Δ=7.9%, p=0.36) compared to preoperative measurements. Comparing immediate postoperative measurements to >2 years follow-up, statistically significant improvement in spinal length T1-T12 (Δ=6.03%, p=0.0002) and T1-L5 (Δ=6.26%, p<0.0001) but not in Cobbs angle (Δ=4.93%, p=0.3) or AVT (Δ=14.77%, p=0.25). 9 complications requiring 3 unplanned surgeries recorded in all patients including 2 broken rods, 2 adding-on and 4 screw dislodgement. Conclusion: APC is a novel technique that has been incorporated in several countries as treatment modality for EOS. Short-term outcomes are promising in terms of clinical improvement, complication rates and decreased need for multiple operations or unplanned surgeries.

Introduction
Active Apex Correction (APC), a hybrid strategy featuring replacing a traditional SHILLA with apex growth modulation through unilateral compression on the convex side associated with translation and rotation and distraction on the concave side , has been shown to be safe and effective for Early Onset Scoliosis. Aims/Objectives To determine the rate of Apex facet fusion in children with Early Onset Scoliosis treated surgically with Active Apex Correction APC technique. Methods Multicenter retrospective study was done for patient who were treated with APC technique as the index surgery for Early Onset Scoliosis children with more than one year follow up. All patients enrolled had a minimum one year follow up with a 3D CT scan determining the rate of facet fusion in the Apex of the deformity treated with posterior tethering Results 16 patients received APC as the index surgery for Early Onset Scoliosis with at least 1-year follow up. The average age of surgery was 8 years, and 9 of cases were congenital, 2 juvenile, 3syndromic, 1 neuromuscular. Mean patient follow up was 26 months. In total 96 facets in the tethered apex were evaluated, with 80% facets demonstrating clear radiological evidence of no fusion, while the remaining were fused or semifused. Conclusions APC for Early Onset Scoliosis offers patients apical correction associated with modulation and non-fusion technique, clearly demonstrated with low incidence of facet fusion levels at the Apex, limiting the crankshaft phenomena seen in cases resulting in arthrodesis at apical levels.

Introduction
VBT/ASC is becoming an increasingly popular technique as an alternative to spinal fusion surgery for some patients with idiopathic scoliosis. However, complications after VBT still occur and many of them are mechanical, which may be related to patient selection. Another perioperative complications although not uncommon, but currently discussed with less interest.
Materials and Methods
Our experience: a total of 511 patients were operated on between 2019 and 2023 using VBT/ASC technic. One side VB–84 pt., doble side VBT-77 pt., one side ASC -135 pt., doble side ASC–133 pt., hybrid instrumentation 82 pt. All operations were performed through thoracotomy/thoracophrenotomy. Complications were identified, recorded and analyzed among all patients.
Results
Complications: Hemothorax, requiring revision (5 pt.-0.97%) and re-drainage (14 pt.-2.74%). Pneumothorax requiring repeated drainage 32 pt. – 6.2%. Chylothorax 3 pt.–0.59%, treated with octreotide and diet without revision. Cord breakage 4 pt.–0.78% without significant loss of correction. Hypercorrection 3 pt. – 0.58%, treatment tactics are determined. Malposition 2 pt. – 0.39%, re-intervention. Neuropathic pain syndrome revision cause 2 pt.-0.39%. Breakage of drainage in the pleural cavity 1 pt.–0.001%, thoracoscopy. Spondylitis 1 pt.–0.001%, conservative treatment. The overall complication rate was 12.9%.
Conclusion
VBT/ASC remains a promising novel procedure that is effective in treating scoliotic deformities non-fusion. The overall complication rate is relatively low and may be related to patient selection criteria, learning curve, hardware, etc. Research is needed to find out the reasons underlying the development of complications, and, in particular, to determine the optimal timing of surgery for a growing spine.

Introduction Despite the active implementation of dynamic correction in case of idiopathic scoliosis, there are no comparative studies of results of posterior and anterior dynamic correction in patients with completed and near-completed growth.
Methods Eighty-six patients with Lenke 5 scoliotic deformities were enrolled in the study. The first GP 54 patients) underwent deformity correction via posterior approach with fusion; the second group (32 patients) — using ASC. Mean age was 22.6±12.8 and 27.3±10.9 years, respectively. We studied radiological data before surgery, immediately after surgery, and 2 or more years after surgery. Blood loss volume, duration of hospital stay, and duration of narcotic analgesics intake in the early postoperative period were analyzed. Functional results were assessed using SRS-22.
Results Preoperative Cobb angle in the first group was 65.5°, and 27.5° at the long-term FU. Mean number of fixed levels was 6.4±1.0 in the first GP and 5.6±1.5 in the second GP. Mobility of the thoracolumbar/lumbar curve was higher in the second group, 28.2±9.1°, compared with 36.0±7.2° in the first group. Preoperatively, lumbar lordosis in the second group was 42.5°, in the long-term period — 43.5°, and in the first group — 43.4° and 44.3°.
Conclusion Both posterior fusion and ASC in case of Lenke 5 idiopathic scoliosis can provide satisfactory radiological results with initially similar thoracolumbar deformities in patients with completed or near-completed growth. However, dynamic approach can reduce blood loss, duration of hospital stay, duration of narcotic analgesics intake after surgery, and improve quality of life in the long-term period.

Objective: Comparison of additive technologies and conventional methods in the surgical treatment of cervicothoracic deformities. Materials: Surgical treatment was performed in 39 patients with cervicothoracic deformities of various etiologies. 19 patients (group I) underwent 2-stage treatment (halo+dorsal instrumentation). 20 patients (group II) underwent 3-stage treatment with anterior decompression and fusion with individual additive implants. Treatment results were assessed over a period of 6 to 42 months. Results: Decompression according to postoperative CT data in group I: insignificant – 3 patients, partial – 3, complete – 2; in group II - insignificant - 0, partial - 3, complete - 8. Results of the dynamics in neurological deficit: Group I: worsening of the deficit - 0 patients, no regression - 3 patients, partial regression - 1 patient, complete regression - 0 patients; group II - worsening in of the deficit - 0 patients, no regression - 1 patient, partial regression - 4 patients, complete regression - 3 patients. Assessment of implants stability during follow-up: Group I – revision interventions in 3 cases. In group II, there were no cases of revision interventions. Conclusions: The use of multi-stage surgical treatment is the most expedient in neurologically complicated patients. According to our observations, additive implants are most appropriate for anatomically complex deformities, which allows for complete decompression and ensures stability of fixation.

Introduction: a system for anterior dynamic scoliotic correction of spinal deformities in adult patients and children has been developed.
Methods: static and dynamic loading tests were carried out to determine the strength characteristics of the dynamic spine correction implant system. The tests were carried out on a universal dynamic testing machine servo-hydraulic type. Five cord samples were examined "at break" and five assemblies (cords fixed in the screw heads). The software recorded the received data. Additionally, cyclic tests were carried out to determine the properties of the samples during long-term operation. Fatigue tests were performed on assemblies identical to static loading samples, under load in one direction.
Results: the value of the load at rupture of the cord in kn was 2, 57. In addition, the average elongation value is 21%. Test results of five assemblies. The beginning of plastic deformation of the vertebral screw (cord is not damaged). After passing 10 million loading cycles, the samples underwent a visual inspection, which revealed minor lapping of the cord in the area of contact with the edge of the groove of the vertebral screw. Conclusion: The created system of anterior dynamic scoliosis correction has high strength characteristics of static and dynamic load and can be recommended for use in the clinic.

Introduction: Pelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), play pivotal roles in assessing sagittal balance pre- and postoperatively. While PI remains constant after skeletal maturity, PT and SS adapt as compensatory mechanisms to maintain head-pelvis alignment. Surgical interventions for adult spinal deformity (ASD), aimed at restoring sagittal balance, can influence PI, often targeted to align within 10° of lumbar lordosis (LL). This study investigates pelvic parameter changes in 80 ASD patients post-surgery. Methods: Eighty patients who underwent pelvic fusions with insertion of 160 S2AI screws were analyzed. Preoperative and one-year follow-up radiographs were analyzed using semi-automated tools in Surgimap to measure PI, SS, PT, and LL. Patients were categorized based on preoperative PI into low (<40°), normal (40°-60°), and high (>60°) groups. Changes in pelvic parameters were assessed using paired t-tests, with significance set at p < 0.01. A change in PI exceeding 6° was deemed significant. The chi-squared test compared the frequency of significant PI changes across the three PI groups. Results: Significant reductions were observed in PI, PT, and PI-LL post-surgery, with no significant change in SS. Preliminary findings indicated no statistically significant difference in the frequency of PI changes across the three preoperative PI groups, though definitive conclusions await further data. Conclusion: Surgery for ASD results in decreased PI, PT, and PI-LL, with early trends suggesting patients with high preoperative PI may retain elevated PI post-surgery.

Introduction: Although scoliosis mostly affects thoracic spine, many time surgeons fuse some lumbar vertebras. Reduced number of free lumbar segments leads to accelerated degeneration of free ones. Aim of this work was to present how we can achieve satisfactory scoliosis correction without instrumentation of L spine in vast majority of patients. Patients and methods: We have analyzed 149 patients whom we have done STF during last 12 years, with minimal follow up of 2 years (8,4. Including criteria were: primary Th curve with compensatory L curve, flexible L curve with Cobb ˂50°, Th˃L curve (type King II). Surgical technique was posterior corrective
spondylodesis Th4-Th12 with surgeon-directed MEP IONM. Results: Postoperative balance and deformity corrections was established in all patients, L curve was disappeared, brace was needed an 31 patients (20%) 3-6 months, average SRS22r score was 3,7±0,6/83±19. There were no
infections, emboli, neither implant loosening and neurological deficit complications. Discussion: Reduction of surgical exposure and free L spine are logical imperative in prevention of late disturbances (pain, loss of balance, revisions). Most of AIS patients that fulfil requirements for STF have fused 9,3 Th segments and skin scar of 26,5cm, no pain, and not reported restriction in any activities.

Abstract
Background
The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40° and 90° Cobb angle.The all-pedicle screw instrumentation method of posterior-only approach arthrodesis, which fuses strategically located vertebrae, avoids the metal and implant-related problems and has a correction rate comparable to other methods. It is also reasonably priced and cost-effective for patients in our setup.

Materials and Methods:
With minimal instrumentation, we selectively fused certain vertebrae to treat 175 patients with severe adolescent idiopathic scoliosis, whose mean age was 17.5 years. The average scoliosis curve measured 86° Cobb. The same senior surgeon handled every case, using both free hand and C-arm guided techniques along with intraoperative neurophysiologic monitoring.

Results:
Mean cobb angle was 86.8  6hich was improved to 163 degree post operatively. 3 patients developed transient neuro deficit which improved with time of average 3 months. 1 patient had superficial wound infection. VAS and ODI improved significantly

Conclusions:

Posterior instrumented fusion by minimum level pedicle screw insertion addressing the strategic vertebrae is a good and effective method for stable correction of Adolescent Idiopathic Scoliosis.

Introduction: Different surgical techniques and approaches have been described for treatment of low grade spondylolisthesis (Grade 1 and 2). Aim of our study was to assess the functional and radiological outcomes in patients with transforaminal lumbar interbody fusion .

Method: A prospective study consisting of 32 patients of Low-grade spondylolisthesis operated with TLIF at a tertiary care centre was undertaken for over 3years.The functional and radiological outcomes were evaluated. The radiological outcome was assessed on sagittal alignment at a specific level, radiologic bony fusion/non-union, intervertebral disc heights and percentage of a slip in relation to the endplate. The functional outcomes were assessed using the Visual Analogue Score (VAS) and the Oswestry Disability Index (ODI).

Results: The mean VAS score improved from 5.96 pre-operatively to 4.72 at POD5,2.78 at 12 weeks, 1.31 at 26 weeks follow-up. The mean ODI score improved from 73.44 preoperatively to 44 at POD5, 31.33 at 12weeks, 11.444 at 26 weeks follow-up. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL) were significantly greater in spondylolisthesis. PI, PT, and SS did not change statistically from the baseline postoperatively but increased LL and Segmental LL (P < 0.001), 86% of the patients with implants in situ had good fusion.

Conclusion: TLIF is effective in treating Low grades of spondylolisthesis with overall good to excellent functional outcome. It emphasizes the effectiveness of the procedure in providing stability , relieving pain, and improving quality of life.

Introduction:The distorted spinal anatomy and critical neurovascular neighborhood in congenital scoliosis make pedicle screw placement and surgical resection of congenital hemivertebrae challenging.We analyzed the feasibility and outcomes of utilizing 3D-printed patient-specific spine models as preoperative surgical simulators for hemivertebra resection and fusion for congenital kyphoscoliosis. Methods:Virtual pre-operative planning, simulation and intraoperative assistance of the patient-specific 3D-printed model was used to perform hemivertebra resection and deformity correction(3DP group) through an all-posterior approach.Operative time, intraoperative blood loss, accuracy of pedicle screw placement(Gertzbain-Robbins classification), and postoperative complications were recorded.Results were compared to a similar historic cohort of 12 patients(control group) who underwent hemivertebra resection and deformity correction without using 3D-printed models.Results:There was a significant reduction in the mean operative time in the 3DP group(262.8+/-64.3min, range 180 – 380 min) vs the control group(336.4+/-33.8min, range 240 – 420min), p<0.05. The intraoperative blood loss was significantly reduced in the 3DP group(390.8+/- 144.2 ml, range 250 – 600 ml) vs the control group(460.5+/-83.2 ml, range 350 – 900 ml), p<0.05. Pedicle screw placement accuracy was significantly higher in the 3DP group [92.8% (77/83 screws)] in comparison with the control group [86.6%(78/90 screws)].Critical pedicle breaches causing neurological deficits were significantly higher in the control group (n=2) vs 3DP group(n=0).The mean scoliosis and kyphosis correction rates were comparable in both groups.The mean SRS-22r scores were comparable in both groups.Conclusion:3D-printed patient-specific spine models as preoperative surgical simulators reduces operative time, blood loss, improves accuracy of pedicle screw placement, and reduces the incidence of neurological deficit due to screw misplacement.

Introduction. Titanium instrumentation in patients with osteoporosis can lead to unsatisfactory results. At the present time there is a clear increase in complication rate that has to do with implant instability.
Materials and Methods. A total of 160 patients aged 40 to 82 with low bone mineral density took part in the investigation. The level of BMD was on average 0.854-0.884 g/cm2 with T-scores ranging from -2.7 to -3.8. All patients received similar surgical treatment: traditional titanium instrumentation and interbody fusion. The patients were divided into two groups: the study group underwent preoperative osteoporosis treatment and the control group only underwent osteoporosis treatment in the postsurgical period. The treatment of osteoporosis included calcium, vitamin D and antiresorptive medications.
Results. The degree of lumbar curve correction in both groups amounted on average to 22° (10° to 35°). Analysis of radiographs and CT scans at a 2.5-year follow-up in the study group showed no implant instability or major bone resorption. Adjacent level instability was not observed, while PJK was observed in 1.5% of the patients. Infectious complications were also observed in 1.5% of the cases. Revision surgery was needed in 2% of the cases. The questionnaire data showed higher results in the study group. The complication rates in the control group were as follows: PJK–8%, implant instability–10%, pseudoarthrosis–6%, infections–3%. Revision surgery was needed in 25% of the cases.
Conclusion. Preoperative preparation in adult patients with osteoporosis that undergo surgical treatment of scoliosis improves surgical outcomes and decreases the complication rate.

Introduction: Atlantoaxial-dislocation (AAD) is a diverse pathology which can have variable etiologies, with catastrophic neurological-sequelae. Congenital-AAD is often associated with highly variable bony and vascular anomalies. It poses a great challenge in restoring normal craniovertebral-junction anatomy, and preventing progressive myelopathy. The treatment options are anterior-release (transoral/extrapharyngeal), along with anterior/posterior-instumentation. Controversy exists regarding the magnitude of correction and need for foramen-magnum decompression. This study highlights the various stages of presentation of congenital-AAD and their systematic management. As per our protocol, irreducible-dislocations were treated with single-stage extra-pharyngeal release of the tethered structures (Longus colli, Anterior Longitudinal Ligament and anterior facet-capsule) which resulted in effective downward-translation of the odontoid. It also allows effective decompression and anterior-fusion and was supplemented with posterior-instrumentation and fusion. Occiput level was spared by doing atlanto-axial-fusion, with occipitocervical-plating being done in cases having occipito-atlantal assimilation. Various reduction maneuvers to reduce retro-odontoid tilt and vertical-translation were used. Methods: Single-centre data of 6-years was analysed and a retrospective, observational-study was done. Out of 103 AAD patients, 25 patients of congenital-AAD were identified and analysed. Results: Majority of the patients had some form of anomaly, either vascular (36%) or bony (92%), the most common being occipito-atlantal assimilation (58%). 80% patients had cord changes. 7/25 (28%) had irreducible dislocations for which anterior release was done. Average C1-C2 angle correction was 20.6̊. Complications occurred in 32% patients. Conclusion: Congenital-AAD poses additional challenges over other forms of AAD in having anatomical variation. Thorough planning and restoration of anatomy is essential for satisfactory clinical-outcomes.

Introduction
Caudal regression syndrome is a rare developmental anomaly that occurs in up to 1:60000 live births. Mild forms are asymptomatic, but in most cases anomaly leads to severe developmental disorders, including neurological manifestations and spinal deformities with lumbosacral junction area dysplasy.
The aim was to study the results of two-stage treatment of patients with caudal regression syndrome and spinal deformity.
Materials and methods
A retrospective monocenter study from 2016 to 2022 enrolled 11 patients with caudal regression syndrome accompanied by the spinal deformity and metabolic osteopathy. Patients were divided into 2 groups. The main group included 5 patients 11.7 y.o. (9-15yy.) who underwent 2-stage surgery. M:F = 1:4. The first stage was implantation of screws. Then patients received osteotropic therapy (calcium supplements and vitamin D3 in age-appropriate dosages) for 6 months. After 6 months repeat CT proceed to assess screw position and preoperative rod preparation. The control group included 6 patients 10.2 y.o. (8-14 yy.) who underwent standard one-stage surgery. M:F = 2:4.
Results
The structural instability and revision surgeries showed the effectiveness of two-stage treatment. One year PostOp, examination of 3 control patients revealed the instrumentation lower pole instability, while in 2 it was symptomatic, requiring re-operation. The patients of the main group showed no signs of structural instability.
Conclusion
Two-stage surgery improved the integration of screws in patients with caudal regression syndrome, which significantly reduced the risk of aseptic instability and revision surgeries. The small sample requires further observations, but the first results are encouraging.

Introduction
A surgical site infection (SSI) is defined as an infection that occurs after surgery in the part of the body where the operation was performed. Modern immunomodulation is becoming important in spinal surgery.
Materials and methods
A prospective, comparative, non-randomized, single-center study. The study included 60 patients, 30 in the experimental group, 30 in the control group. Each patient signed informed consent. When the patient was included in the study, a laboratory examination was performed: T-lymphocytes (CD3+); T-helpers (CD3+CD4+); T-cytotoxic lymphocytes (CD3+CD8+); immunoregulatory index (IRI); B-lymphocytes (CD19+); Natural killers (NK cells, CD3-CD16+/CD56+); T-natural killers (CD3+CD16+CD56+); indicators of phagocytosis of granulocytes and monocytes; circulating immune complexes (CIC), immunoglobulins A (IgA), M (IgM), G (IgG), E (IgE); leukocyte formula with the determination of the proportion (in%) and concentration (thousand cells / μl) of neutrophils, lymphocytes, monocytes, eosinophils, basophils. The described laboratory examination was repeated in patients on the 10th day PostOp after the course of the 200 mg sodium aminodihydrophthalazinedione 1 time per day.
Results
It was found that the percentage of patients with positive dynamics of immunological indicators was significantly higher after the course of sodium aminodihydrophthalazinedione (T-, B-cell immunity, IgG level, the level of lymphocytes, neutrophils), thus this chemical compound potentiates, enhances the positive effect on the main links of immunity in a much larger number of patients .
Conclusion
Sodium aminodihydrophthalazinedione significantly effected on cellular immunity, thereby reduced the possible risks of infectious complications in the surgical area in patients with degenerative diseases of the lumbar spine.

Introduction: In short stature, rhGH is widely used and the concentration of growth hormone varies among types. The epidemiologic characteristics of scoliosis and the role of rhGH in scoliosis remain unclear.
methods: A cross-sectional study was conducted among 3896 patients with short stature, and a 1:1 age and sex-matched control group. The cohort study included 2605 subjects who underwent radiography more than twice.
Results: Compared with controls, patients with short stature had a higher incidence of scoliosis (34.47% in partial GHD, 31.85% in GHD, 32.94% in ISS vs . 8.83% in control, P < 0.001), a higher risk of scoliosis development [hazard ratio (HR) = 1.964 in partial GHD; HR = 1.881 in GHD; HR = 1.706 in ISS), but not a higher risk of progression, brace, or surgery. Among the 3 types of short stature, there were no differences in the incidence, development, and progression of scoliosis or the need for bracing or surgery. RhGH treatment increased the risk of scoliosis development in each short-stature group (HR = 2.673 in partial GHD; HR = 1.924 in GHD; HR = 1.564 in ISS). Vitamin D supplementation was protective against scoliosis development (HR = 0.456 in partial GHD; HR = 0.42 in GHD; HR = 0.838 in ISS).

Conclusions: More attention should be paid to the spinal curve in patients with partial GHD, GHD, or ISS. For short stature treated with rhGH, the risk of scoliosis development was increased. Vitamin D supplementation may be beneficial for prevention.