Objectives: Severe early-onset scoliosis (EOS) can be addressed by different growth-friendly approaches, although the indications of each technique remain controversial. The aim of this study was to compare, in a large series of patients, the potential and limitations of the different distraction-based surgical techniques to establish the most suitable surgical approach to treat EOS. Methods: We conducted a retrospective observational cohort study evaluating 62 EOS cases treated between January 2002 and December 2021 with a traditional growing rod (TGR), a magnetically controlled growing rod (MCGR) and vertical expandable prosthesis titanium ribs (VEPTR) at IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy. The patients included had a mean age of 7 years and a mean follow-up of 36 months. The COBB angle was measured on x-rays at preoperative, early postoperative, and end of follow-up, and complications were recorded. Results: in our cohort, VEPTR was mainly used in congenital scoliosis (50% vs. a mean value of 25.8%) and syndromic scoliosis (42.9% vs. a mean value of 25.8%). MCGR was mainly used in idiopathic scoliosis (73.9% vs. an average value of 41.9%). TGR was mostly used in muscular neurology EOS (16% vs. an average value of 6.5%). The collected data show a similar deformity correction rate in growing-rod implants in VEPTR, TGR, and MCGR. The mean curve reduction was 25.8 95% CI (21.8–29.8) (p < 0.0005). Compared with preoperative measurements, significant differences in curve magnitude correction between subgroups occurred at the final treatment measurements, when patients with MCGR had a significantly larger correction (53.2° ± 20.84 in %33.9 con DS ± 14.27) than VEPTR (27.12°± 19.13 in %19.7° ± 13.7). Conclusions: Different growing-rod techniques are applied based on EOS etiology. While all EOS etiologies benefited from this surgical approach, congenital EOS had poorer results. Overall, MCGR has been the preferred option for idiopathic EOS and appears to be the most effective in correcting the primary curve.

Introduction Minimally invasive spine surgery (MISS) has been shown to be safe and effective in adolescent idiopathic scoliosis (AIS) correction, even though there is no consensus on which treatment provides the best results. Methods and analysis The present study will be a randomised controlled trial with allocation 1:1. We will enrol 126 patients with Cobb≤70° undergoing AIS surgery. Patients will be divided into two groups, according to a randomisation list unknown to the surgeons. Group 1 will be treated with posterior spine fusion and group 2 with MISS. MISS technique: two midline noncontiguous skin incisions of 3 cm in length, 3–4 segments (6–8 pedicles screws) instrumented per skin incision, uniplanar and polyaxial pedicle screws inserted bilaterally on each side of the proximal and distal levels, rod translation manoeuvre and C–D manoeuvre performed on the distal part. Clinical and radiological follow-ups will be performed for 5 years. Values of Cobb angles degrees will be collected to study the correction rate of the structural major curve. Postoperative and preoperative anterior-posterior (AP) direct radiography will be compared with the last follow-up examination. Operative time, preoperative haemoglobin (Hb) and second postoperative day Hb, full length of hospitalisation, time to achieve verticalisation and time to remove the drainage will be recorded. Numeric Rating Scale (NRS) medium score will be assessed immediately after surgery and during the whole postoperative rehabilitation treatment to estimate pain reduction. Complications will be collected postoperatively and throughout the whole follow-up period. Moreover, questionnaires will be administered at follow-up (NRS, Scoliosis Research Society-22 and Oswestry Disability Index) for the clinical assessment. Ethics and dissemination The study protocol has been approved by the local ethic committee Area Vasta Emilia Romagna Centro. Written informed consent will be collected for all the participants. Findings of this study will be disseminated through peer-reviewed publications and conference presentations. Trial registration number NCT05860673.

Introduction Informed consent is an essential component of surgical care; however, patients often struggle to fully understand procedures, associated risks and available alternatives. Factors such as preoperative anxiety, limited health literacy and the complexity of consent documents can further impair comprehension and information retention. The active informed consent (CIA) pathway, based on a Patient Educational Program that combines multimedia resources with a comprehension test, aims to enhance patient understanding, improve satisfaction and reduce medicolegal issues. Methods and analysis The study will be conducted as a multicentre, non-pharmacological, randomised controlled trial in three hospitals in the Emilia-Romagna region (Italy). A total of 300 patients undergoing elective complex spinal surgery or robotic radical prostatectomy will be enrolled and randomised (1:1) to the experimental arm or to the standard informed consent arm, using block randomisation stratified by centre. Outcomes will include patient satisfaction (Client Satisfaction Questionnaire), comprehension, psychological distress (Depression Anxiety Stress Scales), pain (Numeric Rating Scale), functional recovery (Oswestry Disability Index/International Prostate Symptom Score/International Consultation on Incontinence Questionnaire Short Form/International Index of Erectile Function) and medicolegal complaints. Assessments will be performed at baseline (T0), discharge (T1), 2 months (T2) and 6 months (T3), with extended monitoring of medicolegal outcomes for up to 5 years. Ethics and dissemination The study has been approved by the Regional Ethics Committee of Emilia-Romagna (protocol CIA21, V.1.3 dated 14 December 2022). Participation is voluntary and does not affect standard care. Results will be disseminated through peer-reviewed journals, conference presentations and communication with health authorities. If effective, the intervention may be implemented as a scalable model to improve patient empowerment and transparency in surgical consent. Trial registration number NCT06059599.

Introduction: Currently, static interbody cages are the gold standard for achieving solid arthrodesis in the spine, enhancing segmental stability, obtaining neuroforaminal decompression, and improving as well as maintaining segmental lordosis. It is well known that restoring sagittal balance and segmental lordosis is crucial for long-term outcomes in lumbar spine fusion. For some cases, expandable interbody cages are emerging as an alternative to static cages. This study aims to evaluate the radiographic outcomes and complications of standard open transforaminal lumbar interbody fusion (TLIF). Methods: A standard open TLIF procedure using expandable cages was performed at 1 to 3 levels in 71 patients (129 levels in total), with a follow-up of two years. All patients underwent radiological assessments preoperatively, immediately postoperatively, and at one and two years postoperatively. Radiological evaluation was conducted using standing lateral X-rays. Results: Segmental lordosis (SL) increased significantly from the preoperative value (9.0° ± 3.6°) to 24 months postoperatively (15.4° ± 3.0°), with improvements maintained throughout the 24-month follow-up period (p < 0.001). Similarly, anterior disc height (ADH), posterior disc height (PDH), and foraminal height (FH) each increased significantly from preoperative to immediate postoperative measurements, and these gains were maintained over the two-year follow-up (p < 0.001 each). Lumbar lordosis increased significantly from the preoperative value (41.9° ± 10.5°) to the immediate postoperative period (45.7° ± 10.8°); however, this improvement decreased slightly at the one- and two-year follow-ups. No revisions were required for cage-related complications. One patient experienced a surgical site infection, and two patients had mechanical complications (screw loosening and proximal junctional kyphosis). Conclusions: Expandable interbody cages enable excellent restoration and maintenance of disc height and segmental lordosis in a standard open TLIF procedures at two-year. Achieving these outcomes depends on several factors, including proper preparation of the vertebral endplates, accurate cage placement and expansion, posterior facet osteotomy, and the application of posterior compression prior to final fixation. These steps are essential to fully maximize the potential of expandable cage technology.

Introduction: Posterior spinal fusion is the current gold standard for severe adolescent idiopathic scoliosis (AIS). Less invasive techniques have recently gained interest. Case presentation: A 13-year-old female with Lenke 1 AIS (65° thoracic curve) underwent unilateral pedicle screw fixation and posterior fusion via a minimally invasive approach. Surgery lasted 100 min with 200 mL blood loss. Hospitalization was 3 days with minimal postoperative pain. Results: Immediate postoperative x-rays showed correction to 18° (72.3%). Follow-up at 3 years demonstrated stable correction, no mechanical or infectious complications, and complete patient satisfaction. Hypothesis-generating: This case suggests unilateral fusion may be a safe, effective, less invasive alternative in selected Lenke 1 AIS patients. Further studies are required.