{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T04:25:41Z","timestamp":1793679941885,"version":"4.5.1"},"reference-count":37,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"HKU Seed Fund, The University of Hong Kong","award":["#2302101719"],"award-info":[{"award-number":["#2302101719"]}],"id":[{"id":"https:\/\/ror.org\/02zhqgq86","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Li Shu Fan Medical Foundation Professorship in Orthopaedic Surgery"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Single-centre prospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Our study aims to investigate the relationship between preoperative and intraoperative factors with VBT surgical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This is a single-centre prospective study involving consecutive VBT patients. All patients included were followed up for &gt;2\u00a0years postoperatively. Primary outcomes were changes in radiographic parameters from pre-operative to immediate post-operative and between subsequent follow-ups\n                      <jats:underline>.<\/jats:underline>\n                      Secondary outcomes were the relationships between preoperative and intraoperative factors with coronal correction rate. Preoperative factors included fulcrum flexibility and skeletal maturity. Intraoperative factors were intraoperative tensioning, screw positioning, screw length and immediate coronal correction. Presence of growth modulation was defined as &gt;5\u00b0 further curve correction postoperatively, while postoperative clinical success was defined as &lt;30\u00b0 coronal curve magnitude and avoidance of revision surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-one patients (35 females, 6 males) with 53 curves were included. Preoperative curve magnitude was 49.0 \u00b1 7.4\u00b0 and improved to 17.4 \u00b1 8.0\u00b0 immediately post-op (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), with mean correction rate at 64.6 \u00b1 15.4%. Coronal correction rate was persistently maintained at 62.1 \u00b1 29.0% at 2-year. Preoperative flexibility correlated with correction rate at immediate post-operatively up to 18-month (correlation coefficient (r) = 0.768 to 0.933;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002 to\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.044). Strength of intraoperative tensioning at upper and apical curve segments was negatively associated with correction rate up till 9-month (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = \u22120.409 to \u22120.620) but could be explained by decision to tension more in less flexible curves. Preoperative fulcrum flexibility &gt;79.8% (i.e. 80%) predicted postoperative clinical success (AUC 0.760;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VBT improved curve magnitude and shoulder imbalance in scoliosis with progressive spinal growth. Flexible curves were associated with persistent coronal correction, while flexibility above 80% increases chance of clinical success with minimal risk of further progression. Growth modulation was associated with skeletal immaturity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261450865","type":"journal-article","created":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T11:09:26Z","timestamp":1778411366000},"page":"4000-4011","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Fulcrum Flexibility &gt;80% Is Associated With Clinical Success in Vertebral Body Tethering"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6217-2291","authenticated-orcid":false,"given":"Kai Chun Augustine","family":"Chan","sequence":"first","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0800-5935","authenticated-orcid":false,"given":"Chi Chun Garvin","family":"Cheung","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0896-6996","authenticated-orcid":false,"given":"Kai Him Ambrose","family":"Chan","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4201-546X","authenticated-orcid":false,"given":"Long Ki James","family":"Lin","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9716-8313","authenticated-orcid":false,"given":"Elvis Kai Yeung","family":"Tse","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9098-5677","authenticated-orcid":false,"given":"Chi Wai Natalie","family":"Leung","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3213-7373","authenticated-orcid":false,"given":"Prudence Wing Hang","family":"Cheung","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7052-0875","authenticated-orcid":false,"given":"Jason Pui Yin","family":"Cheung","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11092576"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-23-00312"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-023-07787-1"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-021-07076-9"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s43390-024-00857-4"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000472"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.23.01229"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/21925682221100444"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199708000-00005"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-1240.R1"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B12.BJJ-2016-0158.R1"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.21.00747"},{"issue":"4","key":"e_1_3_5_14_2","first-page":"e25.00191","article-title":"The use of proximal femur maturity index in guiding brace weaning for adolescent idiopathic scoliosis","volume":"10","author":"Cheung PWH","year":"2025","unstructured":"Cheung PWH, Canavese F, Wong JSH, Luk KDK, Cheung JPY. 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