{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T23:28:49Z","timestamp":1794353329584,"version":"4.9.0"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T00:00:00Z","timestamp":1707436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a prevalent three-dimensional spinal disorder, with a multifactorial pathogenesis, including genetics and environmental aspects. Treatment options include non-surgical and surgical treatment. Surgical interventions demonstrate positive outcomes in terms of deformity correction, pain relief, and improvements of the cardiac and pulmonary function. Surgical complications, including excessive blood loss and neurologic deficits, are reported in 2.27\u201312% of cases. Navigation-assisted techniques, such as the O-arm system, have been a recent focus with enhanced precision. This study aims to evaluate the results and complications of one-stage posterior instrumentation fusion in AIS patients assisted by O-arm navigation. Materials and Methods: This retrospective study assesses 55 patients with AIS (12\u201328 years) who underwent one-stage posterior instrumentation correction supported by O-arm navigation from June 2016 to August 2023. We examined radiological surgical outcomes (initial correction rate, loss of correction rate, last follow-up correction rate) and complications as major outcomes. The characteristics of the patients, intraoperative blood loss, operation time, number of fusion levels, and screw density were documented. Results: Of 73 patients, 55 met the inclusion criteria. The average age was 16.67 years, with a predominance of females (78.2%). The surgical outcomes demonstrated substantial initial correction (58.88%) and sustained positive radiological impact at the last follow-up (56.56%). Perioperative complications, including major and minor, occurred in 18.18% of the cases. Two patients experienced a major complication. Blood loss (509.46 mL) and operation time (402.13 min) were comparable to the literature ranges. Trend analysis indicated improvements in operation time and blood loss over the study period. Conclusions: O-arm navigation-assisted one-stage posterior instrumentation proves reliable for AIS corrective surgery, achieving significant and sustained positive radiological outcomes, lower correction loss, reduced intraoperative blood loss, and absence of implant-related complications. Despite the challenges, our study demonstrates the efficacy and maturation of this surgical approach.<\/jats:p>","DOI":"10.3390\/medicina60020300","type":"journal-article","created":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T11:42:05Z","timestamp":1707478925000},"page":"300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Navigation-Assisted One-Staged Posterior Spinal Fusion Using Pedicle Screw Instrumentation in Adolescent Idiopathic Scoliosis\u2014A Case Series"],"prefix":"10.3390","volume":"60","author":[{"given":"Pao-Lung","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Education, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Jian-Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Spine Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pang-Hsuan","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Spine Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4370-2219","authenticated-orcid":false,"given":"Chia-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Spine Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-Shun","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Spine Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin County 651, Taiwan"},{"name":"Graduate Institute of Precision Engineering, National Chung Hsing University, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9177-1537","authenticated-orcid":false,"given":"Chun","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Spine Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin County 651, Taiwan"},{"name":"Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling-Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Spine Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Ying","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Spine Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsien-Te","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Spine Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan"},{"name":"Department of Sport Medicine, College of Health Care, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11832-012-0457-4","article-title":"Epidemiology of adolescent idiopathic scoliosis","volume":"7","author":"Konieczny","year":"2013","journal-title":"J. Child. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1007\/s00103-007-0230-x","article-title":"Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)","volume":"50","author":"Kamtsiuris","year":"2007","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1302\/0301-620X.67B2.3980521","article-title":"Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren","volume":"67","author":"Daruwalla","year":"1985","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sung, S., Chae, H.W., Lee, H.S., Kim, S., Kwon, J.W., Lee, S.B., Moon, S.H., Lee, H.M., and Lee, B.H. (2021). Incidence and Surgery Rate of Idiopathic Scoliosis: A Nationwide Database Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18158152"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.1007\/s00586-023-07709-1","article-title":"Idiopathic adolescent scoliosis and obesity: Prevalence study","volume":"32","author":"Catanzariti","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"110585","DOI":"10.1016\/j.mehy.2021.110585","article-title":"Etiopathogenesis of adolescent idiopathic scoliosis: Review of the literature and new epigenetic hypothesis on altered neural crest cells migration in early embryogenesis as the key event","volume":"151","author":"Zaydman","year":"2021","journal-title":"Med. Hypotheses"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2898","DOI":"10.1097\/BRS.0b013e3181891751","article-title":"The pathogenesis of adolescent idiopathic scoliosis: Review of the literature","volume":"33","author":"Kouwenhoven","year":"2008","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"115563","DOI":"10.1016\/j.bone.2020.115563","article-title":"From genetics to epigenetics to unravel the etiology of adolescent idiopathic scoliosis","volume":"140","author":"Bas","year":"2020","journal-title":"Bone"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1097\/CM9.0000000000000652","article-title":"Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis","volume":"133","author":"Peng","year":"2020","journal-title":"Chin. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s00132-016-3274-5","article-title":"Adolescent idiopathic scoliosis: Guideline for practical application","volume":"45","author":"Seifert","year":"2016","journal-title":"Orthopade"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Roach, J.W. (1999). Adolescent idiopathic scoliosis. Orthop Clin. N. Am., 30.","DOI":"10.1016\/S0030-5898(05)70092-4"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1186\/s13018-023-03925-z","article-title":"Saudi patients outcomes after surgical treatment of adolescent idiopathic scoliosis","volume":"18","author":"Alzakri","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1007\/s00586-020-06483-8","article-title":"Severe adolescent idiopathic scoliosis: Posterior staged correction using a temporary magnetically-controlled growing rod","volume":"29","author":"Zanirato","year":"2020","journal-title":"Eur. Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kwan, M.K., Loh, K.W., Chung, W.H., Chiu, C.K., Hasan, M.S., and Chan, C.Y.W. (2021). Perioperative outcome and complications following single-staged Posterior Spinal Fusion (PSF) using pedicle screw instrumentation in Adolescent Idiopathic Scoliosis (AIS): A review of 1057 cases from a single centre. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04225-5"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"44","DOI":"10.33314\/jnhrc.v19i1.3245","article-title":"Correlation between Radiological Outcome and Health Related Quality of Life after Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis","volume":"19","author":"Chaudhary","year":"2021","journal-title":"J. Nepal Health Res. Counc."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"St-Georges, M., Teles, A.R., Rabau, O., Saran, N., Ouellet, J.A., and Ferland, C.E. (2020). Adolescent idiopathic scoliosis: Evaluating perioperative back pain through a simultaneous morphological and biomechanical approach. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03462-4"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E1161","DOI":"10.1097\/BRS.0000000000004060","article-title":"Scoliosis Surgery Normalizes Cardiac Function in Adolescent Idiopathic Scoliosis Patients","volume":"46","author":"Sarwahi","year":"2021","journal-title":"Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1302\/0301-620X.104B1.BJJ-2021-0337.R2","article-title":"Estimating pulmonary function after surgery for adolescent idiopathic scoliosis using biplanar radiographs of the chest with 3D reconstruction","volume":"104-b","author":"Pietton","year":"2022","journal-title":"Bone Jt. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1302\/0301-620X.102B4.BJJ-2019-0447.R1","article-title":"Clinical and radiological outcomes of minimally-invasive surgery for adolescent idiopathic scoliosis at a minimum two years\u2019 follow-up","volume":"102-b","author":"Ansorge","year":"2020","journal-title":"Bone Jt. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1097\/BRS.0000000000002332","article-title":"Evolution of Surgery for Adolescent Idiopathic Scoliosis Over 20 Years: Have Outcomes Improved?","volume":"43","author":"Lonner","year":"2018","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.2106\/00004623-200711000-00013","article-title":"Non-neurologic complications following surgery for adolescent idiopathic scoliosis","volume":"89","author":"Carreon","year":"2007","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Tang, C.Y.K., Kamath, V.H.D., Cheung, P.W.H., and Cheung, J.P.Y. (2021). Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04104-z"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/BRS.0b013e31826c63cb","article-title":"Prediction of massive blood loss in scoliosis surgery from preoperative variables","volume":"38","author":"Yu","year":"2013","journal-title":"Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.jos.2020.07.007","article-title":"The complication trends of pediatric spinal deformity surgery in Japan\u2014The Japanese Scoliosis Society Morbidity and Mortality survey from 2012 to 2017","volume":"26","author":"Sugawara","year":"2021","journal-title":"J. Orthop. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3094","DOI":"10.1007\/s00586-023-07710-8","article-title":"Safety and accuracy of cannulated pedicle screw placement in scoliosis surgery: A comparison of robotic-navigation, O-arm-based navigation, and freehand techniques","volume":"32","author":"Li","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s00590-018-2130-1","article-title":"Intraoperative radiation exposure in spinal scoliosis surgery for pediatric patients using the O-arm\u00ae imaging system","volume":"28","author":"Kobayashi","year":"2018","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"307","DOI":"10.17816\/PTORS473150","article-title":"Computed tomography-guided intraoperative navigation in children with congenital scoliosis versus freehand\/fluoroscopy methods","volume":"11","author":"Abdaliyev","year":"2023","journal-title":"Pediatr. Traumatol. Orthop. Reconstr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s00264-019-04470-3","article-title":"O-arm navigation versus C-arm guidance for pedicle screw placement in spine surgery: A systematic review and meta-analysis","volume":"44","author":"Feng","year":"2020","journal-title":"Int. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Linden, G.S., Ghessese, S., Cook, D., and Hedequist, D.J. (2022). Pedicle Screw Placement in Adolescent Idiopathic Scoliosis: A Comparison between Robotics Coupled with Navigation versus the Freehand Technique. Sensors, 22.","DOI":"10.3390\/s22145204"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E1049","DOI":"10.1097\/BRS.0000000000004037","article-title":"Does Navigation Make Spinal Fusion for Adolescent Idiopathic Scoliosis Safer? Insights From a National Database","volume":"46","author":"Kaur","year":"2021","journal-title":"Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.2106\/JBJS.16.01331","article-title":"Perioperative and Delayed Major Complications Following Surgical Treatment of Adolescent Idiopathic Scoliosis","volume":"99","author":"Bartley","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s43390-020-00217-y","article-title":"Very long-term clinical and radiographic outcomes after posterior spinal fusion with pedicular screws for thoracic adolescent idiopathic scoliosis","volume":"9","author":"Darnis","year":"2021","journal-title":"Spine Deform."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Uehara, M., Kuraishi, S., Ikegami, S., Oba, H., Takizawa, T., Munakata, R., Hatakenaka, T., Koseki, M., and Takahashi, J. (2020). Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study. J. Clin. Med., 9.","DOI":"10.3390\/jcm9124002"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s00586-006-0147-3","article-title":"Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation","volume":"16","author":"Benli","year":"2007","journal-title":"Eur. Spine J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1016\/j.spinee.2018.05.007","article-title":"Radiological and clinical outcome of selective thoracic fusion for patients with Lenke 1C and 2C adolescent idiopathic scoliosis with a minimum follow-up of 2 years","volume":"18","author":"Kwan","year":"2018","journal-title":"Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1097\/BRS.0b013e3181adb35d","article-title":"Correlation of scoliosis curve correction with the number and type of fixation anchors","volume":"34","author":"Clements","year":"2009","journal-title":"Spine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1097\/BRS.0000000000000204","article-title":"Does higher anchor density result in increased curve correction and improved clinical outcomes in adolescent idiopathic scoliosis?","volume":"39","author":"Larson","year":"2014","journal-title":"Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/s00586-011-1808-4","article-title":"Right adolescent idiopathic thoracic curve (Lenke 1 A and B): Does cost of instrumentation and implant density improve radiographic and cosmetic parameters?","volume":"20","author":"Yang","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/BRS.0b013e3181b4af34","article-title":"Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: Does higher implant density improve correction?","volume":"35","author":"Quan","year":"2010","journal-title":"Spine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.spinee.2012.05.029","article-title":"Low-density versus high-density thoracic pedicle screw constructs in adolescent idiopathic scoliosis: Do more screws lead to a better outcome?","volume":"13","author":"Bharucha","year":"2013","journal-title":"Spine J."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Larson, A.N., Polly, D.W., Sponseller, P.D., Kelly, M.P., Richards, B.S., Garg, S., Parent, S., Shah, S.A., Weinstein, S.L., and Crawford, C.H. (J. Bone Jt. Surg. Am., 2023). The Effect of Implant Density on Adolescent Idiopathic Scoliosis Fusion: Results of the Minimize Implants Maximize Outcomes Randomized Clinical Trial, J. Bone Jt. Surg. Am., online ahead of print.","DOI":"10.2106\/JBJS.23.00178"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1016\/j.wneu.2019.08.123","article-title":"Anterior and Posterior Fusion for Large, Rigid Idiopathic Scoliosis: Does Implant Density Matter?","volume":"134","author":"Delman","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"E823","DOI":"10.1097\/BRS.0000000000002984","article-title":"Surgical outcomes of anterior versus posterior fusion in lenke type 1 adolescent idiopathic scoliosis","volume":"44","author":"Vavruch","year":"2019","journal-title":"Spine"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"405","DOI":"10.21037\/atm-22-573","article-title":"Anterior versus posterior approach in Lenke type 1 adolescent idiopathic scoliosis: A comparison of long-term follow-up outcomes","volume":"10","author":"Gu","year":"2022","journal-title":"Ann. Transl. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/BPB.0000000000000543","article-title":"Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery","volume":"28","author":"Boylan","year":"2019","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jspd.2018.05.012","article-title":"Surgery for the adolescent idiopathic scoliosis patients after skeletal maturity: Early versus late surgery","volume":"7","author":"Lonner","year":"2019","journal-title":"Spine Deform."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1007\/s43390-023-00708-8","article-title":"Clinical and radiographic outcomes following correction of idiopathic scoliosis in adolescence vs. young adulthood","volume":"11","author":"LaBarge","year":"2023","journal-title":"Spine Deform."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"f2508","DOI":"10.1136\/bmj.f2508","article-title":"Adolescent idiopathic scoliosis","volume":"346","author":"Altaf","year":"2013","journal-title":"BMJ"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/BPO.0b013e318250c629","article-title":"Comparative analysis of hook, hybrid, and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis","volume":"32","author":"Yilmaz","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/BPB.0000000000000754","article-title":"Operative time in adolescent idiopathic scoliosis surgery: A need for a standard definition","volume":"30","author":"Wagala","year":"2021","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"552","DOI":"10.3171\/2010.4.SPINE09682","article-title":"Brachial plexus injury following spinal surgery: A review","volume":"13","author":"Uribe","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1177\/0885066620954787","article-title":"Reducing the risk and impact of brachial plexus injury sustained from prone positioning\u2014A clinical commentary","volume":"35","author":"Simpson","year":"2020","journal-title":"J. Intensive Care Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1097\/BRS.0b013e31823ced6f","article-title":"Unanticipated revision surgery in adolescent idiopathic scoliosis","volume":"37","author":"Campos","year":"2012","journal-title":"Spine"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/2\/300\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:58:03Z","timestamp":1760104683000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/2\/300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,9]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["medicina60020300"],"URL":"https:\/\/doi.org\/10.3390\/medicina60020300","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,9]]}}}