Anatomical changes in renal vessels and adjacent organs in patients with scoliosis: a retrospective CT- based observational study

Anatomical changes in renal vessels and adjacent organs in patients with scoliosis: a retrospective CT- based observational study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anatomical changes in renal vessels and adjacent organs in patients with scoliosis: a retrospective CT- based observational study Tatsuya Kawamura, Daiki Ikarashi, Mizuki Hisano, Ayato Ito, Ei Shiomi, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8322677/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background Anatomical variations relevant to nephrectomy in patients with scoliosis have not been fully characterized. We aimed to quantify scoliosis-related changes in renal vessels and adjacent organs via computed tomography (CT). Methods In this retrospective single-center study, we evaluated 79 patients who underwent orthopedic surgery for scoliosis. Patients were grouped according to scoliosis severity into mild (Cobb angle: 10–60°), moderate (60–80°), and severe (≥ 80°) categories. The lengths of the renal arteries and veins were compared among these groups for both right- and left-convex curves. In patients with right convex scoliosis, we also examined how curve severity corresponded with liver coverage of the right kidney. Results Among the 79 patients (median age, 68 years; 19 men), 44 had right convex scoliosis, whereas 35 had left convex scoliosis. Scoliosis severity was mild in 65 (82%), moderate in 9 (11%), and severe in 5 (7%) patients. In the right convex scoliosis group, the median length of the right renal artery was significantly greater in the severe group (5.3 cm) than in the mild (4.1 cm) and moderate (4.2 cm) groups (P = 0.013 and P = 0.021). In left convex scoliosis, the renal vessel length did not differ significantly among the severity groups. The degree of liver coverage of the kidney was strongly correlated with the Cobb angle (r = 0.712, P = 0.006). Conclusions Anatomical changes in renal vessels and adjacent organs, particularly on the convex side, are observed in patients with scoliosis and become more pronounced as scoliosis worsens. Preoperative identification of these anatomical variations on CT may help mitigate surgical risks during nephrectomy and other retroperitoneal procedures. Scoliosis Nephrectomy Renal vasculature Hepatic coverage Laparoscopic surgery Figures Figure 1 Figure 2 Background Scoliosis is a three-dimensional spinal deformity characterized by lateral curvature and vertebral rotation. Clinically, a Cobb angle of 10° or greater defines scoliosis. This condition most commonly affects females aged 10–14 years, with a prevalence of approximately 1–2% [ 1 ]. Idiopathic scoliosis accounts for approximately 90% of cases, whereas identifiable causes are relatively uncommon [ 2 ]. Essential parameters for evaluating scoliosis include the Cobb angle and the degree of vertebral rotation, given that they can significantly influence treatment planning [ 3 ]. Treatment strategies are typically based on the degree of curvature. When the Cobb angle is within 20–40°, nonsurgical interventions are considered, but for curves greater than 40°, surgical correction is generally recommended [ 2 ]. However, in clinical practice, some patients with scoliosis remain untreated for various reasons despite meeting the criteria for intervention. Approximately 13% of patients with scoliosis requiring therapeutic intervention reach adulthood without receiving treatment [ 4 ]. We previously performed laparoscopic radical nephrectomy (LRN) on two patients with severe right scoliosis [ 5 , 6 ]. One patient underwent LRN because of recurrent infections and nephrolithiasis, while the other was treated for renal cell carcinoma. In both cases, scoliosis-induced shifts in the surrounding organs and vessels complicated the surgery. Fortunately, through a joint preoperative conference with the orthopedics and anesthesiology teams, along with careful planning, the procedure was completed without any evident complications. In both cases, the liver overlapped with the kidney, requiring cautious hepatic handling throughout the operation. On the basis of these observations, we hypothesized that individuals with scoliosis exhibit distinct anatomical variations in the renal vasculature and adjacent structures compared with those with normal spinal alignment. Accordingly, this retrospective computed tomography (CT)-based single-center study aimed to quantify scoliosis-associated anatomical variations in renal vessels and adjacent organs, with potential implications for nephrectomy and other retroperitoneal procedures. Methods In this retrospective single-center study, we evaluated 79 patients who underwent orthopedic surgery for scoliosis at our hospital between April 2010 and August 2024. We hypothesized that progressive convex scoliosis is associated with systematic shifts in renal vessels and adjacent organ coverage that are clinically relevant for the preoperative planning of nephrectomy and other retroperitoneal procedures. Scoliosis was defined as a spinal curvature with a Cobb angle of 10° or greater. According to the degree of curvature, scoliosis severity was classified as mild (10–60°), moderate (60–80°), or severe (≥ 80°) [ 2 ]. We also classified the patients as having right convex or left convex scoliosis. Right convex scoliosis was defined as a thoracic curve convex to the right, and left convex scoliosis was defined as a thoracic curve convex to the left. The data collected included age, sex, medical history, Cobb angle, vertebral rotation, renal vessel length, and liver coverage of the kidney. The Cobb angle was calculated between the most tilted vertebrae [ 2 ]. On axial imaging, renal vessel length was measured from the vessel origin to the renal hilum. The liver coverage rate of the kidney was calculated as the proportion of the upper pole of the right kidney overlapped by the liver in the sagittal CT images. This coverage rate was expressed as a percentage of the total length of the upper pole in contact with the liver (Supplemental Fig. 1). Because the overlap length can exceed the projected length of the renal upper pole on axial CT, values can exceed 100%. We compared renal vessel lengths according to scoliosis severity (mild, moderate, severe) and curve direction (right/left). Before group comparisons, model assumptions were examined: residual normality via the Shapiro–Wilk test and Q–Q plots, and homogeneity of variances via the Brown–Forsythe (Levene median-centered) test. Because several outcomes showed unequal variances and the sample sizes were unbalanced, we used Welch’s one-way analysis of variance (ANOVA) for the primary comparisons within each outcome. When the overall effect was significant, we identified which group pairs showed substantial differences by conducting post hoc multiple comparisons through Tukey’s honest significant difference test. Furthermore, correlations among the Cobb angle, vertebral rotation, and liver coverage were assessed. In addition to group comparisons, we examined linear associations between vertebral rotation and liver coverage via Pearson’s product–moment correlation coefficient (r). Before computing r, we evaluated linearity via scatterplots and the normality of each variable via Shapiro–Wilk tests with Q–Q plots; no influential outliers were identified via visual inspection. Statistical data were analyzed via the JMP software (SAS Institute, Inc., Cary, NC, USA). Differences with P < 0.05 were considered statistically significant. Results 3.1 Patient characteristics Table 1 summarizes the patient characteristics. The median age was 68 (4–84) years. Among the 79 patients, 44 (56%) had right convex scoliosis, whereas 35 (44%) had left convex scoliosis. The median Cobb angle was 24° (11–86°) in patients with right convex scoliosis and 32.5° (12–101°) in those with left convex scoliosis. Additionally, 65 (82%), 9 (11%), and 5 (7%) patients had mild, moderate, and severe scoliosis, respectively. The median vertebral rotation angle was 18° (3–76°) in the right convex scoliosis group and 22° (8–76°) in the left convex scoliosis group. Table 1 Clinical characteristics of the study population All patients ( n = 79) Right convex ( n = 44) Left convex ( n = 35) P value Age (years), median (range) 68 (4–84) 69 (11–84) 65.5 (4–82) 0.56 Sex, male, n (%) 19 (24%) 10 (28%) 9 (20%) 0.22 Cobb angle (degrees), median (range) 26 (11–101) 24 (11–86) 32.5 (12–101) 0.09 Scoliosis severity, n (%) Mild (Cobb angle ≤ 60°) 65 (82%) 38 (86%) 27 (77%) 0.11 Moderate (Cobb angle 60°–80°) 9 (11%) 3 (7%) 6 (17%) 0.13 Severe (Cobb angle ≥ 80°) 5 (7%) 3 (7%) 2 (6%) 0.56 Vessel length (cm), median (range) Right renal artery 5.2 (2.7–8.9) 4.3 (2.7–6.5) 5.7 (3.0–8.9) 0.04 Right renal vein 2.4 (0.9–5.3) 2.6 (1.2–3.8) 2.3 (0.9–5.3) 0.34 Left renal artery 3.8 (1.1–8.1) 4.8 (3.1–8.1) 3.3 (1.1–5.1) 0.02 Left renal vein 6.6 (4.0–8.5) 7.0 (4.7–8.5) 6.3 (4.0–8.0) 0.19 Vertebral rotation (degrees), median (range) 22 (3–76) 18 (3–76) 22 (8–76) 0.74 Liver coverage of the kidney (%), median (range) 34.5 (5–167) 34.5 (5–149) 32.5 (5–167) 0.68 3.2 Changes in renal vasculature associated with scoliosis progression Among patients with right convex scoliosis, the right renal artery length increased as the severity of scoliosis increased, measuring 4.1 (2.7–5.6), 4.2 (3.1–4.7), and 5.3 (4.5–6.5) cm in patients with mild, moderate, and severe scoliosis, respectively. Conversely, the left renal artery length decreased as the severity of scoliosis increased, measuring 5.0 (3.1–8.1), 4.9 (4.2–5.8), and 3.3 (3.0–3.6) cm, respectively. The right renal vein measured approximately 2.7 (1.6–3.8) cm in mild cases, 2.4 (2.1–2.5) cm in moderate cases, and 2.3 (1.2–3.8) cm in severe cases, whereas the left renal vein measured approximately 7.2 (5.2–8.9), 6.7 (6.6–6.9), and 5.2 (4.7–6.0) cm, respectively. The right renal artery length was significantly different between mild and severe cases (P = 0.013) and between moderate and severe cases (P = 0.021). The left renal artery length also differed significantly between mild and severe right convex scoliosis patients (P = 0.038) (Fig. 1 ). Among patients with left convex scoliosis, the right renal artery length also increased as the severity of scoliosis increased, measuring 5.7 (4.2–8.9), 5.3 (3.0–6.5), and 5.1 (4.2–6.0) cm in patients with mild, moderate, and severe scoliosis, respectively. Moreover, the left renal artery length decreased as the severity of scoliosis increased, measuring 3.0 (1.1–5.1), 3.4 (2.7–4.2), and 3.4 (2.9–3.9) cm, respectively. The right renal vein measured approximately 2.5 (1.6–3.8) cm in mild cases, 2.0 (2.1–2.5) cm in moderate cases, and 2.0 (1.1–3.0) cm in severe cases, whereas the left renal vein measured approximately 6.5 (4.1–8.8), 6.1 (4.8–6.9), and 7.2 (6.6–7.7) cm, respectively. In terms of scoliosis severity, renal vessel length was not significantly different among patients with left convex scoliosis (Supplemental Fig. 2). 3.3 Changes in surrounding organs associated with scoliosis progression The liver coverage of the kidney was 50.7% (9.1%–149%) in right convex scoliosis patients and 37.1% (5.6%–80.5%) in left convex scoliosis patients. The right convex liver coverage of the kidney correlated moderately with vertebral rotation (r = 0.457, P = 0.030) and strongly with the Cobb angle (r = 0.712, P = 0.006) (Fig. 2 ). In patients with left convex scoliosis, the liver coverage rate of the kidney did not correlate with vertebral rotation (r = 0.125, P = 0.358) and Cobb angle (r = 0.233, P = 0.224). Discussion This study demonstrated that the progression of scoliosis is associated with systematic changes in renal vascular anatomy and hepatic coverage of the right kidney, which are directly related to the risk of bleeding and organ injury during nephrectomy and other retroperitoneal procedures. In particular, patients with right convex scoliosis presented with elongated renal vessels and increased hepatic coverage of the right kidney as curve severity increased (Supplemental Fig. 3). Although several case reports of malignant tumor surgery in patients with scoliosis exist across various medical fields, reports in urology, where bilaterally located organs such as the kidneys and ureters are especially susceptible to anatomical distortion, remain scarce; to date, only four such cases have been reported (Table 2). Given the relatively advanced age of our cohort (median 68 years), these findings are most directly applicable to adults with degenerative scoliosis rather than to adolescents with idiopathic scoliosis. As the severity of scoliosis increases, the renal vessels tend to become longer on the convex side and shorter on the concave side. Several case reports have described the aorta and renal vasculature of patients with scoliosis. Tamura et al. [ 5 ] reported that lateral displacement of the aorta results in a more laterally positioned inferior vena cava, making the psoas muscle difficult to visualize. Milbrandt et al. [ 9 ] demonstrated that the aorta is more anteriorly and medially displaced toward the right in individuals with left thoracic scoliosis than in those with a customarily aligned spine. Moreover, Amanullah et al. [ 10 ] reported that the compensatory curvature of the spine tends to increase as the scoliosis progresses. Therefore, if the thoracic spine moves to the right side, the lumbar spine compensates by moving to the left side, causing renal vessel changes according to the severity of scoliosis. In our study, patients with right convex scoliosis exhibited significant vascular changes, whereas those with left convex scoliosis demonstrated no such changes. This discrepancy may be attributed to the study’s limited sample size and retrospective, single-center design. Further research with more extensive, multicenter cohorts is warranted to validate these findings. Furthermore, the degree of liver coverage increased as scoliosis worsened in patients with right convex scoliosis. The hepatic changes may have resulted from thoracic deformation, which causes the lungs to descend posteriorly, displacing the liver anteriorly toward the kidney. Byun et al. [ 11 ] indicated that vertebral rotation leads to lateral spine displacement in patients with scoliosis, causing the ribs on the convex side to protrude posteriorly, as if the thorax was being compressed. The associated thoracic cage deformity may support our finding of a positional shift in the liver. This study has certain limitations. First, the study included only two nephrectomy cases in patients with scoliosis, so the observed anatomical variations cannot be directly linked to operative difficulty or perioperative complications. Moreover, surgical difficulty and perioperative complications were not systematically assessed in this cohort and remain to be clarified in future studies. Surgical treatment for malignant tumors in patients with scoliosis has been reported only through case reports, not only in urology but also across other surgical fields [ 12 , 13 ]. Further studies with larger sample sizes are warranted to elucidate these associations. Second, renal vasculature and scoliosis parameters were assessed via only two-dimensional imaging. Although this method is frequently employed because of its accessibility and simplicity, it may not accurately capture complex three-dimensional anatomical relationships, especially in patients with spinal deformities such as scoliosis. Two-dimensional assessments may underestimate vessel length or fail to capture spatial displacement resulting from anatomical variations [ 14 , 15 ]. Hence, researchers must conduct investigations utilizing three-dimensional reconstruction or CT angiography to obtain more precise anatomical information. Thus, caution should be exercised when generalizing the present study’s findings, and multicenter prospective studies with larger cohorts are necessary to validate the results. Nonetheless, a key strength of this study is the identification of scoliosis-related anatomical changes in the renal vasculature and adjacent organs. This strength may directly inform preoperative planning and enhance surgical outcomes. In right convex scoliosis, we noted elongated renal vessels and increased hepatic coverage of the kidney; if recognized beforehand, these anatomical insights can help anticipate challenges such as limited surgical exposure and an elevated risk of vascular injury. These findings emphasize that detailed preoperative CT imaging is crucial when planning nephrectomy and other retroperitoneal procedures in patients with complex spinal deformities. Conclusions Anatomical changes in renal vessels and adjacent organs, particularly on the convex side, are observed in patients with scoliosis and become more pronounced as scoliosis worsens. Preoperative identification of these anatomical variations on CT may help mitigate surgical risks during nephrectomy and other retroperitoneal procedures. Abbreviations LRN laparoscopic radical nephrectomy CT computed tomography ANOVA analysis of variance Declarations Ethics approval and consent to participate This retrospective study was approved by the Institutional Review Board of Iwate Medical University (approval no. MH2025-080). The requirement for written informed consent was waived because of the retrospective design and the use of anonymized data. Consent for publication Not applicable. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions TK conceived the study and drafted the manuscript. DI and MH collected and curated the data. AI and RK performed the image analysis. SM and MK contributed to data interpretation. SK and WO critically revised the manuscript for important intellectual content. All the authors read and approved the final manuscript. Acknowledgements Not applicable. Authors' information Not applicable. References Akazawa T, Kotani T, Sakuma T, et al. Pulmonary function improves in patients with adolescent idiopathic scoliosis who undergo posterior spinal fusion regardless of thoracoplasty: A mid-term follow-up. Spine Surg Relat Res. 2021;5(1):22–27. http://doi.org/10.22603/ssrr.2020-0077 Chen J, Shengru W, Guodong Y, En L, Zize L. A review of the methods on Cobb angle measurements for spinal curvature. Sensors. 2022;22(9):3258. http://doi.org/10.3390/s22093258 Li J, Gao J, Zhao Z, et al. Quantitative computed tomography assessment of bone mineral density in adolescent idiopathic scoliosis: Correlations with Cobb angle, vertebral rotation, and Risser sign. Transl Pediatr. 2024;13(4):610–623. http://doi.org/10.21037/tp-24-74 Pehrsson K, Sven L, Anders O, Alf N. Long-term follow-up of patients with untreated scoliosis: A study of mortality, causes of death, and symptoms. Spine. 1992;17(9):1091–1096. http://doi.org/10.1097/00007632-1992090000-00014 Tamura D, Ito A, Kikuchi D, et al. Laparoscopic nephrectomy in a patient with severe scoliosis: A case report. Asian J Endosc Surg. 2019;12(1):122–124. http://doi.org/10.1111/ases.12597 Kawamura T, Ikarashi D, Ito A, et al. Robot-assisted laparoscopic radical nephrectomy in a renal cell carcinoma patient with severe scoliosis: A case report. IJU Case Rep. 2025;8(4):352–355. http://doi.org/10.1002/iju5.70037 Kumar K, Kannan R, Chandran H, et al. Retroperitoneal approach for laparoscopic nephrectomy is feasible in a child with difficult access due to severe scoliosis. J Pediatr Urol. 2010;6(3):324–326. http://doi.org/10.1016/j.jpurol.2009.11.001 Hermans T, Pasmans H, Fossion L, et al. Transperitoneal laparoscopic radical nephrectomy in a patient with severe scoliosis. Urology. 2013;82(2):485–488. http://doi.org/10.1016/j.urology.2013.03.016 Milbrandt A, Sucato J. The position of the aorta relative to the spine in patients with left thoracic scoliosis: A comparison with normal patients. Spine. 2007;32(12):348–353. http://doi.org/10.1097/BRS.0b013e318059aeda Amanullah A, Taemin O, Toll J, et al. Risk factors for progression of cervical congenital scoliosis and associated compensatory curve behavior. J Clin Med. 2024;13(11):3039. http://doi.org/10.3390/jcm13113039 Byun Y, Iida N, Yamada K, et al. Long-term pulmonary function after posterior spinal fusion in main thoracic adolescent idiopathic scoliosis. PLoS One. 2020;15(6):e0235123. http://doi.org/10.1371/journal.pone.0235123 Taguchi D, Yamashita K, Momose K, et al. A case of Barrett’s esophageal adenocarcinoma and severe scoliosis with successful salvage esophagectomy after definitive chemoradiotherapy. Surg Case Rep. 2023;9(1):204. http://doi.org/10.1186/s40792-023-01776-8 Vivian R, Antti S, Eetu S, Stina S, Minna K. Severe untreated scoliosis and early onset breast cancer in a patient with neurofibromatosis associated with a nonsense variant of the NF1 gene. Orthop Res Rev. 2023;15:183–189. http://doi.org/10.2147/ORR.S415978 Pasha S, Cahill P, Dormans J, Flynn J. Characterizing the differences between the 2D and 3D measurements of spine in adolescent idiopathic scoliosis. Eur Spine J. 2016;25(10):3137–3145. http://doi.org/10.1007/s00586-016-4582-5 Urban B, Ratner L, Fishman E. Three-dimensional volume-rendered CT angiography of the renal arteries and veins: Normal anatomy, variants, and clinical applications. Radiographics. 2001;21(2):373–386. http://doi.org/10.1148/radiographics.21.2.g01mr19373 Additional Declarations No competing interests reported. Supplementary Files Supplementalfigure.pptx Supplemental figure 1: The example of the liver coverage of the kidney A vertical red line is drawn perpendicular to the abdominal wall, and the ratio of the total renal length (white arrow) to the length of the kidney covered by the liver (blue arrow) in the sagittal plane is computed. (a) A normal person, (b) a patient with mild right convex scoliosis (Cobb angle of 30°, liver coverage of the kidney at 50%), and (c) a patient with severe right convex scoliosis (Cobb angle of 81.4°, liver coverage of the kidney at 138%). Supplemental figure 2: Comparison of renal vessel lengths in patients with left convex scoliosis categorized by scoliosis severity (a) Right renal artery, (b) left renal artery, (c) right renal vein, (d) left renal vein. Supplemental figure 3: Changes in the renal vasculature and surrounding organs in patients with right convex scoliosis Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 29 Apr, 2026 Reviews received at journal 26 Apr, 2026 Reviews received at journal 25 Apr, 2026 Reviews received at journal 19 Apr, 2026 Reviews received at journal 16 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviews received at journal 11 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers invited by journal 13 Jan, 2026 Editor assigned by journal 18 Dec, 2025 Submission checks completed at journal 18 Dec, 2025 First submitted to journal 09 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8322677","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":573940564,"identity":"a31957a3-0327-467c-9968-c6989789fe6a","order_by":0,"name":"Tatsuya Kawamura","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIie2RsQrCMBCGUwOX5dQ1oPgMhUJRFHwVRegU30B0ELqpT6C+gpOzEMwmrlkl4CAOglCcxEad246C+YbcEf6PuxBCHI7fhTeATXe2qedmkVBbOkEFVc8qWFSJ+isu/M9FHl12VDUcSS8m4n7RoyYSJvebzCk4gBoqSYEctm2h0sUwinT2YlYBCeDNtoGAVOEYZitVkypPiUDxHIhnEYWnU8pxxAGQmmFcRNEmaC3nHR8QQjqcc4S8t7BF/6SvCZ+s18bcRTJuVJlUmYql9P0L4O8zL27xHp9Kb0XSDofD8X+8AMhdPfCs8tUkAAAAAElFTkSuQmCC","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Tatsuya","middleName":"","lastName":"Kawamura","suffix":""},{"id":573940565,"identity":"e7950978-60e8-43b7-a6fc-0aaaf0c01e1e","order_by":1,"name":"Daiki Ikarashi","email":"","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Daiki","middleName":"","lastName":"Ikarashi","suffix":""},{"id":573940566,"identity":"749fd701-50fd-4cb9-bd48-160a5ec49828","order_by":2,"name":"Mizuki Hisano","email":"","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mizuki","middleName":"","lastName":"Hisano","suffix":""},{"id":573940577,"identity":"7f7ac999-3bc2-4a08-9ee7-201737bee1e3","order_by":3,"name":"Ayato Ito","email":"","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ayato","middleName":"","lastName":"Ito","suffix":""},{"id":573940579,"identity":"281db43c-aa79-49ac-9f56-d3aa160726aa","order_by":4,"name":"Ei Shiomi","email":"","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ei","middleName":"","lastName":"Shiomi","suffix":""},{"id":573940586,"identity":"13fc9575-c190-4ce4-b43e-3f828cb05616","order_by":5,"name":"Shigekatsu Maekawa","email":"","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shigekatsu","middleName":"","lastName":"Maekawa","suffix":""},{"id":573940587,"identity":"7c5e317e-9bb8-40e6-859e-6d1189f9d4e0","order_by":6,"name":"Renpei Kato","email":"","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Renpei","middleName":"","lastName":"Kato","suffix":""},{"id":573940588,"identity":"5b53e03d-66cc-4c4b-ab2e-63f5ec3d7b5b","order_by":7,"name":"Mitsugu Kanehira","email":"","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mitsugu","middleName":"","lastName":"Kanehira","suffix":""},{"id":573940591,"identity":"5a02c928-edb5-410b-90d4-75f8b5de1bcd","order_by":8,"name":"Susumu Konari","email":"","orcid":"","institution":"Iwate Prefectural Ninohe Hospital","correspondingAuthor":false,"prefix":"","firstName":"Susumu","middleName":"","lastName":"Konari","suffix":""},{"id":573940593,"identity":"99e24b38-3f55-48eb-bf45-315f1678a8b5","order_by":9,"name":"Wataru Obara","email":"","orcid":"","institution":"Iwate Medical University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Wataru","middleName":"","lastName":"Obara","suffix":""}],"badges":[],"createdAt":"2025-12-10 03:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8322677/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8322677/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100408315,"identity":"efe3ef71-be99-48ee-8d93-9302eb2d0d56","added_by":"auto","created_at":"2026-01-16 13:05:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58955,"visible":true,"origin":"","legend":"","description":"","filename":"EJMRmanuscriptver2.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/dca8085d04bb9cd6e786c655.docx"},{"id":100408459,"identity":"325c1cc6-9263-4847-bb8b-9b3cd9db3750","added_by":"auto","created_at":"2026-01-16 13:06:16","extension":"json","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10582,"visible":true,"origin":"","legend":"","description":"","filename":"360cd528f9774e749c07225390ee4275.json","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/d756de4836f2b3bcf66474f7.json"},{"id":100408299,"identity":"9429b8df-70bc-42ac-aa39-998da72094e3","added_by":"auto","created_at":"2026-01-16 13:05:57","extension":"pptx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2213183,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementalfigure.pptx","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/22b88b00b59ad4439486d169.pptx"},{"id":100408462,"identity":"44321872-fd84-44d8-841d-ab46f366851e","added_by":"auto","created_at":"2026-01-16 13:06:17","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60855,"visible":true,"origin":"","legend":"","description":"","filename":"360cd528f9774e749c07225390ee42751enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/bfb64dd0c3454fe9cf735ea9.xml"},{"id":100408209,"identity":"eb859f7b-a72e-4040-b228-9bb41692d406","added_by":"auto","created_at":"2026-01-16 13:05:45","extension":"pptx","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":169055,"visible":true,"origin":"","legend":"","description":"","filename":"Figurever3.0.pptx","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/029fcbf30c25574eb406cbf6.pptx"},{"id":100408468,"identity":"58f8f85d-affa-4ab7-a0ec-30171c5f0376","added_by":"auto","created_at":"2026-01-16 13:06:17","extension":"eps","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":134275,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage1.eps","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/dd60531ebe9f0ae7afea1bf4.eps"},{"id":100408205,"identity":"ee06128e-f4f8-49a5-b553-042c819339de","added_by":"auto","created_at":"2026-01-16 13:05:44","extension":"jpeg","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1074,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/6d77bc61cf141709ebcd442f.jpeg"},{"id":100408415,"identity":"893c6ccf-d7ba-43ea-b8b4-b23918e561b4","added_by":"auto","created_at":"2026-01-16 13:06:13","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":935,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/c1f7a2940a02f898cf9835d8.png"},{"id":100408309,"identity":"fe78f8a8-e9a4-4c4c-9c46-bc64d5705f0d","added_by":"auto","created_at":"2026-01-16 13:05:58","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60247,"visible":true,"origin":"","legend":"","description":"","filename":"360cd528f9774e749c07225390ee42751structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/d260474e35fcb02e434caf67.xml"},{"id":100408039,"identity":"52e772cd-af40-4496-98c4-b21b6f92f464","added_by":"auto","created_at":"2026-01-16 13:05:28","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69139,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/939abbc3a9efa0e9dadc9935.html"},{"id":100408195,"identity":"bdf94c14-f18f-4af5-b108-a6caed5363f6","added_by":"auto","created_at":"2026-01-16 13:05:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92584,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of renal vessel lengths in patients with right convex scoliosis categorized by severity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(a) Right renal artery, (b) left renal artery, (c) right renal vein, and (d) left renal vein.\u003c/p\u003e","description":"","filename":"Slide1.png","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/832056e7cc94cd3c13487dc2.png"},{"id":100408387,"identity":"4c30db84-9f46-4385-9e07-c437b0ca6974","added_by":"auto","created_at":"2026-01-16 13:06:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":64626,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePearson correlation between scoliosis severity and liver coverage in patients with right convex scoliosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(a) Correlation between the Cobb angle and liver coverage, and (b) between vertebral rotation and liver coverage.\u003c/p\u003e","description":"","filename":"Slide2.png","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/0d4f414ade6671925369b6d9.png"},{"id":100546579,"identity":"11f71a3c-2f40-4070-94a9-4efea0b4b65a","added_by":"auto","created_at":"2026-01-19 08:11:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":757755,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/cd1a323a-9825-42be-a7fe-d588eaf2f539.pdf"},{"id":100421870,"identity":"c1fffc6a-8a24-48ea-a288-4675255aa866","added_by":"auto","created_at":"2026-01-16 13:59:16","extension":"pptx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2213183,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplemental figure 1: The example of the liver coverage of the kidney\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA vertical red line is drawn perpendicular to the abdominal wall, and the ratio of the total renal length (white arrow) to the length of the kidney covered by the liver (blue arrow) in the sagittal plane is computed. (a) A normal person, (b) a patient with mild right convex scoliosis (Cobb angle of 30°, liver coverage of the kidney at 50%), and (c) a patient with severe right convex scoliosis (Cobb angle of 81.4°, liver coverage of the kidney at 138%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplemental figure 2: Comparison of renal vessel lengths in patients with left convex scoliosis categorized by scoliosis severity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(a) Right renal artery, (b) left renal artery, (c) right renal vein, (d) left renal vein.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplemental figure 3: Changes in the renal vasculature and surrounding organs in patients with right convex scoliosis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Supplementalfigure.pptx","url":"https://assets-eu.researchsquare.com/files/rs-8322677/v1/97efb65ea4ab49aefd97aabd.pptx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anatomical changes in renal vessels and adjacent organs in patients with scoliosis: a retrospective CT- based observational study","fulltext":[{"header":"Background","content":"\u003cp\u003eScoliosis is a three-dimensional spinal deformity characterized by lateral curvature and vertebral rotation. Clinically, a Cobb angle of 10\u0026deg; or greater defines scoliosis. This condition most commonly affects females aged 10\u0026ndash;14 years, with a prevalence of approximately 1\u0026ndash;2% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Idiopathic scoliosis accounts for approximately 90% of cases, whereas identifiable causes are relatively uncommon [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Essential parameters for evaluating scoliosis include the Cobb angle and the degree of vertebral rotation, given that they can significantly influence treatment planning [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Treatment strategies are typically based on the degree of curvature. When the Cobb angle is within 20\u0026ndash;40\u0026deg;, nonsurgical interventions are considered, but for curves greater than 40\u0026deg;, surgical correction is generally recommended [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, in clinical practice, some patients with scoliosis remain untreated for various reasons despite meeting the criteria for intervention. Approximately 13% of patients with scoliosis requiring therapeutic intervention reach adulthood without receiving treatment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe previously performed laparoscopic radical nephrectomy (LRN) on two patients with severe right scoliosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. One patient underwent LRN because of recurrent infections and nephrolithiasis, while the other was treated for renal cell carcinoma. In both cases, scoliosis-induced shifts in the surrounding organs and vessels complicated the surgery. Fortunately, through a joint preoperative conference with the orthopedics and anesthesiology teams, along with careful planning, the procedure was completed without any evident complications. In both cases, the liver overlapped with the kidney, requiring cautious hepatic handling throughout the operation. On the basis of these observations, we hypothesized that individuals with scoliosis exhibit distinct anatomical variations in the renal vasculature and adjacent structures compared with those with normal spinal alignment. Accordingly, this retrospective computed tomography (CT)-based single-center study aimed to quantify scoliosis-associated anatomical variations in renal vessels and adjacent organs, with potential implications for nephrectomy and other retroperitoneal procedures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this retrospective single-center study, we evaluated 79 patients who underwent orthopedic surgery for scoliosis at our hospital between April 2010 and August 2024. We hypothesized that progressive convex scoliosis is associated with systematic shifts in renal vessels and adjacent organ coverage that are clinically relevant for the preoperative planning of nephrectomy and other retroperitoneal procedures. Scoliosis was defined as a spinal curvature with a Cobb angle of 10\u0026deg; or greater. According to the degree of curvature, scoliosis severity was classified as mild (10\u0026ndash;60\u0026deg;), moderate (60\u0026ndash;80\u0026deg;), or severe (\u0026ge;\u0026thinsp;80\u0026deg;) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. We also classified the patients as having right convex or left convex scoliosis. Right convex scoliosis was defined as a thoracic curve convex to the right, and left convex scoliosis was defined as a thoracic curve convex to the left. The data collected included age, sex, medical history, Cobb angle, vertebral rotation, renal vessel length, and liver coverage of the kidney. The Cobb angle was calculated between the most tilted vertebrae [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. On axial imaging, renal vessel length was measured from the vessel origin to the renal hilum. The liver coverage rate of the kidney was calculated as the proportion of the upper pole of the right kidney overlapped by the liver in the sagittal CT images. This coverage rate was expressed as a percentage of the total length of the upper pole in contact with the liver (Supplemental Fig.\u0026nbsp;1). Because the overlap length can exceed the projected length of the renal upper pole on axial CT, values can exceed 100%.\u003c/p\u003e \u003cp\u003eWe compared renal vessel lengths according to scoliosis severity (mild, moderate, severe) and curve direction (right/left). Before group comparisons, model assumptions were examined: residual normality via the Shapiro\u0026ndash;Wilk test and Q\u0026ndash;Q plots, and homogeneity of variances via the Brown\u0026ndash;Forsythe (Levene median-centered) test. Because several outcomes showed unequal variances and the sample sizes were unbalanced, we used Welch\u0026rsquo;s one-way analysis of variance (ANOVA) for the primary comparisons within each outcome. When the overall effect was significant, we identified which group pairs showed substantial differences by conducting post hoc multiple comparisons through Tukey\u0026rsquo;s honest significant difference test. Furthermore, correlations among the Cobb angle, vertebral rotation, and liver coverage were assessed. In addition to group comparisons, we examined linear associations between vertebral rotation and liver coverage via Pearson\u0026rsquo;s product\u0026ndash;moment correlation coefficient (r). Before computing r, we evaluated linearity via scatterplots and the normality of each variable via Shapiro\u0026ndash;Wilk tests with Q\u0026ndash;Q plots; no influential outliers were identified via visual inspection. Statistical data were analyzed via the JMP software (SAS Institute, Inc., Cary, NC, USA). Differences with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Patient characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the patient characteristics. The median age was 68 (4\u0026ndash;84) years. Among the 79 patients, 44 (56%) had right convex scoliosis, whereas 35 (44%) had left convex scoliosis. The median Cobb angle was 24\u0026deg; (11\u0026ndash;86\u0026deg;) in patients with right convex scoliosis and 32.5\u0026deg; (12\u0026ndash;101\u0026deg;) in those with left convex scoliosis. Additionally, 65 (82%), 9 (11%), and 5 (7%) patients had mild, moderate, and severe scoliosis, respectively. The median vertebral rotation angle was 18\u0026deg; (3\u0026ndash;76\u0026deg;) in the right convex scoliosis group and 22\u0026deg; (8\u0026ndash;76\u0026deg;) in the left convex scoliosis group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of the study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll patients (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRight convex (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLeft convex (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (4\u0026ndash;84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (11\u0026ndash;84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.5 (4\u0026ndash;82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCobb angle (degrees), median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (11\u0026ndash;101)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (11\u0026ndash;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.5 (12\u0026ndash;101)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoliosis severity, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild (Cobb angle\u0026thinsp;\u0026le;\u0026thinsp;60\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (Cobb angle 60\u0026deg;\u0026ndash;80\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere (Cobb angle\u0026thinsp;\u0026ge;\u0026thinsp;80\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVessel length (cm), median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight renal artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.2 (2.7\u0026ndash;8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3 (2.7\u0026ndash;6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.7 (3.0\u0026ndash;8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight renal vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4 (0.9\u0026ndash;5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6 (1.2\u0026ndash;3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3 (0.9\u0026ndash;5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft renal artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8 (1.1\u0026ndash;8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8 (3.1\u0026ndash;8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3 (1.1\u0026ndash;5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft renal vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.6 (4.0\u0026ndash;8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0 (4.7\u0026ndash;8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.3 (4.0\u0026ndash;8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertebral rotation (degrees), median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (3\u0026ndash;76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (3\u0026ndash;76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (8\u0026ndash;76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver coverage of the kidney (%), median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.5 (5\u0026ndash;167)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.5 (5\u0026ndash;149)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.5 (5\u0026ndash;167)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Changes in renal vasculature associated with scoliosis progression\u003c/h2\u003e \u003cp\u003eAmong patients with right convex scoliosis, the right renal artery length increased as the severity of scoliosis increased, measuring 4.1 (2.7\u0026ndash;5.6), 4.2 (3.1\u0026ndash;4.7), and 5.3 (4.5\u0026ndash;6.5) cm in patients with mild, moderate, and severe scoliosis, respectively. Conversely, the left renal artery length decreased as the severity of scoliosis increased, measuring 5.0 (3.1\u0026ndash;8.1), 4.9 (4.2\u0026ndash;5.8), and 3.3 (3.0\u0026ndash;3.6) cm, respectively. The right renal vein measured approximately 2.7 (1.6\u0026ndash;3.8) cm in mild cases, 2.4 (2.1\u0026ndash;2.5) cm in moderate cases, and 2.3 (1.2\u0026ndash;3.8) cm in severe cases, whereas the left renal vein measured approximately 7.2 (5.2\u0026ndash;8.9), 6.7 (6.6\u0026ndash;6.9), and 5.2 (4.7\u0026ndash;6.0) cm, respectively. The right renal artery length was significantly different between mild and severe cases (P\u0026thinsp;=\u0026thinsp;0.013) and between moderate and severe cases (P\u0026thinsp;=\u0026thinsp;0.021). The left renal artery length also differed significantly between mild and severe right convex scoliosis patients (P\u0026thinsp;=\u0026thinsp;0.038) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong patients with left convex scoliosis, the right renal artery length also increased as the severity of scoliosis increased, measuring 5.7 (4.2\u0026ndash;8.9), 5.3 (3.0\u0026ndash;6.5), and 5.1 (4.2\u0026ndash;6.0) cm in patients with mild, moderate, and severe scoliosis, respectively. Moreover, the left renal artery length decreased as the severity of scoliosis increased, measuring 3.0 (1.1\u0026ndash;5.1), 3.4 (2.7\u0026ndash;4.2), and 3.4 (2.9\u0026ndash;3.9) cm, respectively. The right renal vein measured approximately 2.5 (1.6\u0026ndash;3.8) cm in mild cases, 2.0 (2.1\u0026ndash;2.5) cm in moderate cases, and 2.0 (1.1\u0026ndash;3.0) cm in severe cases, whereas the left renal vein measured approximately 6.5 (4.1\u0026ndash;8.8), 6.1 (4.8\u0026ndash;6.9), and 7.2 (6.6\u0026ndash;7.7) cm, respectively. In terms of scoliosis severity, renal vessel length was not significantly different among patients with left convex scoliosis (Supplemental Fig.\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Changes in surrounding organs associated with scoliosis progression\u003c/h2\u003e \u003cp\u003eThe liver coverage of the kidney was 50.7% (9.1%\u0026ndash;149%) in right convex scoliosis patients and 37.1% (5.6%\u0026ndash;80.5%) in left convex scoliosis patients. The right convex liver coverage of the kidney correlated moderately with vertebral rotation (r\u0026thinsp;=\u0026thinsp;0.457, P\u0026thinsp;=\u0026thinsp;0.030) and strongly with the Cobb angle (r\u0026thinsp;=\u0026thinsp;0.712, P\u0026thinsp;=\u0026thinsp;0.006) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In patients with left convex scoliosis, the liver coverage rate of the kidney did not correlate with vertebral rotation (r\u0026thinsp;=\u0026thinsp;0.125, P\u0026thinsp;=\u0026thinsp;0.358) and Cobb angle (r\u0026thinsp;=\u0026thinsp;0.233, P\u0026thinsp;=\u0026thinsp;0.224).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated that the progression of scoliosis is associated with systematic changes in renal vascular anatomy and hepatic coverage of the right kidney, which are directly related to the risk of bleeding and organ injury during nephrectomy and other retroperitoneal procedures. In particular, patients with right convex scoliosis presented with elongated renal vessels and increased hepatic coverage of the right kidney as curve severity increased (Supplemental Fig.\u0026nbsp;3). Although several case reports of malignant tumor surgery in patients with scoliosis exist across various medical fields, reports in urology, where bilaterally located organs such as the kidneys and ureters are especially susceptible to anatomical distortion, remain scarce; to date, only four such cases have been reported (Table\u0026nbsp;2). Given the relatively advanced age of our cohort (median 68 years), these findings are most directly applicable to adults with degenerative scoliosis rather than to adolescents with idiopathic scoliosis.\u003c/p\u003e \u003cp\u003eAs the severity of scoliosis increases, the renal vessels tend to become longer on the convex side and shorter on the concave side. Several case reports have described the aorta and renal vasculature of patients with scoliosis. Tamura et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] reported that lateral displacement of the aorta results in a more laterally positioned inferior vena cava, making the psoas muscle difficult to visualize. Milbrandt et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] demonstrated that the aorta is more anteriorly and medially displaced toward the right in individuals with left thoracic scoliosis than in those with a customarily aligned spine. Moreover, Amanullah et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] reported that the compensatory curvature of the spine tends to increase as the scoliosis progresses. Therefore, if the thoracic spine moves to the right side, the lumbar spine compensates by moving to the left side, causing renal vessel changes according to the severity of scoliosis. In our study, patients with right convex scoliosis exhibited significant vascular changes, whereas those with left convex scoliosis demonstrated no such changes. This discrepancy may be attributed to the study\u0026rsquo;s limited sample size and retrospective, single-center design. Further research with more extensive, multicenter cohorts is warranted to validate these findings.\u003c/p\u003e \u003cp\u003eFurthermore, the degree of liver coverage increased as scoliosis worsened in patients with right convex scoliosis. The hepatic changes may have resulted from thoracic deformation, which causes the lungs to descend posteriorly, displacing the liver anteriorly toward the kidney. Byun et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] indicated that vertebral rotation leads to lateral spine displacement in patients with scoliosis, causing the ribs on the convex side to protrude posteriorly, as if the thorax was being compressed. The associated thoracic cage deformity may support our finding of a positional shift in the liver.\u003c/p\u003e \u003cp\u003eThis study has certain limitations. First, the study included only two nephrectomy cases in patients with scoliosis, so the observed anatomical variations cannot be directly linked to operative difficulty or perioperative complications. Moreover, surgical difficulty and perioperative complications were not systematically assessed in this cohort and remain to be clarified in future studies. Surgical treatment for malignant tumors in patients with scoliosis has been reported only through case reports, not only in urology but also across other surgical fields [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Further studies with larger sample sizes are warranted to elucidate these associations.\u003c/p\u003e \u003cp\u003eSecond, renal vasculature and scoliosis parameters were assessed via only two-dimensional imaging. Although this method is frequently employed because of its accessibility and simplicity, it may not accurately capture complex three-dimensional anatomical relationships, especially in patients with spinal deformities such as scoliosis. Two-dimensional assessments may underestimate vessel length or fail to capture spatial displacement resulting from anatomical variations [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Hence, researchers must conduct investigations utilizing three-dimensional reconstruction or CT angiography to obtain more precise anatomical information. Thus, caution should be exercised when generalizing the present study\u0026rsquo;s findings, and multicenter prospective studies with larger cohorts are necessary to validate the results.\u003c/p\u003e \u003cp\u003eNonetheless, a key strength of this study is the identification of scoliosis-related anatomical changes in the renal vasculature and adjacent organs. This strength may directly inform preoperative planning and enhance surgical outcomes. In right convex scoliosis, we noted elongated renal vessels and increased hepatic coverage of the kidney; if recognized beforehand, these anatomical insights can help anticipate challenges such as limited surgical exposure and an elevated risk of vascular injury. These findings emphasize that detailed preoperative CT imaging is crucial when planning nephrectomy and other retroperitoneal procedures in patients with complex spinal deformities.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAnatomical changes in renal vessels and adjacent organs, particularly on the convex side, are observed in patients with scoliosis and become more pronounced as scoliosis worsens. Preoperative identification of these anatomical variations on CT may help mitigate surgical risks during nephrectomy and other retroperitoneal procedures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLRN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elaparoscopic radical nephrectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eanalysis of variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was approved by the Institutional Review Board of Iwate Medical University (approval no. MH2025-080). The requirement for written informed consent was waived because of the retrospective design and the use of anonymized data.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTK conceived the study and drafted the manuscript. DI and MH collected and curated the data. AI and RK performed the image analysis. SM and MK contributed to data interpretation. SK and WO critically revised the manuscript for important intellectual content. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' information\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAkazawa T, Kotani T, Sakuma T, et al. Pulmonary function improves in patients with adolescent idiopathic scoliosis who undergo posterior spinal fusion regardless of thoracoplasty: A mid-term follow-up. Spine Surg Relat Res. 2021;5(1):22\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.22603/ssrr.2020-0077\u003c/span\u003e\u003cspan address=\"10.22603/ssrr.2020-0077\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Shengru W, Guodong Y, En L, Zize L. A review of the methods on Cobb angle measurements for spinal curvature. Sensors. 2022;22(9):3258. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.3390/s22093258\u003c/span\u003e\u003cspan address=\"10.3390/s22093258\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Gao J, Zhao Z, et al. Quantitative computed tomography assessment of bone mineral density in adolescent idiopathic scoliosis: Correlations with Cobb angle, vertebral rotation, and Risser sign. Transl Pediatr. 2024;13(4):610\u0026ndash;623. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.21037/tp-24-74\u003c/span\u003e\u003cspan address=\"10.21037/tp-24-74\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePehrsson K, Sven L, Anders O, Alf N. Long-term follow-up of patients with untreated scoliosis: A study of mortality, causes of death, and symptoms. Spine. 1992;17(9):1091\u0026ndash;1096. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1097/00007632-1992090000-00014\u003c/span\u003e\u003cspan address=\"10.1097/00007632-1992090000-00014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamura D, Ito A, Kikuchi D, et al. Laparoscopic nephrectomy in a patient with severe scoliosis: A case report. Asian J Endosc Surg. 2019;12(1):122\u0026ndash;124. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1111/ases.12597\u003c/span\u003e\u003cspan address=\"10.1111/ases.12597\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawamura T, Ikarashi D, Ito A, et al. Robot-assisted laparoscopic radical nephrectomy in a renal cell carcinoma patient with severe scoliosis: A case report. IJU Case Rep. 2025;8(4):352\u0026ndash;355. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1002/iju5.70037\u003c/span\u003e\u003cspan address=\"10.1002/iju5.70037\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar K, Kannan R, Chandran H, et al. Retroperitoneal approach for laparoscopic nephrectomy is feasible in a child with difficult access due to severe scoliosis. J Pediatr Urol. 2010;6(3):324\u0026ndash;326. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1016/j.jpurol.2009.11.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jpurol.2009.11.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHermans T, Pasmans H, Fossion L, et al. Transperitoneal laparoscopic radical nephrectomy in a patient with severe scoliosis. Urology. 2013;82(2):485\u0026ndash;488. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1016/j.urology.2013.03.016\u003c/span\u003e\u003cspan address=\"10.1016/j.urology.2013.03.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMilbrandt A, Sucato J. The position of the aorta relative to the spine in patients with left thoracic scoliosis: A comparison with normal patients. Spine. 2007;32(12):348\u0026ndash;353. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1097/BRS.0b013e318059aeda\u003c/span\u003e\u003cspan address=\"10.1097/BRS.0b013e318059aeda\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmanullah A, Taemin O, Toll J, et al. Risk factors for progression of cervical congenital scoliosis and associated compensatory curve behavior. J Clin Med. 2024;13(11):3039. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.3390/jcm13113039\u003c/span\u003e\u003cspan address=\"10.3390/jcm13113039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eByun Y, Iida N, Yamada K, et al. Long-term pulmonary function after posterior spinal fusion in main thoracic adolescent idiopathic scoliosis. PLoS One. 2020;15(6):e0235123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1371/journal.pone.0235123\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0235123\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaguchi D, Yamashita K, Momose K, et al. A case of Barrett\u0026rsquo;s esophageal adenocarcinoma and severe scoliosis with successful salvage esophagectomy after definitive chemoradiotherapy. Surg Case Rep. 2023;9(1):204. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1186/s40792-023-01776-8\u003c/span\u003e\u003cspan address=\"10.1186/s40792-023-01776-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVivian R, Antti S, Eetu S, Stina S, Minna K. Severe untreated scoliosis and early onset breast cancer in a patient with neurofibromatosis associated with a nonsense variant of the NF1 gene. Orthop Res Rev. 2023;15:183\u0026ndash;189. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.2147/ORR.S415978\u003c/span\u003e\u003cspan address=\"10.2147/ORR.S415978\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePasha S, Cahill P, Dormans J, Flynn J. Characterizing the differences between the 2D and 3D measurements of spine in adolescent idiopathic scoliosis. Eur Spine J. 2016;25(10):3137\u0026ndash;3145. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1007/s00586-016-4582-5\u003c/span\u003e\u003cspan address=\"10.1007/s00586-016-4582-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUrban B, Ratner L, Fishman E. Three-dimensional volume-rendered CT angiography of the renal arteries and veins: Normal anatomy, variants, and clinical applications. Radiographics. 2001;21(2):373\u0026ndash;386. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1148/radiographics.21.2.g01mr19373\u003c/span\u003e\u003cspan address=\"10.1148/radiographics.21.2.g01mr19373\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Scoliosis, Nephrectomy, Renal vasculature, Hepatic coverage, Laparoscopic surgery","lastPublishedDoi":"10.21203/rs.3.rs-8322677/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8322677/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAnatomical variations relevant to nephrectomy in patients with scoliosis have not been fully characterized. We aimed to quantify scoliosis-related changes in renal vessels and adjacent organs via computed tomography (CT).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this retrospective single-center study, we evaluated 79 patients who underwent orthopedic surgery for scoliosis. Patients were grouped according to scoliosis severity into mild (Cobb angle: 10\u0026ndash;60\u0026deg;), moderate (60\u0026ndash;80\u0026deg;), and severe (\u0026ge;\u0026thinsp;80\u0026deg;) categories. The lengths of the renal arteries and veins were compared among these groups for both right- and left-convex curves. In patients with right convex scoliosis, we also examined how curve severity corresponded with liver coverage of the right kidney.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 79 patients (median age, 68 years; 19 men), 44 had right convex scoliosis, whereas 35 had left convex scoliosis. Scoliosis severity was mild in 65 (82%), moderate in 9 (11%), and severe in 5 (7%) patients. In the right convex scoliosis group, the median length of the right renal artery was significantly greater in the severe group (5.3 cm) than in the mild (4.1 cm) and moderate (4.2 cm) groups (P\u0026thinsp;=\u0026thinsp;0.013 and P\u0026thinsp;=\u0026thinsp;0.021). In left convex scoliosis, the renal vessel length did not differ significantly among the severity groups. The degree of liver coverage of the kidney was strongly correlated with the Cobb angle (r\u0026thinsp;=\u0026thinsp;0.712, P\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAnatomical changes in renal vessels and adjacent organs, particularly on the convex side, are observed in patients with scoliosis and become more pronounced as scoliosis worsens. Preoperative identification of these anatomical variations on CT may help mitigate surgical risks during nephrectomy and other retroperitoneal procedures.\u003c/p\u003e","manuscriptTitle":"Anatomical changes in renal vessels and adjacent organs in patients with scoliosis: a retrospective CT- based observational study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 11:03:39","doi":"10.21203/rs.3.rs-8322677/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-29T04:30:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T16:51:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T00:31:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-20T03:02:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T11:21:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303695077084254841741523004952039367089","date":"2026-04-13T05:56:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-11T14:53:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132190306645273123810163731842235106305","date":"2026-04-10T05:32:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30899058392347587571878431406522064158","date":"2026-04-09T17:13:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211774012539960213011745994346692622061","date":"2026-04-08T10:24:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104981898228598356249177839780533054691","date":"2026-04-08T08:07:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252793255752161349639863276952493523488","date":"2026-04-08T07:29:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-13T08:12:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-18T06:15:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-18T06:14:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2025-12-10T03:36:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b1fa7da-0c48-4a2b-8a69-17c5d4e88827","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-29T04:30:52+00:00","index":75,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-16T11:03:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 11:03:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8322677","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8322677","identity":"rs-8322677","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}