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Generalized Joint Hypermobility in Adolescent Idiopathic Scoliosis: Greater Curve Flexibility, Larger Thoracic

Di Liu^1,2,3,4, Kexin Xu^1,2,3,4, Xiangjie Yin^1,2,3,4

¹Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

Orthopaedic Surgery

|June 4, 2026

Abstract

Objectives:

Generalized joint hypermobility (GJH) is prototypical clinical feature of hypermobility spectrum disorders, and emerging studies have found a correlation between GJH and structural spinal changes. This study aims to investigate the preoperative radiographic characteristics and clinical outcomes of patients with GJH and adolescent idiopathic scoliosis (AIS).

Methods:

Patients with AIS were prospectively recruited between July 2023 and August 2024 and divided into GJH (Beighton score ≥ 6) and non-GJH (Beighton score < 6) groups. The GJH group was matched 1:1 with controls based on age (±1 year), sex, main curve magnitude (±5°), curve type of the Lenke classification, triradiate cartilage status, and Risser stage (±1 grade). Baseline characteristics and surgical data were recorded. Preoperative and immediately postoperative radiographic parameters were measured. The Scoliosis Research Society-22 revised (SRS-22r) questionnaire was collected preoperatively and at least 1 year postoperatively. Univariate analysis and multivariable linear regression analysis were used to identify factors associated with main curve flexibility, TK, and T1 tilt angle.

Results:

A total of 136 consecutive patients were included, with 29 patients (21.3%) classified into the GJH group. After mating, the GJH showed greater flexibility of the main curve (60.0% ± 27.7% vs. 45.8% ± 22.1%, p = 0.020) and increased thoracic kyphosis (22.9° ± 11.5° vs. 16.7° ± 11.7°, p = 0.031) compared to the control group. Multivariable linear regression analyses revealed that the GJH was correlated with increased spinal flexibility (β = 14.09, p = 0.015) and larger thoracic kyphosis (β = 6.11, p = 0.043). The GJH group demonstrated a relatively higher risk of surgical complications compared to the non-GJH group (17.2% [5/29] vs. 4.7% [5/107], p = 0.036). However, no significant differences were observed in patient-reported outcome measures (PROMs) between the two groups.

Conclusions:

In patients with AIS, GJH is associated with increased spinal flexibility and greater thoracic kyphosis and, importantly, a higher risk of surgical complications.

Keywords:

adolescent idiopathic scoliosis flexibility generalized joint hypermobility kyphosis

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