Adolescent idiopathic scoliosis

Sex and age differences in depression and anxiety networks among adolescents with idiopathic scoliosis: A network analysis

BACKGROUND

Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis (AIS), affecting individuals across both sex and age groups.

AIM

To explore the network structure of depression and anxiety symptoms, with a focus on identifying differences at the symptom level between sex and age subgroups.

METHODS

A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale (PHO-9) and the Generalized Anxiety Disorder Scale (GAD-7), and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized to construct and compare the depression-anxiety symptoms networks among sex and age subgroups.

RESULTS

The results revealed GAD3 “Excessive worry” and PHQ2 “Sad mood” were the most significant central symptoms in all subgroups, while “Sad mood” had higher strength than “Excessive worry” in the lower age group. In the network comparisons, the female network exhibited tighter connectivity, especially on GAD6 “Irritability” and GAD2 “Uncontrollable worry”, while only PHQ3 “Sleep” and PHQ9 “Suicidal ideation” had differences at the local level in the lower age group.

CONCLUSION

Several interventions targeting excessive worry and sad mood could reduce the risk of depression and anxiety symptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbances and suicidal ideation in the lower age group, should be addressed at an early stage to prevent significant disruptions in mental health trajectories.

A novel portable and radiation-free method for assessing scoliosis: an accurate and reproducible study

BACKGROUND

This study aimed to evaluate the accuracy and reproducibility of a newly developed portable and radiation-free three-dimensional spine sensing system (3D-SSS) for scoliosis assessment.

METHODS

A total of 145 patients underwent full-spine imaging using the EOS imaging system, and 3D-SSS data were collected between February 2023 and April 2023. A radiologist used sterEOS software to reconstruct the spine in 3D and obtain the Cobb angle. One radiologist and one orthopedist independently measured the patients using 3D-SSS, with the orthopedist performing two measurements per patient. The 3D-SSS post-processing system automatically generated the Cobb angle.

RESULTS

The mean Cobb angles obtained from EOS and 3D-SSS were 13.7 ± 9.9° (0.5∽45.7°) and 12.5 ± 8.6° (0.4∽40°), respectively. The intraclass correlation coefficient (ICC) for reliability between EOS and 3D-SSS was 0.921, indicating excellent agreement. Bland-Altman analysis revealed a bias of -1.171° between EOS and 3D-SSS, with only 10 patients outside the limits of agreement (-8.3∽6.0°). The root mean square error between EOS and 3D-SSS was 3.2°. A strong correlation was observed between the Cobb angles measured by EOS and 3D-SSS (r = 0.931, P < 0.001). The receiver operating characteristics curve showed that the diagnostic performance of 3D-SSS for scoliosis was 0.953 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of 3D-SSS for diagnosing scoliosis were 87.8%, 92.1%, 93.5%, and 85.3%, respectively. The intraobserver and interobserver ICCs for Cobb angles derived from 3D-SSS were 0.969 and 0.934, respectively, demonstrating excellent reproducibility.

CONCLUSIONS

The portable and radiation-free 3D-SSS accurately measured scoliosis and provided highly reproducible data. This system offers a novel method for clinicians to screen and monitor scoliosis in young patients.

Sensitivity of intraoperative electrophysiological monitoring for scoliosis correction in identifying postoperative neurological deficits: a retrospective chart review of the Scoliosis Research Society morbidity and mortality database

BACKGROUND

Surgical intervention is the ultimate treatment for scoliosis, but iatrogenic spinal cord injury is one of the major concerns. Although intraoperative electrophysiological monitoring can aid in detecting and reducing postoperative neurological complications, its use is still controversial.

METHODS

A retrospective chart review of 6,577 scoliotic patients who underwent surgery for curve correction with a reported complication was conducted. Our dataset was sourced from the morbidity and mortality database of the Scoliosis Research Society spanning the period from 2013 to 2023. The sensitivity of intraoperative monitoring was evaluated.

RESULTS

Intraoperative monitoring was used in 60% of surgeries, while 26% of the reported complications in the study cohort were new postoperative neurologic deficits. The overall monitoring performance indicated a sensitivity of 45%. Neurogenic motor evoked potential showed the best outcomes among the individual monitoring methods. The highest sensitivity (60.4%) was achieved using four monitoring methods, demonstrating significantly better results than one, two, and three methods.

CONCLUSIONS

The monitoring practice benefits in distinguishing postoperative neurologic deficits within the scoliosis population. Employing four monitoring techniques yielded the most favourable outcomes.

Genome-wide profiling of circulating microRNAs in adolescent idiopathic scoliosis and their relation to spinal deformity severity, and disease pathophysiology

Adolescent Idiopathic Scoliosis (AIS) is the most common orthopedic condition requiring surgery, affecting 4% of adolescents. There is currently no proven method or prognostic test to identify symptomatic patients at risk of developing severe scoliosis who could benefit from growth-guided devices or minimally invasive non-fusion instrumentation surgeries. These innovative treatments must be performed at an early disease stage in younger patients to benefit from their growth potential. In this prospective cross-sectional study, we investigated the clinical utility of circulating microRNAs (miRNAs), an important class of small non-coding RNA, as biomarkers to predict the risk of developing severe scoliosis in AIS. Blood samples and clinical data were collected from 116 AIS patients who were followed until skeletal maturity and stratified according to their clinical outcome. Genome-wide expression profiling of miRNAs was performed with plasma obtained at the time of diagnosis of AIS (mean age of 13.3 ± 1.7 years with a mean Cobb angle of 24.4° ± 12.4°). This approach led to the identification of 15 circulating miRNAs that are upregulated in AIS patients who developed a severe scoliosis (Cobb angle ≥ 45°) at skeletal maturity compared to moderate and mild scoliosis groups (Cobb angle between 25°-44° and < 25° respectively). After optimization and the application of Random Forest Models a panel of six miRNAs (miR-1-3p, miR-19a-3p, miR-19b-3p, miR-133b, miR-143-3p, and miR-148b-3p) out of 15 led us to develop an algorithm predicting the risk of developing a severe scoliosis with great accuracy (100%), sensitivity (100%) and specificity (100%). Having a scoliosis predictive bioassay and decision-making tools to predict curve progression in order to find the best treatment plan will undoubtedly transform the orthopedic care system in the field of pediatric scoliosis by integrating innovative precision medicine approaches. In addition, investigation of genes targeted by these miRNAs could fill our gaps in our understanding of AIS pathogenesis and reveal new actionable targets.

Detection Rate and Risk Factors of Abnormal Spinal Curvature Among Children and Adolescents - Jiangsu Province, China, 2021-2023

What is already known about this topic?

Spinal curvature abnormalities have emerged as a major public health challenge for children and adolescents in China, with detection rates showing a concerning upward trend in recent years.

What is added by this report?

This population-based surveillance study revealed a 2.1% detection rate of abnormal spinal curvature among children and adolescents aged 6-17 years in Jiangsu Province. The findings emphasize the critical need for early intervention programs targeting modifiable risk factors, including insufficient physical activity, inadequate sleep duration, and improper reading and writing posture.

What are the implications for public health practice?

The increasing burden of abnormal spinal curvature requires targeted attention, particularly for high school students and females during growth spurts. A comprehensive approach combining early lifestyle interventions, such as adequate outdoor activities, with appropriate referrals to public health specialists and orthopedic surgeons may enhance risk mitigation. Success in addressing this challenge requires coordinated multisectoral collaboration and active parental engagement.

Patient and parent perspectives on being invited to join a trial of night-time only versus full-time bracing for adolescent idiopathic scoliosis : a qualitative study

Aims

The Bracing Adolescent Idiopathic Scoliosis (BASIS) study is a randomized controlled non-inferiority pragmatic trial of 'full-time bracing' (FTB) compared to 'night-time bracing' (NTB) for the treatment of adolescent idiopathic scoliosis (AIS). We anticipated that recruiting patients to BASIS would be challenging, as it is a paediatric trial comparing two markedly different bracing pathways. No previous studies have compared the experiences of AIS patients treated with FTB to those treated with NTB. This qualitative study was embedded in BASIS to explore families' perspectives of BASIS, to inform trial communication, and to identify strategies to support patients treated in a brace.

Methods

Semi-structured interviews were conducted with parents (n = 26) and young people (n = 21) who had been invited to participate in BASIS at ten of the 22 UK paediatric spine services in hospitals recruiting to BASIS. Audio-recorded interviews were transcribed and analyzed thematically.

Results

Families viewed their interactions with BASIS recruiters positively, but were often confused about core aspects of BASIS, such as the aims, expectations of bracing, and the process of randomization. Participants typically expressed a preference for NTB, but recruiters may have framed NTB more favourably. Patients and parents reported challenges wearing a brace, such as physical discomfort, feelings of self-consciousness, difficulty participating in physical activities, and strain on financial resources to support brace use. Patients in FTB reported more pronounced challenges. While families valued health professional support, they felt there was a lack of social, emotional, and school support, and relied on online resources, as well private counselling services to address this need.

Conclusion

The findings informed the development of resources and strategies, including guidance for schools and the recommendations in this paper, to support patients to wear NTB and FTB as prescribed. The results indicated opportunities for recruiters to enhance trial communication in ways that could improve informed consent and recruitment to BASIS, and inform future trials of bracing.

A noninvasive spinal device for measuring adolescent idiopathic scoliosis: validity, reliability, and factors influencing measurement difference

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is a common deformity, requiring regular screening and monitoring. While radiological measurements are considered the gold standard, X-ray exposure poses significant risks. A noninvasive spinal device offers a radiation-free alternative for measuring spinal curvature. This study evaluates the validity and reliability of its measurements and explores factors associated with measurement discrepancy.

METHODS

This study involved AIS patients in an outpatient setting from June to August 2023. Participants underwent device measurements to assess the scoliosis angle (SA) in the frontal plane, which were evaluated by two orthopedists and compared to radiological measurements (Cobb angle) from EOS images.

RESULTS

A total of 112 patients were included in the study. The Cobb angle measured on EOS images was 30.3°± 12.4°. The SA measurements by observer 1, observer 2, and their average were 25.5° ± 10.9°, 25.4° ± 10.3°, and 25.4° ± 9.9°, respectively. The reliability analysis showed good agreement between observers (ICC = 0.77) and within observers (ICCs of 0.81 and 0.86). The validity analysis showed a very strong correlation between the SA and Cobb angle (r = 0.76). Logistic regression analysis indicated that high BMI, great scoliosis magnitude, and large maximal vertebral rotation (MVR) were associated with measurement discrepancy. Multivariate linear regression formula was: Cobb angle = 0.83×SA + 0.55×TRA + 0.21×BMI.

CONCLUSION

This device measurement demonstrated good reliability and validity compared with radiological measurement, highlighting its safety and feasibility for screening and monitoring AIS progression. However, high BMI, great scoliosis magnitude, and large MVR were associated with measurement inaccuracy.

Digital Physiotherapeutic Scoliosis-Specific Exercises for Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial

Importance

The effectiveness of a training support program of individually tailored physiotherapeutic scoliosis-specific exercises (PSSEs) delivered via a digital care system is unclear.

Objective

To determine the effectiveness of a digital care program in which patients receive PSSE supervision and guidance via the Healbone Intelligent Rehabilitation System and educational videos compared with a conventional intervention involving 3 treatment sessions conducted by qualified physiotherapists at outpatient clinics or specialized orthopedic institutions and unsupervised home-based PSSE training.

Design, Setting, and Participants

This randomized clinical trial recruited patients aged 9 to 17 years from Peking Union Medical College Hospital in Beijing, China, who had adolescent idiopathic scoliosis with a primary curve Cobb angle of 10° or greater and skeletal immaturity (as determined via the Risser grading system). The trial was conducted from June 1, 2023, to August 10, 2024.

Interventions

Patients were randomly assigned to a digital care (DC) group, in which each patient received fully remote and home-based PSSE training supported by a digital care system, or a usual care group, in which each patient completed 3 treatment sessions conducted by qualified physiotherapists at outpatient clinics or specialized orthopedic institutions and home-based PSSE training without supervision.

Main Outcomes and Measures

The primary outcome was a change in the Cobb angle of the major curve between baseline and month 6 of the intervention. Primary and secondary outcomes were evaluated using an independent samples t test. The proportion of patients who exhibited disease progression or improvement in the Cobb angle between the 2 groups was compared using a χ2 test.

Results

Of 591 patients assessed for eligibility, 436 did not meet the eligibility criteria, 12 declined to participate, and 15 withdrew before randomization. The remaining 128 patients were randomized to 2 parallel groups, with 64 patients in each group (mean [SD] age, 11.1 (2.2) years; 97 female [75.8%]), all of whom completed the baseline assessment and 6-month follow-up. The mean difference in the improvement of the Cobb angle between the DC group and the usual care group after a 6-month intervention was -4.23° (95% CI, -6.08° to -2.39°) in the intention-to-treat analysis and -4.01° (95% CI, -5.68° to -2.35°) in the per-protocol analysis. The posttreatment Cobb angle was adjusted by using analysis of covariance, and the mean of the difference in the adjusted posttreatment Cobb angle between 2 groups was -4.24° (95% CI, -6.09° to -2.38°).

Conclusions and Relevance

In this randomized clinical trial, the effectiveness of individually tailored PSSE training support delivered via a digital care system was superior to that of a conventional PSSE training model in improving the Cobb angle. This mode of exercise may be an effective and convenient alternative for individuals with adolescent idiopathic scoliosis.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2300076563.

Patient-Reported Mental Health and Quality of Life in Pediatric Adolescent Idiopathic Scoliosis Patients

Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity that can affect patients' mental health and overall quality of life. Orthopaedic providers commonly employ questionnaires such as the (scoliosis research society) SRS-22, PROMIS, and pediatric/s quality of life, among others, to assess patient-reported outcomes, including pain interference, depressive symptoms, and self-image. This article aims to examine the effect of various AIS treatments on patients' mental health and health-related quality of life (HRQoL), while also discussing the utility of these questionnaires in clinical research. The reviewed studies consistently demonstrate that treatment may influence patients' mental health, emphasizing the vital role of questionnaires in measuring mental health and HRQoL throughout their treatment journey. Furthermore, these instruments enable healthcare providers to implement strategies that enhance patients' mental well being as part of their treatment plans. AIS poses a risk factor for poor mental health and HRQoL. However, further research is warranted to determine the longitudinal effect of AIS on mental health and HRQoL. These investigations will empower healthcare providers to identify optimal treatment plans, thereby alleviating the burden on the mental health and HRQoL of AIS patients.

Reducing the Brace Correction Stress on the Secondary Lumbar Curve Results in Excellent Muscle, Bone, and Disc Mechanical Performance: A Musculoskeletal Finite Element Simulation of AIS Patient With Rigo A3

OBJECTIVES

The biomechanical mechanism of brace intervention on bone, muscle, and disc should be comprehensively considered for AIS patients. We aimed to developmentally construct a musculoskeletal finite element model of adolescent idiopathic scoliosis to simulate the coupling of corrective forces and analyze the mechanical properties of bone, muscle, and disc. Investigateing, more effective clinical interventions to break the vicious cycle of patients during growth.

METHODS

A finite element model, including muscle, bone, and disc, was established using computed tomography data of a patient with RigoA3 adolescent idiopathic scoliosis. The three-point force coupling, antigravity, and bending effects of the Chêneau brace were simulated, and the correction force of the secondary lumbar bend was gradually reduced while observing the mechanical characteristics of bone, muscle, and disc. The correction force in line with symmetrical spine growth was comprehensively evaluated.

RESULTS

The correction rate of the main thoracic (MT) curve, the intervertebral space height on the concave side of the vertebrae at the apex, and the stress ratio of the intervertebral discs were optimal when the maximum corrective pressure threshold was reached. However, the proximal thoracic (PT) curve was aggravated and the axial forces on the concave side were unbalanced. At this time, the biomechanical performance of the model is also not optimal. The correction rate of the Cobb Angle of the MT curve decreased with the decrease of the correction pressure in the lumbar region. When reduced to 25% of the maximum threshold, the convex side of disc stress, intervertebral space, and muscle axial force is more in line with the biomechanical mechanism of correction and can avoid sacrificing the PT curve.

CONCLUSIONS

Downward adjustment of the corrective force to the secondary lumbar curve, using the Chêneau brace, results in better primary thoracic curvature mechanics in the musculoskeletal finite element model, suggesting that breaking the vicious cycle of scoliosis progression to guide benign spinal growth is beneficial.

Tributyl phosphate inhibits neurogenesis and motor functions during embryonic development in zebrafish

Tributyl phosphate (TBP), an organophosphate ester (OPE), is heavily used as a solvent in chemical industries, a plasticizer, and to extract radioactive molecules. Thus, widespread uses of TBP in industrialized countries led to the release of TBP and its metabolites, dibutyl phosphate (DBP) and monobutyl phosphate (MBP), in the environment and were detected in human samples. Accumulating these OPEs over time in humans and aquatic animals may develop toxicological effects. The reports also say TBP passes through the mother-fetal transmission route and may affect embryonic development. However, the impact of TBP and its metabolites on vertebrate development has been poorly studied. Ex-utero development, high fecundity, and optical transparency make the zebrafish a preferred model for toxicological evaluation. Thus, we aim to explore the toxic effects of TBP and its metabolites on aquatic animals using zebrafish as a model organism. Embryos in the chorion were incubated in 10-60 µM test chemicals from 6 to 48 h post fertilization (hpf), and analyzed the adverse effects on embryos. Our study found that 10-20 µM TBP inhibits neural growth, resulting in decreased spontaneous movement frequency and locomotive behavior without altering the overall embryonic growth and muscle functions. In contrast, DBP-treated embryos showed increased spontaneous movement frequency without changing the motor neuron growth and locomotive behavior. Further, in higher concentrations, TBP is teratogenic, and DBP is lethal to the embryos. Altogether, we found that TBP inhibits neurogenesis and motor behavior; however, its metabolite DBP is neuroexcitatory in zebrafish embryos.

Dystrophinopathy in the paravertebral muscle of adolescent idiopathic scoliosis: a prospective case-control study in China

STUDY DESIGN

A prospective case-control study.

PURPOSE

This prospective case-control study aimed to analyze the paravertebral muscle changes in patients with adolescent idiopathic scoliosis (AIS) and determine paravertebral myopathological changes associated with the clinical progression of AIS.

OVERVIEW OF LITERATURE

The incidence of AIS is significant globally and worsens before bone maturation, causing a serious effect. Many studies have investigated its causes-such as genetic, epigenetic, and hormonal factors-but more research remains warranted.

METHODS

This study enrolled 40 patients with AIS, 20 patients with congenital scoliosis (CS), and 20 patients with spinal degenerative disease (SDD). All patients underwent open posterior surgery in our hospital, and a paravertebral muscle (multifidus muscle) biopsy was performed intraoperatively. This study included many indexes that describe muscle, especially dystrophin staining. The above pathological results were compared among the AIS, CS, and SDD groups. The correlation between the Cobb angle and Nash-Moe classification and the above pathological results was analyzed in patients with AIS.

RESULTS

Significant reductions in the dystrophin staining of dystrophin-1 (p<0.001), dystrophin-2 (p<0.001), and dystrophin-3 (p<0.001) were observed in the AIS group than in the CS and SDD groups. The higher the Nash-Moe classification in the AIS group, the more significant the loss of dystrophin-2 (p=0.042) in the convex paraspinal muscles. Additionally, a significantly positive correlation was observed between the reductions of dystrophin-2 on the concave side of the AIS group and Cobb angle (p=0.011).

CONCLUSIONS

Dystrophin protein deficiency in the paraspinal muscles plays a crucial role in AIS formation and progression. The severity of scoliosis in patients with AIS is correlated with the extent of dystrophin loss in the paravertebral muscles. Therefore, dystrophin dysfunction may be relevant to AIS occurrence and development.

On mobility and gait in scoliosis patients: a comparison of conventional and 3D-printed braces during an instrumented timed-up and go test

OBJECTIVE

Spinal orthoses are the most viable conservative treatment for scoliosis, and additive manufacturing techniques have shown huge perspective in producing patient-specific braces, reducing material waste, and production times. This pilot study aimed at determining whether 3D-printed braces could induce advantages or disadvantages compared to conventional braces in terms of mobility and gait, and at quantitatively evaluating the effects of braces on mobility and gait.

METHODS

Ten participants were included in the study, eight with adolescent idiopathic scoliosis and two with osteogenesis imperfecta. Participants were asked to perform Timed-Up and Go (TUG) tests wearing a triaxial accelerometer under three conditions: unbraced, wearing a conventional (i.e., thermoformed) brace, and wearing a 3D-printed brace. After segmenting each TUG test in sub-phases, metrics quantifying gait and mobility were computed, and Friedman tests among all conditions were performed.

RESULTS

No significant differences in scoliotic patients mobility and gait between conventional and 3D-printed brace conditions were found, potentially suggesting that 3D-printed braces are as effective as conventional ones. Conversely, Stand flexion amplitude and Sit extension amplitude were lower in both conventional and 3D-printed brace conditions compared to the unbraced, meaning that braces limited the trunk range of motion. As for gait parameters, no significant differences in Walk Cadence and Walk Velocity among the three conditions were found, indicating that braces did not affect gait, at least during TUG tests.

TRIAL REGISTRATION

The study was registered at Clinicaltrials.gov (Study ID NCT04282408, Date of Registration February 11th, 2020).

Loss of Tyrosine Phosphatase Mu Promotes Scoliosis Progression Through Osteopontin-α5β1 Integrin Signaling and PIPK1γ90 Activity

Adolescent idiopathic scoliosis (AIS) is characterized by a curvature of the spine affecting approximately 4% of the pediatric population, and the mechanisms driving its progression remain poorly understood. Whole-exome sequencing of a French-Canadian AIS cohort with severe scoliosis identified rare variants in the PTPRM gene, which encodes Protein Tyrosine Phosphatase μ (PTPµ). However, these rare variants alone did not account for the pronounced reduction in PTPµ at both mRNA and protein levels in severe AIS cases. This led us to investigate epigenetic regulators and the identification of five microRNAs (miR-103a-3p, miR-107, miR-148a-3p, miR-148b-3p, and miR-152-3p) that target PTPRM mRNA. These microRNAs were significantly elevated in plasma from severe AIS patients, and miR-148b-3p was also upregulated in AIS osteoblasts. Phenotypic analysis of bipedal Ptrprm knockout (PTPµ -/-) mice showed increased prevalence and severity of scoliosis, while quadrupedal PTPµ -/- mice did not develop scoliosis, underscoring PTPµ's role as a disease-modifying factor. Mechanistically, PTPµ deficiency was found to disrupt Gi-coupled receptor signaling in osteoblasts by enhancing the interaction between osteopontin (OPN) and α5β1 integrin, along with increased tyrosine phosphorylation of phosphatidylinositol-4-phosphate 5-kinase type I (PIPKIγ90). These findings provide novel insights into the molecular mechanisms underlying spinal deformity progression in AIS, linking PTPµ depletion to aberrant OPN-α5β1 integrin signaling and highlighting potential therapeutic targets to stop, mitigate, or prevent scoliosis.

The Application of Integrated Force and Temperature Sensors to Enhance Orthotic Treatment Monitoring in Adolescent Idiopathic Scoliosis: A Pilot Study

Orthosis-wearing compliance is crucial for achieving positive treatment outcomes in patients with adolescent idiopathic scoliosis (AIS), for whom 23 h of daily wear is typically prescribed. However, self-reported compliance is subjective and often based on patients' memory, leading to inaccuracies. While portable electronic devices have been developed to objectively monitor compliance, relying solely on temperature or force data can be insufficient. This study introduced a novel method that integrated both force and temperature data to estimate orthosis-wearing compliance. Twelve patients (eight females and four males) diagnosed with moderate AIS were included. Each patient was prescribed a thoracic-lumbar-sacral orthosis equipped with an integrated force and temperature sensor system. After one month of orthotic treatment, self-reported wear time averaged 17.8 ± 6.2 h/day, while the sensor indicated an average wear time of 13.3 ± 5.0 h/day. Most patients overestimated their compliance. Nighttime was the most common period for orthosis wear (6.1 h/day), whereas compliance during school hours (2.8 h/day) and after-school hours (3.7 h/day) was lower. The integration of force and temperature sensors provides a more comprehensive understanding of orthosis compliance. Future studies with larger samples and longer monitoring periods are needed to investigate the correlation between compliance and treatment outcomes.

Enhanced recovery after surgery for adolescent idiopathic scoliosis: a revised systematic review and meta‑analysis

PURPOSE

Adolescent idiopathic scoliosis surgery (AIS) is often associated with high costs and significant recovery challenges. Enhanced recovery after surgery (ERAS) protocols aim to improve outcomes, reducing hospital stays and complications compared to traditional (TD) pathways. This study evaluates the impact of ERAS protocols on AIS treatment.

METHODS

Following PRISMA guidelines, a systematic review identified 30 studies (n = 15,954 patients). Search terms included "ERAS," "adolescent idiopathic scoliosis," and "posterior spinal fusion." Outcomes assessed included surgical metrics, recovery milestones, complications, and pain. A meta-analysis was performed, and the risk of bias was evaluated using the MINORS score.

RESULTS

ERAS patients (n = 5582) had shorter surgical durations (- 23 min, p = 0.08) and reduced blood loss (- 126 mL, p = 0.033) compared to TD patients (n = 7916). Recovery milestones improved, including earlier ambulation (- 37.4 h, p < 0.0001), patient-controlled analgesia discontinuation (- 1.1 days, p < 0.0001), catheter removal (- 0.75 days, p < 0.001), and shorter hospital stays (- 1.7 days, p < 0.0001). Complications were lower in the ERAS group (4% vs. 8%, p = 0.0074), while wound-related complications and 30-day readmission rates were comparable. Pain scores were significantly reduced from surgery day to postoperative day 2 (p < 0.0181).

CONCLUSION

ERAS protocols improve recovery and reduce complications in AIS surgery, with shorter hospital stays and enhanced patient outcomes. These findings support broader implementation and further randomized trials to evaluate long-term benefits and patient satisfaction.

2D and 3D Classification Systems for Adolescent Idiopathic Scoliosis: Clinical Implications and Technological Advances

Classification systems for Adolescent Idiopathic Scoliosis (AIS) play an important role in guiding both surgical planning and conservative treatments. Traditional 2D classification systems, such as the Lenke, King and Lehnert-Schroth classifications, have been widely used for the clinical diagnosis and treatment of scoliosis. However, with the growing understanding of the three-dimensional nature of scoliosis and advancements in 3D reconstruction technologies, 3D classification systems are gaining increasing attention. This paper reviews the current applications, advantages, and limitations of different 2D and 3D classification systems, focusing on their clinical significance in treatment planning. While 3D classification systems offer clear advantages in capturing the complexity of spinal deformities, their clinical implementation faces challenges such as high costs and technical complexity. Additionally, studies show that computer-assisted technologies, artificial intelligence can significantly improve the accuracy and consistency of classification systems, reducing human errors. The paper also explores the future directions of classification system development, emphasizing the potential of combining 2D and 3D technologies and the impact of these advancements on personalized scoliosis treatment.

Adolescent idiopathic scoliosis: treatment outcomes, quality of life and implications for practice

Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder among children and adolescents, with most cases being diagnosed around puberty. While the majority of people with AIS do not undergo treatment, a small but significant number are treated, depending on the extent of their spinal curvature. Treatment typically involves bracing, which requires substantial adherence, and/or surgery, which is invasive and permanent. Furthermore, decisions about treatment often need to be made at a critical stage of the person's development. This article examines the evidence on AIS and its treatment, synthesising the current literature and drawing from the authors' empirical work to explore the clinical outcomes of bracing and surgery, as well as the longer-term effects on people's quality of life. Drawing from this evidence, the authors provide guidance for nurses and healthcare professionals who care for people with AIS.

Clinical and Topographic Screening for Scoliosis in Children Participating in Routine Sports: A Prevalence and Accuracy Study in a Spanish Population

Background: Idiopathic scoliosis (IS) is a common spinal deformity affecting 0.5% to 5.2% of children worldwide, with a higher reported range in Spain (0.7-7.5%). Early detection through screening is crucial to prevent the progression of mild cases to severe deformities. Clinical methods such as the ADAM test and trunk rotation angle (TRA) are widely used, but the development of three-dimensional (3D) surface topography (ST) technologies has opened new avenues for non-invasive screening. The objectives of this study were (1) to perform clinical and ST-based scoliosis screening in a sample of healthy children involved in club sports, (2) to estimate the agreement between clinical and ST screening methods, (3) to describe the prevalence of scoliosis by sport, sex, and age, and (4) to evaluate the diagnostic performance of both screening approaches using available radiographs as a reference standard. Methods: A total of 343 children (58.7% males, 41.3% females; mean age 11.69 ± 2.05 years) were screened using both clinical and ST methods. Clinical screening included the ADAM test and TRA measurement, while ST screening was performed using BackSCNR®, a markerless 3D scanning software. The children with positive screening results were recommended to obtain radiographs to confirm the diagnosis. Kappa agreement, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for both screening modalities using radiographic results as the gold standard. Results: The prevalence of scoliosis was 3.2% (n = 11) based on radiographic confirmation. The prevalence by sport was highest in swimming (17.6%), with minimal differences by sex (males 3.6%, females 2.5%). The clinical screening showed a sensitivity of 73%, specificity of 97%, PPV of 47%, NPV of 99%, and accuracy of 96%. The ST screening showed a sensitivity of 36%, specificity of 99%, PPV of 80%, NPV of 97%, and accuracy of 97%. The kappa values indicate a moderate influence of chance for both methods (clinical κ = 0.55; ST κ = 0.48). The balanced accuracy was 84% for the clinical screening and 68% for the ST screening. Conclusions: The clinical screening method showed superior sensitivity and balanced accuracy compared to ST screening. However, ST screening showed higher specificity and PPV, suggesting its potential as a complementary tool to reduce the high positive predictive value. These results highlight the importance of combining screening methods to improve the accuracy of the early detection of IS in physically active children, with the radiographic confirmation of the positive screened cases remaining essential for accurate diagnosis.

Spinal scoliosis: insights into developmental mechanisms and animal models

Spinal scoliosis, a prevalent spinal deformity impacting both physical and mental well-being, has a significant genetic component, though the exact pathogenic mechanisms remain elusive. This review offers a comprehensive exploration of current research on embryonic spinal development, focusing on the genetic and biological intricacies governing axial elongation and straightening. Zebrafish, a vital model in developmental biology, takes a prominent role in understanding spinal scoliosis. Insights from zebrafish studies illustrate genetic and physiological aspects, including notochord development and cerebrospinal fluid dynamics, revealing the anomalies contributing to scoliosis. In this review, we acknowledge existing challenges, such as deciphering the unique dynamics of human spinal development, variations in physiological curvature, and disparities in cerebrospinal fluid circulation. Further, we emphasize the need for caution when extrapolating findings to humans and for future research to bridge current knowledge gaps. We hope that this review will be a beneficial frame of reference for the guidance of future studies on animal models and genetic research for spinal scoliosis.

High inpatient-opioid consumption predicts extended length of hospital stay in patients undergoing spinal fusion for adolescent idiopathic scoliosis

OBJECTIVES

Opioids are common medications used following spine surgery. However, few studies have assessed the impact of increased inpatient-opioid consumption on outcomes following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to determine the impact of increased inpatient-opioid consumption on hospital length of stay (LOS) following PSF for AIS.

METHODS

A retrospective cohort study was performed using the Premier Healthcare Database (2016-2017). Adolescent patients (11-17 years old) who underwent PSF for AIS, identified using ICD-10-CM coding, were stratified by inpatient MME (morphine milligram equivalent) consumption into Low (< 25th percentile for the cohort), Medium (25-75th percentile), and High (> 75th percentile) cohorts. Demographics, comorbidities, intraoperative procedures, perioperative adverse events (AEs), length of hospital stay (LOS), non-routine discharge rates, cost of admission, and 30-day readmission rates were assessed. A logistic multivariate regression analysis was performed to determine the association between inpatient MME consumption and extended LOS.

RESULTS

Of the 1042 study patients, 260 (24.9%) had Low-MME consumption, 523 (50.2%) had Medium-MME consumption, and 259 (24.9%) had High-MME consumption. A greater proportion of patients in the High cohort identified as non-Hispanic white (Low: 46.5% vs Medium: 61.4% vs High: 65.3%, p < 0.001), while the proportion of patients reporting any comorbidity did not vary across the cohorts (p = 0.940). The number of post-operative AEs experienced also did not vary across the cohorts (p = 0.629). A greater proportion of patients in the High cohort had an extended LOS (Low: 6.5% vs Medium: 8.6% vs High: 19.7%, p < 0.001), while a greater proportion of patients in the Low cohort had an increased cost of admission (Low: 33.1% vs Medium: 20.3% vs High: 26.6%, p < 0.001). The High cohort had increased 30-day readmission rates relative to the Low and Medium cohorts (Low: 0.8% vs Medium: 0.2% vs High: 1.5%, p = 0.049). Non-routine discharge rates did not vary among the cohorts (p = 0.441). On multivariate analysis, High-MME consumption was significantly associated with extended LOS, while Medium-MME consumption was not [Medium: aOR: 1.48, CI (0.83, 2.74), p = 0.193; High: aOR: 4.43, CI (2.47, 8.31), p < 0.001].

CONCLUSIONS

Our study showed that high post-operative-MME consumption was significantly associated with extended LOS in patients undergoing PSF for AIS. In light of these findings, changes to existing protocols that decrease the reliance on opioids for post-operative analgesia are merited to improve patient outcomes and reduce health-care expenditures.

The benefits of touched vertebra concept for the selection of the lowest instrumented vertebra in thoracic curves of adolescent idiopathic scoliosis

PURPOSE

To assess the benefits of using the touched vertebra (TV) rule in Lenke classification for thoracic curves of adolescent idiopathic scoliosis (AIS).

METHODS

A total of 141 AIS patients with thoracic curves determined by Suk classification were divided based on whether the lowest instrumented vertebra (LIV) matched the TV into groups of mTV (n = 84, LIV = TV), TV- (n = 21, LIV above TV), and TV+ (n = 36, LIV below TV) for 5-year follow-up. The radiological parameters were the central sacral vertical line (CSVL)-LIV distance, distal end vertebra rotation, coronal, and sagittal parameters. Complications included adding-on phenomenon, coronal imbalance, and distal junctional kyphosis.

RESULTS

Adding-on phenomenon and coronal imbalance were significantly higher in the TV- group (P = 0.006) and TV + group (P = 0.006), respectively. The distal motion segments were significantly saved in the mTV group (P < 0.001). The CSVL-LIV distance was significantly improved in the mTV group compared to the others during the 5-year follow-up (P = 0.007). The 5-year follow-up CSVL-LIV distance correlated with LIV tilt angle (r = 0.442, P = 0.021) and coronal balance (r = 0.437, P = 0.023).

CONCLUSIONS

Selecting the TV as LIV minimizes the loss of the distal mobile segment and reduces the complications in the thoracic curves of AIS, which produces a more stable LIV on the CSVL. Therefore, TV is an ideal landmark for determining the distal fusion level using the Lenke classification or Suk classification.

Neuromuscular disturbances in adolescent idiopathic scoliosis observed from the anticipatory muscle activations in scapula stabilizers: a cross-sectional study

BACKGROUND

While it is well-stablished that scoliosis can lead to neuromuscular control disorders, the specific characteristics of these impairments remain unclear. This study aimed to explore the neuromuscular features of scapula stabilizers in adolescents with idiopathic scoliosis (AIS) through an analysis of anticipatory muscle activations (AMAs).

METHODS

A cross-sectional observational study was conducted with 17 AIS and 19 age-matched healthy subjects. Both the AIS and healthy groups performed right and left upper limb reaching tasks at three different heights while surface electromyography monitored the activity of scapular stabilizers. The muscles examined included the bilateral infraspinatus, upper trapezius, lower trapezius, serratus anterior, latissimus dorsi and the anterior deltoid. The incidence, onset latencies, and amplitude of AMAs were compared between the AIS and healthy groups.

RESULTS

Among scapular stabilizers, ipsilateral upper trapezius (iUT) and ipsilateral infraspinatus (iIS) exhibited the highest AMAs incidence at 72.59% and 70.06%, respectively. However, AMAs incidence significantly declined on the concave side of the thoracic curve in AIS group, particularly in iUT (55.63 ± 14.74 vs. 45.21 ± 19.92, t = 2.330, P = 0.034) and iIS (59.38 ± 20.16 vs. 48.13 ± 22.11, t = 2.316, P = 0.035). Regarding onset latencies, the AIS group exhibited delayed activation of ipsilateral lower trapezius (F = 3.586, P < 0.05, η2p = 0.006) and advanced activation of contralateral upper trapezius (F = 7.753, P < 0.001, η2p = 0.027) and contralateral infraspinatus (F = 6.554, P < 0.01, η2p = 0.024) on concave side compared to the healthy group. Additionally, almost all scapula stabilizers in AIS group exhibited reduction of AMAs amplitude compared to the healthy group.

CONCLUSIONS

This preliminary study suggests potential neuromotor control impairments in the AIS population, as indicated by observed trends in the incidence, amplitude, and timing of AMAs in scapular stabilizers. These preliminary insights may inform the design of future rehabilitation interventions, with attention to neurodevelopmental needs during adolescence.

TRIAL REGISTRATION NUMBER

ChiCTR2300075167, Date: 2023-08-28.

The Assessment of the Dynamics of Changes in the Torques of Redressing and Derotating Forces Acting on the Spine During Active Kyphosis-Deepening Exercises in the Dynamic Individual Stimulation and Control for Spine Device (DISC4SPINE, D4S)

Background: The study aimed to assess the dynamics of changes in the torques of derotating and redressing forces acting on the apexes of deformation curvature arches during active, kyphosis-inducing exercises using the D4S device. Methods: The study group included 12 girls aged 9 to 10 years (age X = 9.36, SD = 1.52; weight X = 31.34 kg, SD = 3.28; height X = 134.23 cm, SD = 8.25). The study was carried out using the D4S interactive spine and posture rehabilitation system with dynamic, personalised stimulation. Measurements were taken during six successive therapeutic visits of each patient, each containing five repeated sets. A single set involved applying pressure on the device heads 20 times for 8 s. For each patient, the resistance head was in the right top (RT) setting, individually adjusted for patient needs. Results: The results showed that the values of the measured moments of the derotating-redressing forces acting on the curvature peak vertebrae ranged from 24.1 N/cm2 to 39.9 N/cm2. The analysis of the differences in the values of the pressure of the derotating head on the spine in subsequent measurements, accounting for all measurements taken in subsequent cycles of the study, indicates significant variation in pressure values (K-W = 31.0660, p = 0.00029 *). Similar dynamics of changes and variation in the results were noted for the values of the pressure applied with the derotating head in subsequent cycles of the study. In this case, the variation in the results was also statistically significant (K-W = 24.4747, p = 0.00018 *). Conclusions: The values of forces increase slightly with the subsequent series of exercises. The assessment of the value of forces may be an element of optimal and more effective training plans in the therapy discussed.

Current Status of Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: An Umbrella Review

Background

Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity among teenagers worldwide. Vertebral body tethering (VBT) is an innovative, minimally invasive technique developed to address spinal curvature by modulating vertebral growth. However, the existing body of evidence regarding the effectiveness and safety of VBT in treating AIS is fragmented and requires thorough consolidation and critical assessment.

Methods

Six databases were thoroughly examined, yielding 11 relevant systematic reviews and meta-analyses. The methodological quality of the included studies was evaluated using the Joanna Briggs Institute's critical appraisal checklist. The key findings were encapsulated using a narrative synthesis approach.

Results

The reviews indicated notable improvements in coronal plane radiographic parameters, transverse plane clinical outcomes, and health-related quality of life scores following VBT. Nevertheless, the complication rates associated warrant attention. Additionally, the variability in methodological quality across the included reviews underscores the necessity for more robust and systematic investigations in this domain.

Conclusion

This umbrella review revealed promising results for VBT as a treatment option for AIS. However, further research is needed to address knowledge gaps and limitations, focusing on long-term outcomes, patient selection, standardized techniques, and comparison with traditional treatments.

Novel rare variation of CCDC40 plays a role in the development of idiopathic scoliosis possibly via dysfunction of cilia motility

BACKGROUND CONTEXT

Motile cilia dysfunction was reported to lead to scoliosis-like phenotypes in zebrafish models. There is still a lack of population-based study supporting the role of cilia motility associated genes in the etiology of idiopathic scoliosis (IS).

PURPOSE

To investigate the molecular mechanism underlying the relationship between cilia motility associated genes and the development of adolescent idiopathic scoliosis (AIS).

STUDY DESIGN

Population-based genetic study METHODS: A cohort of 56 female AIS patients and 30 age-matched non-scoliotic controls were included for tissue expression analysis. 28 patients with lower CCDC40 expression were selected for the exon sequencing. The novel variation was replicated in an independent cohort of 1326 AIS patients and 954 healthy controls. Exogenous versions of WT or mutant human CCDC40 mRNAs were expressed in zebrafish and the phenotype of body axis curvature was observed.

RESULTS

CCDC40 was found significantly down-expressed in AIS patients as compared with the nonscoliotic controls. A novel coding variant rs185157579 (c.1459G>A) was found significantly associated with AIS, with the mutant allele A adding to the risk of AIS by 2.44 folds. Zebrafish embryo injected with CCDC40 mRNAs containing mutant c.1459G>A presented significantly higher incidence of scoliosis-like phenotype than the wild group.

CONCLUSIONS

The mutation c.1459G>A in the exon 10 of CCDC40 may lead to body axis curvature of zebrafish by impacting mRNA expression. The underlying molecular mechanism is worthy of further investigation.

CLINICAL SIGNIFICANCE

Our findings shed a new light on the etiopathogenesis of AIS. The downstream signaling of CCDC40 may be candidate for potential drug targets to prevent the development of AIS. Moreover, the novel variation can be used as a genetic marker of polygenic risk score predicting the risk of AIS.

How Accurate Are Anatomical Surface Topography Parameters in Indicating the Presence of a Scoliosis?

STUDY DESIGN

Retrospective analysis of a longitudinal cohort.

OBJECTIVE

To identify the presence of scoliosis from surface data.

SUMMARY OF BACKGROUND DATA

Identifying AIS can be difficult. Screening is not universal for reasons including high false positive and negative rates. These difficulties can lead to some adolescents missing out on bracing.

METHODS

Logistic regression analysis of ISIS2 surface topography images only was performed. The x,y positions of the shoulders (Sh), axillae (Ax), waist (waist) and the x,y,z positions of the most prominent points over the posterior torso (scap) were used for the thoracic, thoracolumbar/lumbar and whole spine. The models were used to identify the presence of a 20-degree or larger scoliosis. Differences in the position of the landmarks were analyzed comparing left and right, with the suffix "Ht" representing a difference in the y coordinate, "Off" the x coordinate, and "Depth," the z coordinate. Model accuracy was assessed as both percentages and ROC curves with the coefficients as odds ratios.

RESULTS

There were 1283 images (1015 females and 268 males) all with a diagnosis of AIS. The models identified scoliosis in the thoracic spine with an 83% accuracy (AUC 0.91), thoracolumbar/lumbar spine with 74% accuracy (AUC 0.76), and whole spine with 80% accuracy (AUC 0.88). Significant parameters were AxDiffHt, AxDiffOff, WaistDiffHt, ScapDiffOff, and ScapDiffHt for the thoracic curves, AxDiffHt, AxDiffOff, WaistDiffHt for the thoracolumbar/lumbar curves, and AxDiffHt, AxDiffOff, WaistDiffHt and ScapDiffHt for the whole spine.

CONCLUSIONS

The use of fixed anatomical points around the torso, analyzed using logistic regression, has a high accuracy for identifying curves in the thoracic, thoracolumbar/lumbar, and whole spines. While coming from surface topography images, the results raise the future use of digital photography as a tool for the identification of small scoliosis without using other imaging techniques.

Superior performance of a center-point AI model over VFLDNet in automated cobb angle estimation for scoliosis assessment

PURPOSE

Aims to establish the superiority of our proposed model over the state-of-the-art vertebra-focused landmark detection network (VFLDNet) in automating Cobb angle estimation from spinal radiographs.

METHODS

Utilizing a private dataset for external validation, we compared the performance of our center-point detection-based vertebra localization and tilt estimation network (VLTENet) with the key-point detection-based VFLDNet. Both models' Cobb angle predictions were rigorously evaluated against manual consensus score using metrics such as mean absolute error (MAE), correlation coefficient, intraclass correlation coefficient (ICC), Fleiss' kappa, Bland-Altman analysis, and classification metrics [sensitivity (SN), specificity, accuracy] focusing on major curve estimation and scoliosis severity classification.

RESULTS

A retrospective analysis of 118 cases with 342 Cobb angle measurements revealed that our model achieved a MAE of 2.15° for total Cobb angles and 1.89° for the major curve, significantly outperforming VFLDNet's MAE of 2.80°and 2.57°, respectively. Both models demonstrated robust correlation and ICC, but our model excelled in classification consistency, particularly in predicting major curve magnitude (ours: kappa = 0.83; VFLDNet: kappa = 0.67). In subgroup analyses by scoliosis severity, our model consistently surpassed VFLDNet, displaying superior mean (SD) differences, narrower limits of agreement, and higher SN, specificity, and accuracy, most notably in moderate (ours: SN = 86.84%; VFLDNet: SN = 83.16%) to severe (ours: SN = 92.86%; VFLDNet: SN = 85.71%) scoliosis.

CONCLUSION

Our model emerges as the superior choice for automated Cobb angle estimation, particularly in assessing major curve and moderate to severe scoliosis, underscoring its potential to revolutionize clinical workflows and enhance patient care.

Stigma assessment scale for adolescent idiopathic scoliosis: A new tool for spine deformity stigma evaluation

PURPOSE

Stigma is the negative attitudes towards an illness or difference. The literature lacks detailed scales specifically addressing stigmatization in AIS. This study aimed to develop Adolescent Idiopathic Scoliosis Stigma Assessment Scale (AIS-SAS) to measure stigmatization in AIS patients.

METHODS

In creating the AIS-SAS, we developed items via literature review and expert input, confirmed content validity, and conducted a field test for construct validity and reliability. Our experts designed 38 items in three subscales: Scoliosis, Brace, and Surgery-related stigma. Exploratory factor analysis (EFA) and convergent validity were examined for construct validity. The convergent validity of AIS-SAS was assessed through its correlations with the Rosenberg Self-Esteem Scale (RSES), SRS-22, and Spinal Appearance Questionnaire (SAQ). Reliability was gauged via internal consistency and test-retest methods.

RESULTS

Sixty-seven adolescents with AIS were included in the study. EFA results confirmed one-dimensionality for each subscale, with factor loadings from 0.51 to 0.96, leading to the removal of 8 items with loadings below 0.3 from the AIS-SAS. The final AIS-SAS has three subscales: scoliosis (18 items), brace (5 items), and surgery-related stigma (7 items). Regarding convergent validity, the scoliosis-related stigma scores significantly correlated with SRS-22 self-image (r= -0.413 p = 0.001) and SAQ-Appearance (r = 0.441 p = 0.002). The RSES-Total score shows a negative correlation with Scoliosis, Brace, and Surgery-related stigma scores: -0.500 (p < 0.001), -0.435 (p = 0.049), and  -0.498 (p = 0.042), respectively. AIS-SAS subscales showed good reliability (Cronbach-α > 0.8 ICC > 0.8).

CONCLUSION

AIS-SAS is the first valid and reliable high-quality scale assessing stigmatization from AIS, measuring scoliosis, brace, and surgery-related stigma via three subscales.

The Mid-term Outcome of Intervertebral Disc Degeneration After Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: Magnetic Resonance Imaging-based Analysis for a Mean 11.6-year Follow-up

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

To evaluate the mid-term effect of intervertebral disc degeneration (DD) in patients with adolescent idiopathic scoliosis (AIS) who underwent pedicle screw instrumentation (PSI) and rod derotation (RD) with direct vertebral rotation (DVR).

SUMMARY OF BACKGROUND DATA

Posterior spinal fusion is a mainstay of surgical treatment in AIS, and DVR is considered a main corrective maneuver for vertebral rotation. However, the mid-term effect of intervertebral DD after DVR is still unknown in AIS.

METHODS

A total of 336 vertebrae for 48 patients with AIS who underwent PSI and RD with DVR were retrospectively assessed for intervertebral DD. They were divided into two groups based upon intervertebral DD, defined as Pfirmann grade more than IV. The Pfirrmann grade and modic change were evaluated at the disc above the uppermost instrumented vertebra (UIV), the disc below the lowest instrumented vertebra (LIV), and the lumbar disc levels.

RESULTS

With the 11.6 years of mean follow-up, 41.7% (20/48) of patients exhibited DD, while modic changes were observed in 4.2% (2/48) of the included patients. The discs below the LIV, L4-5, and L5-S1 were significantly shown to have an increasing trend of Pfirmann grade. The preoperative thoracic kyphosis was significantly lower in the DD group (22.0°) than in the non-DD group (31.4°) ( P = 0.025) and negatively correlated with DD ( r = -0.482, P = 0.018). The Pfirrmann grade of L5-S1 showed a high level of correlation with DD ( r = 0.604, P < 0.001).

CONCLUSIONS

The degenerative change at the disc below the LIV, L4-5, and L5-S1 levels was observed following PSI and RD with DVR. Thoracic hypokyphosis may negatively influence intervertebral discs in patients with AIS required for deformity correction. Therefore, the restoration of thoracic kyphosis is important to prevent long-term DD in AIS.

Benefits of Intensive Rehabilitation Programs Using Physiotherapeutic Scoliosis-Specific Exercises in Adolescent Idiopathic Scoliosis

Purpose Adolescent Idiopathic Scoliosis (AIS) affects 3% of adolescents. Physiotherapeutic Scoliosis Specific Exercises (PSSE) are recommended to limit AIS progression, especially within intensive multidisciplinary programs. Our study evaluated the efficiency of these programs in AIS cases with a high progression risk. Methods We conducted a controlled retrospective observational study using data collected from a multicenter cohort that was prospectively collected. One hundred and forty-three major AIS cases with a high progression risk, treated with a corrective brace, were included and divided into two matched groups. In the PSSE group, 72 adolescents followed an intensive 4-week PSSE rehabilitation program; in the control group, 71 adolescents did not follow this program. Patient files were assessed at V0 (inclusion), V1 (6 to 12 months after V0) and V2 (≥ 6 months after V1). The evaluation criteria were: change in Cobb angle and percentage of patients reaching surgical stage at V2. Results At V1, 54.2% of patients in the PSSE group showed improvement compared to 16.9% in the control group (p < 0.001). In contrast, 38.9% of patients in the PSSE group were stabilized, compared to 53.3% in the control group (p = 0.2). At V2, 34.7% of patients in the PSSE group improved compared to 15.5.% in the control group (p <0.006). At V2, 55.6% of patients in the PSSE group were stabilised versus 40.8% in the control group (p < 0.05). At V2, 8.3% of patients in the PSSE group reached the surgical stage versus 21.1% in the control group (p = 0.005). Conclusion Our study is an additional argument in favor of using PSSE rehabilitation in AIS.

A comparison of patients receiving vertebral body tethering for adolescent idiopathic scoliosis in the public and private hospital setting

PURPOSE

Vertebral body tethering (VBT) is a new growth-modulating surgery for adolescent idiopathic scoliosis (AIS) requiring a distinct skillset and intraoperative setup. We compared perioperative details and outcomes of VBTs performed in a public pediatric orthopedic hospital and a general private hospital setting.

METHODS

We identified all patients receiving VBT for AIS from 1/2020 to 12/2023 with ≥ 6 months post-operative follow-up, with surgeries performed by the same senior surgeons. Clinical, radiological, and surgical details were retrieved.

RESULTS

24 VBTs were performed in the private setting and 16 in the public setting. Average age at operation was 11.9 ± 1.1 at a Sanders staging of 3.8 ± 1.2 when the major curve Cobb angle was 50.5 ± 8.0°. Tethered curves were most often thoracic in location (23/40) followed by thoracolumbar/lumbar curves (10/40) and double curve tethers (7/40). Overall correction ratio of 68.0 ± 19.0% was achieved. Time from booking to operation (82.2 ± 39.2 vs 63.1 ± 34.4 days, p = 0.112) and operation time (310 ± 86.4 min vs. 289 ± 87.4 min, p = 0.054) were longer in the public and private setting respectively but failed to reach statistical significance. Time to chest drain removal (1.5 ± 0.8 vs. 3.5 ± 1.7 days, p < 0.001) and length of stay (4.3 ± 0.9 vs. 6.6 ± 1.8 days, p < 0.001) were significantly shorter in the private setting, whilst complication rates remained similar (7/24 vs. 3/16, p = 0.456).

CONCLUSION

Expertise, resource availability, and costs differ in the public and private healthcare setting. With regards to VBT, the conditions for referral and surgical outcomes remained similar. Earlier drain removal and discharge for patients managed in the private setting was not associated with an increase in complication rate.

Intra-rater and inter-rater reliability of the fixed plumb line for postural and scoliosis assessment in the sagittal plane: a pilot study

Background

The plumb line (PL) is a common tool for assessing the sagittal curvatures of the spine, but its accuracy depends on the ability of the physician to use it correctly. This study aimed to present a fixed plumb line (FPL) no longer held by a physician but fixed to a support, evaluating the reliability in posture assessment, comparing it with PL in both adolescent with and without scoliosis.

Methods

The study evaluated the sagittal distances of the spine using a PL and a FPL in 80 young adults aged between 28.7 ± 7.2 and 55 adolescents aged between 12.4 ± 2.3, with and without scoliosis. Two expert and two novice clinicians tested the patients to evaluate the intra-rater and inter-rater reliability of FPL. Each clinician assessed participants twice on the same day, with a predetermined time interval (>1 h) to reduce recall bias. Multi-factor multivariate analysis of variance and two-way analysis of variance assessed the statistical significance, while intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) validated FPL consistency.

Results

FPL provided an ICC coefficient >0.90 for all the measures, while PL an average of 0.70. On AIS patients, PL and FPL showed a significant difference for C7 p < 0.001 and T12 p < 0.001. The measured parameters were sensitive to gender and age for the FPL, furthermore, the C7 and L3 measurements were statistically different between PL and FPL (p < 0.001). Intra-rater reliability results for FPL ranged from 0.94 to 0.98 across various parameters, while the SEM and MDC values underscore the valuable precision of the FPL with changes exceeding 1 cm being meaningful. These findings suggest that FPL could be a reliable and accurate tool for measuring sagittal distances of the spine in both scoliotic and non-scoliotic patients.

Association between postural habits and lifestyle factors of adolescent idiopathic scoliosis in Syria

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis in children between the ages of 10 and 16. Nevertheless, risk factors for AIS, especially adjustable ones, are still poorly understood. This study seeks to examine the associations of lifestyle and social environment factors with AIS in Syrian schoolchildren. This matched case-control study uses survey data from a school-based scoliosis screening approach. We utilized logistic regression models to estimate the relative risk of AIS prevalence for each variable in the analysis. A multivariate logistic regression was performed to investigate the independent influence of each component on AIS development, with odds ratios (ORs) adjusted for the important factors. Overall, 1102 participants from 22 schools were included in this study, comprising 551 AIS cases and 551 controls. Mean age of the study population was 13.5 years ± 1.08. Six hundred and twenty (56.3%) of the study subjects were girls. After adjusting for other significant factors, age between 13 and 15 years (OR = 2.45; 95% CI, 1.37-6.17), inappropriate desk heights, either too low (OR = 1.53, 95% CI 1.12-1.85) or too high (OR = 1.46, 95% CI 1.13-1.87), standing with anterior pelvic tilt (OR = 1.97, 95% CI 1.46-3.43), and sleeping on the right side (OR = 1.92, 95% CI 1.54-2.23), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.73 (95% CI 0.43-0.94) for sitting normally, and 0.63 (95% CI 0.31-0.97) for sitting positions change. This study investigated the correlation between desk heights and AIS and revealed that incorrect desk heights were associated with more AIS risk. To prevent schoolchildren from developing AIS, stakeholders should consider installing height-adjustable desks in the classroom, changing students' sitting positions on an ongoing basis, and establishing training courses that assist students in keeping proper sitting postures.

Maturation of the vertebral ring apophysis is delayed in girls with adolescent idiopathic scoliosis compared to the normal population

PURPOSE

The ring apophysis is a secondary ossification center on both sides of each vertebral body, to which the annulus of the intervertebral disc inserts. Recently, its pattern of ossification and fusion to the vertebral body was described for the normal growing spine. The aim of the present study was to investigate the ossification and fusion of the ring apophysis in patients with adolescent idiopathic scoliosis (AIS) and compare it to the normal growing population.

METHODS

Ring apophysis maturation along the entire thoracic and lumbar spine was analyzed on CT scans of 99 female, pre-operative AIS patients and compared to 134 CT scans of non-scoliotic girls, aged 12 to 20.

RESULTS

The ring apophysis maturation in AIS patients was delayed at all spinal levels in AIS patients compared to non-scoliotic controls. Ossification starts at T4-T11 at age 12, followed by T1-T5 and L3-S1 at age 15. The fusion process in AIS patients continues longer in the midthoracic region as compared to the other regions and as compared to non-scoliotic controls, with many incomplete fusions still at age 20.

CONCLUSION

The ring apophysis maturation in AIS is delayed compared to that in the normal population and lasts longer in the mid/low thoracic spine. Delayed maturation of the spine's most important stabilizer, while the body's dimensions continue to increase, could be part of the patho-mechanism of AIS.

Posterior Correction and Fusion Using a 4D Anatomical Spinal Reconstruction Technique Improves Postural Stability Under the Eye-Closed Condition in Patients with Adolescent Idiopathic Scoliosis

Background: Patients with adolescent idiopathic scoliosis (AIS) has been reported to exhibit impaired postural stability. Posterior correction and fusion using four-dimensional (4D) anatomical spinal reconstruction techniques may improve postural stability to correct the spine for optimal anatomical alignment. This prospective study aimed to determine the effect of posterior correction and fusion using a 4D anatomical spinal reconstruction technique on postural stability in the eye-open and eye-closed standing position in patients with thoracic AIS. Methods: Thirty-three patients with AIS, excluding those with Lenke type 5C AIS, participated in the study. The mean and standard deviation of the minimum values of the time-to-boundary (TTB) were determined. All patients were asked to perform the quiet standing position under the eye-open and eye-closed condition on a force plate preoperatively and at 1 week and 2 years postoperatively. The TTB value was calculated from the velocity and distance to the foot boundary of the acquired center-of-pressure data. Results: Under the eye-closed condition, the mean and standard deviation of the minimum TTB were significantly higher at 2 years postoperatively than preoperatively and at 1 week postoperatively. The mean and standard deviation of the minimum TTB values were significantly lower at 1 week postoperatively than preoperatively. Conclusions: The results of this study suggest that surgery using the 4D anatomical spinal reconstruction technique reduces postural stability immediately after surgery; however, it improves postural stability at 2 years compared to the preoperative values.

Anatomical landmark detection on bi-planar radiographs for predicting spinopelvic parameters

INTRODUCTION

Accurate landmark detection is essential for precise analysis of anatomical structures, supporting diagnosis, treatment planning, and monitoring in patients with spinal deformities. Conventional methods rely on laborious landmark identification by medical experts, which motivates automation. The proposed deep learning pipeline processes bi-planar radiographs to determine spinopelvic parameters and Cobb angles without manual supervision.

METHODS

The dataset used for training and evaluation consisted of 555 bi-planar radiographs from un-instrumented patients, which were manually annotated by medical professionals. The pipeline performed a pre-processing step to determine regions of interest, including the cervical spine, thoracolumbar spine, sacrum, and pelvis. For each ROI, a segmentation network was trained to identify vertebral bodies and pelvic landmarks. The U-Net architecture was trained on 455 bi-planar radiographs using binary cross-entropy loss. The post-processing algorithm determined spinal alignment and angular parameters based on the segmentation output. We evaluated the pipeline on a test set of 100 previously unseen bi-planar radiographs, using the mean absolute difference between annotated and predicted landmarks as the performance metric. The spinopelvic parameter predictions of the pipeline were compared to the measurements of two experienced medical professionals using intraclass correlation coefficient (ICC) and mean absolute deviation (MAD).

RESULTS

The pipeline was able to successfully predict the Cobb angles in 61% of all test cases and achieved mean absolute differences of 3.3° (3.6°) and averaged ICC of 0.88. For thoracic kyphosis, lumbar lordosis, sagittal vertical axis, sacral slope, pelvic tilt, and pelvic incidence, the pipeline produced reasonable outputs in 69%, 58%, 86%, 85%, 84%, and 84% of the cases. The MAD was 5.6° (7.8°), 4.7° (4.3°), 2.8 mm (3.0 mm), 4.5° (7.2°), 1.8° (1.8°), and 5.3° (7.7°), while the ICC was measured at 0.69, 0.82, 0.99, 0.61, 0.96, and 0.70, respectively.

CONCLUSION

Despite limitations in patients with severe pathologies and high BMI, the pipeline automatically predicted coronal and sagittal spinopelvic parameters, which has the potential to simplify clinical routines and large-scale retrospective data analysis.

Dinucleotide composition representation -based deep learning to predict scoliosis-associated Fibrillin-1 genotypes

Introduction

Scoliosis is a pathological spine structure deformation, predominantly classified as "idiopathic" due to its unknown etiology. However, it has been suggested that scoliosis may be linked to polygenic backgrounds. It is crucial to identify potential Adolescent Idiopathic Scoliosis (AIS)-related genetic backgrounds before scoliosis onset.

Methods

The present study was designed to intelligently parse, decompose and predict AIS-related variants in ClinVar database. Possible AIS-related variant records downloaded from ClinVar were parsed for various labels, decomposed for Dinucleotide Compositional Representation (DCR) and other traits, screened for high-risk genes with statistical analysis, and then learned intelligently with deep learning to predict high-risk AIS genotypes.

Results

Results demonstrated that the present framework is composed of all technical sections of data parsing, scoliosis genotyping, genome encoding, machine learning (ML)/deep learning (DL) and scoliosis genotype predicting. 58,000 scoliosis-related records were automatically parsed and statistically analyzed for high-risk genes and genotypes, such as FBN1, LAMA2 and SPG11. All variant genes were decomposed for DCR and other traits. Unsupervised ML indicated marked inter-group separation and intra-group clustering of the DCR of FBN1, LAMA2 or SPG11 for the five types of variants (Pathogenic, Pathogeniclikely, Benign, Benignlikely and Uncertain). A FBN1 DCR-based Convolutional Neural Network (CNN) was trained for Pathogenic and Benign/ Benignlikely variants performed accurately on validation data and predicted 179 high-risk scoliosis variants. The trained predictor was interpretable for the similar distribution of variant types and variant locations within 2D structure units in the predicted 3D structure of FBN1.

Discussion

In summary, scoliosis risk is predictable by deep learning based on genomic decomposed features of DCR. DCR-based classifier has predicted more scoliosis risk FBN1 variants in ClinVar database. DCR-based models would be promising for genotype-to-phenotype prediction for more disease types.

Early Sagittal Shape of the Spine Predicts Scoliosis Development in a Syndromic (22q11.2DS) Population: A Prospective Longitudinal Study

BACKGROUND

Scoliosis is a deformation of the spine and trunk that, in its more severe forms, creates a life-long burden of disease and requires intensive treatment. For its most prevalent form, adolescent idiopathic scoliosis, no underlying condition can be defined, and the pathomechanism appears to be multifactorial; however, it has been suggested that the biomechanics of the spine play a role. For nonidiopathic scoliosis, underlying conditions can be recognized, but what drives the deformity remains unclear. In this study, we examined the early sagittal shape of the spine before the onset of scoliosis in a population with 22q11.2 deletion syndrome (22q11.2DS). This cohort was chosen since children with this syndrome have an approximately 50% chance of developing scoliosis that shares certain characteristics with idiopathic scoliosis, namely, age of onset, curve morphology, and rate of progression.

METHODS

This prospective cohort study included patients with 22q11.2DS who were followed with the use of spinal radiographs during adolescent growth. All of the children, who initially had no scoliosis while still skeletally immature (Risser stages 0 and 1), were followed at 2-year intervals until they reached skeletal maturity (Risser stages 3 to 5). We assessed the segment of the spine that has previously been shown to be rotationally unstable, the posteriorly inclined segment, to determine if it was predictive of later scoliosis development. For quantification, the area of the "posteriorly inclined triangle" (PIT), a previously described parameter that integrates both the inclination and length of the at-risk segment, was measured.

RESULTS

Of the 50 children who initially had no scoliosis (mean age at inclusion, 10.7 ± 1.7 years; mean follow-up, 4.8 ± 1.6 years), 24 (48%) developed scoliosis. Patients with an above-average PIT area (>60 cm2) at inclusion showed a relative risk of 2.55 for scoliosis development (95% confidence interval [CI]:1.22 to 5.34). PIT inclination was correlated with curve type: a taller and steeper hypotenuse predicted later thoracic scoliosis, while a shorter and less steep inclination predicted the development of (thoraco)lumbar scoliosis.

CONCLUSIONS

This prospective study identified the pre-scoliotic sagittal shape of the spine as a risk factor for the later development of scoliosis in the population of children with 22q11.2DS.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Investigating the long-term outcomes and efficacy of surgical intervention in patients with adolescent idiopathic scoliosis and Cobb angles ranging between 40 and 50 degrees

PURPOSE

Patients with adolescent idiopathic scoliosis (AIS) are either managed with non-operative strategies or surgery depending on the severity of lateral curvature and impact on quality of life. However, supportive evidence for the appropriate treatment approach is lacking in AIS patients with Cobb angles between 40 and 50 degrees. Therefore, we investigated differences in long-term patient-centered outcomes in AIS patients with Cobb angles between 40 and 50 degrees who received either operative or non-operative management.

METHODS

A total of 919 patients aged 10-21 years old with adolescent idiopathic scoliosis and 40-50 degree Cobb angles were identified from the HARMS Study Group (HSG) registry and dichotomized based on operative or non-operative management. Baseline and 2 year follow-up SRS-22 scores from these patients were analyzed for significant differences between the total score values, domain values, and the magnitude of score change over time using multiple comparisons analyses. Multivariable regressions adjusting for age, body mass index, location of spinal deformity, and management strategy were also performed.

RESULTS

Operative versus non-operative strategy was significantly, independently associated with differences in SRS-22 total and domain scores over time (effect likelihood ratio test, p < 0.03 for all regressions). Operatively managed patients had significantly greater improvement in SRS-22 total and domain scores over the follow-up duration compared to non-operatively managed patients (p < 0.02 for all comparisons).

CONCLUSIONS

This preliminary analysis suggests that operatively managed patients may have had better long-term outcomes than non-operatively managed patients within this AIS subpopulation. These findings support the need for further prospective investigation to determine the optimal management strategy to improve evidence-based, patient-reported outcomes for AIS patients with Cobb angles between 40 and 50 degrees.

LEVEL OF EVIDENCE

Level III.

National and regional trends in the prevalence of adolescent idiopathic scoliosis in South Korean military draftees

INTRODUCTION

Recent epidemiological and aetiological data on adolescent idiopathic scoliosis (AIS) among military draftees are scarce in nationwide and population-based databases. This retrospective, nationwide and population-based study aims to assess national and regional trends in the prevalence of AIS among military draftees in South Korea from 2013 to 2022.

METHODS

A total of 3 166 669 Korean males were screened at regional Military Manpower Administration (MMA) offices between 2013 and 2022. Based on routine chest radiographs, individuals with Cobb's angle of ≥10° were screened and diagnosed with AIS using whole spine radiographs after excluding surgically treated AIS patients. Data from the MMA were retrospectively collected and the annual prevalence of the total and neglected AIS cases, along with 95% CIs, was assessed. Spearman correlation analysis was performed to evaluate the correlation between the prevalence of AIS and several aetiological factors.

RESULTS

The prevalence rate of AIS in the male adolescent population gradually increased from 2013 (0.44%, 95% CI 0.42% to 0.46%) to 2022 (1.33%, 95% CI 1.28% to 1.37%). The AIS rate increased overall in both capital/metropolitan areas and provinces but showed a fluctuating pattern in the capital/metropolitan area. The prevalence rate of neglected AIS showed a very slight increased trend during the same period (mean 0.05%, 95% CI 0.04% to 0.06%) and exhibited a similar pattern in both capital/metropolitan areas and provinces. Using correlation analysis with aetiological factors, the prevalence rate of AIS correlated with overweight or obesity rate (r=0.90, p<0.001) and growth hormone use (r=0.83, p<0.001).

CONCLUSIONS

The prevalence of AIS in the male population has increased, with a similar trend observed between capital/metropolitan areas and provinces in South Korea. Our correlation results support both the multifactorial cascade concepts for altered body composition effects and biomechanical progression based on the Hueter-Volkmann effect as the pathomechanisms of AIS.

Prediction Model for Lumbar Curve Correction After Selective Thoracic Fusion in Lenke 1 and 2 Adolescent Idiopathic Scoliosis

STUDY DESIGN

A retrospective study.

OBJECTIVE

To identify independent risk factors and construct a prediction model for lumbar curve correction (LCC) after selective thoracic fusion (STF) in patients with Lenke 1 and 2 adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA

STF has been widely applied to Lenke 1 and 2 AIS patients. However, LCC after STF is still controversial.

METHODS

One hundred twenty-eight patients undergoing STF with at least 2 years of follow-up were included. Cases were divided into a high-LCC group and a low-LCC group according to a rounded-up median of 65%. Forty-nine variables were taken into account. Logistic regression was applied to identify independent predictive factors. A prediction model was established by backward stepwise regression, and its evaluation was implemented on R.

RESULTS

Five parameters showed independent predictive value for low LCC: right shoulder higher before surgery (right shoulder higher versus balanced: odds ratio [OR]=0.244, P =0.014), postoperative Cobb angle of lumbar curve (LC) (OR=1.415, P =0.001, cutoff value=11°), lowest instrumented vertebra (LIV) distal to end vertebra (no vs. yes: OR=4.587, P =0.013), postoperative LIV tilt (OR=0.686, P =0.010, cutoff value=6.85°) and postoperative LIV+1 tilt (OR=1.522, P =0.005, cutoff value=6.25°). The prediction model included 6 variables: lumbar modifier, preoperative shoulder balance, postoperative Cobb angle of LC, LIV position, postoperative LIV tilt, and postoperative LIV+1 tilt. The model evaluation demonstrated satisfactory capability and stability (area under curve=0.890, 10-fold cross-validation accuracy=0.782).

CONCLUSION

Preoperative shoulder balance, Cobb angle of LC, LIV position, postoperative LIV and LIV+1 tilt could be used to prognosticate LCC after STF. A model with solid prediction ability was established, which could further our understanding of LCC and assist in making clinical decisions.

Risk of coronal imbalance after posterior surgery for adolescent idiopathic scoliosis of type Lenke5C

PURPOSE

To investigate the incidence, risk factors, and clinical impact of persistent coronal imbalance (PCI) in Lenke5C adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF).

METHODS

We analyzed the medical records of 112 Lenke5C AIS patients. They were grouped into PCI (+) group and PCI (-) group according to the occurrence of PCI at 2 years after surgery. Coronal and sagittal parameters were measured and compared between both groups preoperatively, immediately postoperatively, and 2 years postoperatively. Scoliosis Research Society-22 (SRS-22) score was used to evaluate clinical outcomes.

RESULTS

Of the 112 patients, 12 had coronal imbalance persisting 2 years after surgery. Logistic regression analysis indicated risk factors including older age [odds ratio (OR) = 1.841, 95% confidence interval (CI) = 1.147-2.132, p = .001], lower preoperative flexibility main thoracic (MT) curve (OR = 1.308, 95% CI = 1.041-2.015, p = .016), greater preoperative apical vertebral translation (AVT) of the thoracolumbar/lumbar (TL/L) curve (AVT-TL/L) (OR = 2.291, 95% CI = 1.120-4.719, p = .001), larger preoperative lowest instrumented vertebra tilt (LIV lilt) (OR = 2.141, 95% CI = 1.491-3.651, p = .011), and postoperative immediate coronal imbalance (OR = 5.512, 95% CI = 4.531-6.891, p = .001). The satisfaction and total score of the SRS-22 scale in the PCI (+) group were lower than those in the PCI (-) group at 2 years after surgery (p <.05).

CONCLUSIONS

We found a 10.7% incidence of PCI in patients with Lenke5C AIS undergoing PSF. PCI adversely affects clinical outcomes. Risk factors of PCI included older age, reduced preoperative MT curve flexibility, increased preoperative AVT in the TL/L curve, greater preoperative LIV tilt, and immediate postoperative coronal imbalance.

Single nucleotide polymorphisms of estrogen receptors are risk factors for the progression of adolescent idiopathic scoliosis: a systematic review and meta-analyses

BACKGROUND

There have been some studies on the occurrence of ESR1 and 2 polymorphisms and AIS, but some data extraction is wrong, and there are no studies on the progress of AIS.

METHODS

Computer searches were conducted on PubMed, EMBASE, ScienceDirect and Scopus from the establishment of the database to April 2024. Cross-sectional and case-control studies on estrogen receptor ESR1, two single nucleotide polymorphisms, and the occurrence and development of AIS were collected, and statistical analysis was performed using the Revman 5.3 software.

RESULTS

In the comparison of the association between single nucleotide polymorphisms of estrogen receptors ESR1 and 2 and the occurrence and development of AIS, eight studies were included, including 2706 cases and 1736 controls.The results showed that the AA genotype [OR = 0.50,95%Cl(0.34,0.72),P = 0.0003] at the XbaI locus of ESR1,CC genotype [OR = 1.67,95%Cl(1.16,2.42), P = 0.006], C allele [OR = 1.28,95%Cl(1.03,1.59),P = 0.03], and T allele [OR = 0.78,95%] Cl(0.63,0.97),P = 0.03] at the PvuII locus of ESR1 and TT genotype [OR = 0.50,95%Cl(0.26,0.93),P = 0.03] at the AlwNI locus of ESR2 showed statistically significant differences between the progressive and stable AIS patients.

CONCLUSION

Single nucleotide polymorphisms of ESR1 and ESR2 were not related to the occurrence of AIS; however, some of them were related to the progression of AIS.

A New Method for Scoliosis Screening Incorporating Deep Learning With Back Images

STUDY DESIGN

Retrospective observational study.

OBJECTIVES

Scoliosis is commonly observed in adolescents, with a world0wide prevalence of 0.5%. It is prone to be overlooked by parents during its early stages, as it often lacks overt characteristics. As a result, many individuals are not aware that they may have scoliosis until the symptoms become quite severe, significantly affecting the physical and mental well-being of patients. Traditional screening methods for scoliosis demand significant physician effort and require unnecessary radiography exposure; thus, implementing large-scale screening is challenging. The application of deep learning algorithms has the potential to reduce unnecessary radiation risks as well as the costs of scoliosis screening.

METHODS

The data of 247 scoliosis patients observed between 2008 and 2021 were used for training. The dataset included frontal, lateral, and back upright images as well as X-ray images obtained during the same period. We proposed and validated deep learning algorithms for automated scoliosis screening using upright back images. The overall process involved the localization of the back region of interest (ROI), spinal region segmentation, and Cobb angle measurements.

RESULTS

The results indicated that the accuracy of the Cobb angle measurement was superior to that of the traditional human visual recognition method, providing a concise and convenient scoliosis screening capability without causing any harm to the human body.

CONCLUSIONS

The method was automated, accurate, concise, and convenient. It is potentially applicable to a wide range of screening methods for the detection of early scoliosis.

Asymmetric Osteopenia in Adolescent Idiopathic Scoliosis Based on Hounsfield Unit of Computed Tomography

Purpose

To characterize the asymmetrical loss of bone mass and identify the association between scoliosis and osteopenia in patients with adolescent idiopathic scoliosis (AIS).

Methods

Demographic information, Cobb angle, and Hounsfield unit (HU) of the neutral vertebra (NV) and apical vertebra (apex) of the major curve were collected retrospectively in 54 AIS patients. For 84 control subjects, HU values were measured at T12 and L5. Propensity score matching was performed to balance the interference of age and BMI.

Results

In the AIS group, the concave and convex lateral HU of the NV and the convex lateral HU of the apex were negatively correlated with the Cobb angle. The AIS patients had lower bilateral HU. The mean HU and the apex-convex HU were also lower in the AIS group, while the apex-concave HU was slightly higher. After matching, the apex-convex HU of the AIS group remained lower, while the apex-concave HU was higher.

Conclusion

Patients with AIS exhibit osteopenia, particularly on the convex side. The severity of scoliosis was found to be directly proportional to the severity of bone loss and the degree of bilateral osteopenia asymmetry. Appropriate intervention for bone loss may be able to curb the progression of scoliosis.

The morphological discrepancy of neuromuscular junctions between bilateral paraspinal muscles in patients with adolescent idiopathic scoliosis: A quantitative immunofluorescence assay

Introduction

Prior studies suggested that neuromuscular factors might be involved in the pathogenesis of adolescent idiopathic scoliosis (AIS). The neuromuscular junction (NMJ) is the important pivot where the nervous system interacts with muscle fibers, but it has not been well characterized in the paraspinal muscles of AIS. This study aims to perform the quantitative morphological analysis of NMJs from paraspinal muscles of AIS.

Methods

AIS patients who received surgery in our center were prospectively enrolled. Meanwhile, age-matched congenital scoliosis (CS) and non-scoliosis patients were also included as controls. Fresh samples of paraspinal muscles were harvested intraoperatively. NMJs were immunolabeled using different antibodies to reveal pre-synaptic neuronal architecture and post-synaptic motor endplates. A confocal microscope was used to acquire z-stack projections of NMJs images. Then, NMJs images were analyzed on maximum intensity projections using ImageJ software. The morphology of NMJs was quantitatively measured by a standardized 'NMJ-morph' workflow. A total of 21 variables were measured and compared between different groups.

Results

A total of 15 AIS patients, 10 CS patients and 5 normal controls were enrolled initially. For AIS group, NMJs in the convex side of paraspinal muscles demonstrated obviously decreased overlap when compared with the concave side (34.27% ± 8.09% vs. 48.11% ± 10.31%, p = 0.0036). However, no variables showed statistical difference between both sides of paraspinal muscles in CS patients. In contrast with non-scoliosis controls, both sides of paraspinal muscles in AIS patients demonstrated significantly smaller muscle bundle diameters.

Conclusions

This study first elucidated the morphological features of NMJs from paraspinal muscles of AIS patients. The NMJs in the convex side showed smaller overlap for AIS patients, but no difference was found in CS. This proved further evidence that neuromuscular factors might contribute to the mechanisms of AIS and could be considered as a novel potential therapeutic target for the treatment of progressive AIS.

Computer Assisted Navigation Does Not Improve Outcomes in Posterior Fusion for Adolescent Idiopathic Scoliosis

STUDY DESIGN

Retrospective Cohort Study.

OBJECTIVE

The aim of this study was to compare the efficacy of CT-based computer assisted navigation (CAN) to conventional pedicle screw placement for patients with Adolescent Idiopathic Scoliosis (AIS).

METHODS

This retrospective cohort study drew data from the National Readmissions Database, years 2016-2019. Patients undergoing posterior fusion for AIS, either via CAN or fluoroscopic-guided procedures, were identified via ICD-10 codes. Multivariate regression was performed to compare outcomes between operative techniques. Negative binomial regression was used to asses discharge disposition, while Gamma regression was performed to assess length of stay (LOS) and total charges. Patient demographics and comorbidities, measured via the Elixhauser comorbidity index, were both controlled for in our regression analysis.

RESULTS

28,868 patients, 2095 (7.3%) undergoing a CAN procedure, were included in our analysis. Patients undergoing CAN procedures had increased surgical complications (Odds Ratio (OR) 2.23; P < 0.001), namely, blood transfusions (OR 2.47; P < 0.001). Discharge disposition and LOS were similar, as were reoperation and readmission rates; however, total charges were significantly greater in the CAN group (OR 1.37; P < 0.001). Mean charges were 191,489.42 (119,302.30) USD for conventional surgery vs 268 589.86 (105,636.78) USD for the CAN cohort.

CONCLUSION

CAN in posterior fusion for AIS does not appear to decrease postoperative complications and is associated with an increased need for blood transfusions. Given the much higher total cost of care that was also seen with CAN, this study calls into question whether the use of CAN is justified in this setting.

The Influence of the Dominant Leg in Body Asymmetries in Children and Adolescent Male Soccer Players

The current study aimed to examine (a) whether the dominant leg (DL) was associated with the contralateral side of functional scoliosis and (b) if any of the postural asymmetries' evaluation variables may be a reliable predictor of the functional scoliosis development in young male soccer players. Six hundred-nine (n = 609) male soccer players (age: 10.8 ± 2.7 years; height: 147 ± 17 cm; weight: 43.4 ± 14.6 kg; DL: Right 81.6%, Left 14%, Both 4.4%) participated in this study. The spinal asymmetries evaluation included thoracic kyphosis, lumbar lordosis, truncal rotation, shoulders alignment from posterior view, anterior and posterior pelvic tilt, anterior superior iliac spine (ASIS), hamstring tightness, and lower extremities discrepancy. A significant association was observed between the DL and the truncal rotation side: χ2(4) = 30.84, p = 0.001, V = 0.16. Participants with longer left legs were likelier to present a spinal asymmetry (OR = 1.18). The participants with higher left shoulders were 2.13 times more likely to have spinal asymmetry than the participants with normal shoulders level. Participants with left ASIS higher were 3.08 times more likely to present asymmetry than those with normally aligned ASIS levels. There was also a significant association between the DL and the side of truncal rotation: χ2(2) = 13.30, p = 0.001, V = 0.449. Logistic regression analysis for the functional scoliotic group and truncal rotation side demonstrated that the taller participants and participants with shorter right legs were more likely to have asymmetry on the left side (OR = 1.29, OR = 0.32). Participants with greater right hamstring stiffness were likelier to have a truncal rotation on the right side (OR = 0.93). Participants with higher left shoulders were 0.20 times less likely to have a truncal rotation on the left side than the participants with normal shoulders level. In conclusion, leg dominance in children and in youth soccer players may be a factor causing truncal rotation on the contralateral side. Additional causes, such as leg length discrepancy and pelvic tilt, may progressively lead to functional scoliosis.