Effects of Specific Exercise Therapy on Adolescent Patients With Idiopathic Scoliosis: A Prospective Controlled Cohort Study

An Innovative Method for the Conservative Treatment of Idiopathic Scoliosis Using the GraviSpine Device According to the Concept of Spinal Reflex Balance

Objectives: Conservative treatment of idiopathic scoliosis is more effective as a result of early diagnosis in conjunction with the use of specific physiotherapy and bracing techniques. Our aim was to investigate the effectiveness of specific physiotherapy developed according to the concept of spinal reflex balance using the GraviSpine device. This study is a retrospective analysis of prospectively collected data. Methods: A total of 199 patients aged 6-17 years, with a mean age of 11.26 ± 3.35 years, including 168 girls (84.4%) and 31 boys (15.6%), out of a total of 830 patients treated for IS at the Scoliosis Treatment Center in 2014-2019 were included in the assessment, which was conducted according to the inclusion and exclusion criteria. The study group was divided into three age groups. Group A subjects were 6-9 years old; group B, 10-12 years old; and group C, 13-17 years old. The mean follow-up time was 28.71 ± 10.98 months. Treatment outcomes were compared, based on changes in the Cobb angle and the angle of trunk rotation before and after treatment, both within the groups and with respect to sex and curvature location, using the Wilcoxon signed-rank test. Cobb angle changes in patients were classified as improvements, stabilizations, or deteriorations according to the SOSORT criteria. Results: A majority of patients improved or stabilized after treatment, with 67%, 71%, and 90% of subjects in groups A, B, and C, respectively, achieving these results. In group C (the oldest children), a statistically significant reduction of -1.84° ± 6.88° (6.31%) in the mean Cobb angle was achieved after treatment. With regard to sex, improvements and stabilizations accounted for 81% of cases in girls and 61% in boys, respectively. With respect to location, statistically significant reductions in the Cobb angle were noted for thoracic and thoracolumbar spines of -2.2° ± 7.54° (10.17%) p = 0.022 and -2.2° ± 6.58° (6.36%) p = 0.049, respectively. A significant reduction in the mean angle of trunk rotation was obtained in the group and in three curvature locations. Conclusions: Based on the presented research findings, the utilization of the GraviSpine device as an adjunct to specific PSSE (physiotherapeutic scoliosis-specific exercises) physiotherapy and bracing in the management of pediatric patients with mild to moderate scoliosis appears to enhance treatment efficacy.

A Novel Classification of Juvenile and Adolescent Idiopathic Scoliosis for Conservative Treatment

BACKGROUND

The operative classification of scoliosis is well-developed but inadequate for guiding conservative treatment. The current conservative classification for juvenile and adolescent idiopathic scoliosis (JAIS) exhibits noticeable deficiencies. This study aimed to establish the Peking Union Medical College Hospital (PUMCH) classification and assess its clinical value in the conservative treatment of JAIS.

METHODS

This study consisted of 2 parts. First, it involved a retrospective analysis of patients treated for JAIS in the Department of Rehabilitation Medicine, the ∗∗∗ Union Medical College Hospital, between January 2013 and June 2020. Second, it involved an ambispective cohort study that enrolled patients with JAIS in the above hospital between July and December 2020.

RESULTS

A total of 989 patients with JAIS were enrolled, with 899 patients for establishing the PUMCH classification and 90 patients with JAIS for validating the PUMCH classification. The classification demonstrated an average reliability of 88.22% with a kappa coefficient of 0.862. After 1 week, the remeasured results presented a mean reproducibility of 92.78% and a kappa coefficient of 0.908. After 1-year follow-up, the Cobb angle decreased significantly from 16.61 ± 2.88° to 12.16°± 9.97° (P = 0.002) in 51 patients with PUMCH-scoliosis-specific exercise (SSE) treatment, while the Cobb angle increased significantly from 15.74 ± 2.75° to 17.64 ± 5.60° (P = 0.014) in 39 patients without PUMCH-SSE treatment.

CONCLUSIONS

The PUMCH-SSE classification demonstrates good inter-observer reliability and intra-observer reproducibility. In addition, the classification may be used to guide the conservative treatment of JAIS in clinical settings.

Comparison of the efficacy of thoracolumbosacral and lumbosacral orthosis for adolescent idiopathic scoliosis in patients with major thoracolumbar or lumbar curves: a prospective controlled study

Introduction

Thoracolumbosacral orthosis (TLSO) is the most commonly used type of brace for the conservative treatment of adolescent idiopathic scoliosis (AIS). Although lumbosacral orthosis (LSO) is designed to correct single thoracolumbar or lumbar (TL/L) curves, its effectiveness remains underexplored. This novel article aims to compare the effectiveness of LSO with TLSO in treating AIS with main TL/L curves.

Methods

This prospective controlled cohort study enrolled patients with AIS with main TL/L curves and minor thoracic curves who were treated with either TLSO or LSO. Demographic and radiographic data were compared between the two groups. Treatment outcomes were also assessed. Risk factors for minor curve progression were identified, and a cut-off value was determined within the LSO group.

Results

Overall, 82 patients were recruited, including 44 in the TLSO group and 38 in the LSO group. The initial TL/L curves showed no difference between both groups. However, the baseline thoracic curves were significantly larger in the TLSO group compared to the LSO group (25.98° ± 7.47° vs. 18.71° ± 5.95°, P < 0.001). At the last follow-up, LSO demonstrated similar effectiveness to TLSO in treating TL/L curves but was less effective for thoracic curves. The initial magnitude of thoracic curves was identified as a risk factor for minor curve outcomes in the LSO group. The ROC curve analysis determined a cut-off value of 21° for thoracic curves to predict treatment outcomes.

Discussion

In contrast to TLSO, LSO exhibits comparable effectiveness in treating main TL/L curves, making it a viable clinical option; however, it is less effective for thoracic minor curves. The initial magnitude of the minor thoracic curves may guide the selection of the appropriate brace type for patients with AIS with main TL/L curves.

The Relationship Between Compliance of Physiotherapeutic Scoliosis Specific Exercises and Curve Regression With Mild to Moderate Adolescent Idiopathic Scoliosis

STUDY DESIGN

Retrospective Case-control Study.

OBJECTIVES

To determine the requisite exercise compliance (EC) of physiotherapeutic scoliosis-specific exercise (PSSE) for achieving curve regression; to analyze whether the apical translation (AT), apical wedging (AW), and apical rotation (AR) of the major curve improve with regression effect.

METHODS

Between 2019 and 2021, a total of 763 patients undertook a 6-month PSSE treatment. This resulted 426 compliable and 302 uncompliable patients remained available for analysis. For compliable patients, 213 with curve regression and 213 age-/sex-matched with curve stabilization/deterioration at the 6-month, were eligible for regression analysis to detect the relationship between EC and regression effect at the 6-month; receiver operating characteristic (ROC) curve analysis and Youden's index were applied to identify the threshold of EC leading to curve regression at the 6-month. The AT, AW, and AR of the major curve were compared before and after 6-month PSSE to investigate the radiographic parameters that improved with regression effect.

RESULTS

EC was correlated with regression effect (odds ratio: 19.9, 95% confidence interval: 11.3-35.0, P < .001) and the cutoff threshold of EC was 4.4 h/week for 6 months to realize such an effect. AT was improved by 47.6% with curve regression, in which 152 cases remained curve regression and no case progressed into the operative threshold at the 1.5- to 2-year.

CONCLUSIONS

A 6-month PSSE protocol of 4.4 hours per week was potentially leading to curve regression in treating mild to moderate scoliosis. An improvement in AT of the major curve was observed with the regression effect.

Higher Baseline Serum Myokine of FSTL1 May Serve as a Potential Predictive Biomarker for Successful Brace Treatment in Girls With Adolescent Idiopathic Scoliosis

STUDY DESIGN

A retrospective case-control study.

OBJECTIVE

This study aimed to investigate whether myokine, which is related to exercise and muscle mass, could serve as a biomarker for predicting bracing outcomes.

SUMMARY OF BACKGROUND DATA

Several risk factors have been documented to be associated with bracing failure in patients with adolescent idiopathic scoliosis (AIS). However, serum biomarkers have not been extensively explored.

PATIENTS AND METHODS

Skeletally immature females with AIS, without previous histories of bracing or surgery, were included. Peripheral blood was collected at the time of the bracing prescription. Baseline serum concentrations of 8 myokines [apelin, fractalkine, brain-derived neurotrophic factor, erythropoietin, osteonectin, fatty-acid-binding protein 3, follistatin-like 1 (FSTL1), and musclin] were measured by multiplex assays. Patients were followed up until weaned from bracing and then designated as a "failure" (defined as Cobb angle progression >5°) or "success." A logistic regression analysis was performed that accounted for serum myokines and skeletal maturity.

RESULTS

We included 117 patients, with 27 in the failure group. Patients in the failure group had lower initial Risser sign and lower baseline serum levels of myokines, including FSTL1 (2217.3 ± 617.0 vs . 1369.3 ± 704.9, P = 0.002), apelin [116.5 (12.0, 335.9) vs . 83.5 (10.5, 221.1), P = 0.016], fractalkine (979.6 ± 457.8 vs . 743.8 ± 456.1, P = 0.020), and musclin [211.3 (16.3, 370.3) vs . 67.8 (15.5, 325.6), P = 0.049]. Following adjusted analysis, serum FSTL1 [odds ratio = 10.460; (2.213-49.453)] was determined to be predictive of bracing effectiveness.

CONCLUSION

Patients who failed AIS bracing had significantly lower mean baseline levels of FSTL1 than those who achieved success. FSTL1 may serve as a biomarker that can inform outcomes after bracing.

Overview of adolescent idiopathic scoliosis and associated factors: a scoping review

Around the world, idiopathic scoliosis accounts for the majority of occurrences of adolescent scoliosis. The absence of underlying congenital or neuromuscular problems distinguishes adolescent idiopathic scoliosis (AIS), which affects children ages 13 to 18, from other kinds of scoliosis. The prevalence of AIS is influenced by a number of variables, such as physical activity, gender, backpacks, body mass index, and others. AIS has an impact on the child's development not just physically but also psychologically, emotionally, and mentally. This study used nationwide databases to describe the prevalence of adolescent idiopathic scoliosis and associated risk variables. The current review analysis showed that AIS was significant worldwide and that adolescent gender, physical activity, body mass index, backpack carrying and backpack weight were all significant risk factors for developing AIS.

Is Lenke type V adolescent idiopathic scoliosis associated with different muscular morphometry?

The aim of the study was to evaluate the changes in psoas major (PM), erector spinae (ES), multifidus (MF), and rectus abdominis (RA) morphometry in Lenke type V adolescent idiopathic scoliosis (AIS) and control. Forty-two Lenke V AIS patients and 30 control were enrolled. The cross-sectional area (CSA) and CSA index (CI) of the PM, ES, MF, and RA at the T9-L5 levels were measured and compared between Lenke type V patients and control. The CI of the RA was significantly higher in the control group than the Lenke V group in multiple levels. On the other hand, there was no significant difference between patients with Lenke V AIS and control regarding the CI of the RA, ES, and PM. There was no significant difference between concave and convex sides of the Lenke V group regarding the CI of the RA, PM, MF, and ES. RA muscle mass is significantly affected in Lenke type 5 AIS regardless of convex or concave sides. This difference may be related to postural differences and back pain development in Lenke type 5 patients. Level of evidence: Level III.

A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis

PURPOSE

The purpose of this study was to determine the feasibility and efficacy of a United States multi-site randomized control trial (RCT) of the Schroth-based therapy program in Risser 0 patients with mild adolescent idiopathic scoliosis (AIS) curves.

METHODS

Six sites enrolled 98 Risser 0 patients with single AIS curves between 12° and 24°. Patients were randomized to Exercise:Control group in a 2:1 ratio. Exercise group patients were instructed on the Schroth-based method and a home exercise program of 75 min/week for 1 year.

RESULTS

Enrollment across 6 institutions averaged 2.2 patients per month over 45 months. Patient attrition was 42% after 1 year (41/98) and 52% after 2 years (51/98). Exercise group patients were significantly younger (11.6 vs 12.5 years) without differences in the baseline Cobb angle (16.2° vs 17.1°). Self-reported exercise adherence averaged 82% at 6 months and 63% at 1 year (n = 35). A significantly lower frequency of patients was braced in the Exercise group after 1 year (26% vs 55%, p = 0.03) but not after 2 years (48% vs 63%, p = 0.31). Curve magnitude changes between groups were not significant after 1 and 2 years.

CONCLUSION

Performing a multi-site RCT for mild AIS in the United States is challenging with slow enrollment and high attrition. Young patients with small curves have difficulty adhering to the intensive demands of Schroth-based therapy.

LEVEL OF EVIDENCE

II.

Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article

AIM

This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration.

METHODS

Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework.

CONCLUSIONS AND IMPLICATIONS

As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.

Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

(1) Background: Idiopathic scoliosis can be defined as a complex three-dimensional deformity of the spine and trunk, which occurs in basically healthy children. Schroth scoliosis-specific exercises have shown good results in reducing idiopathic scoliosis progression. This study aimed to critically evaluate the effect size of Schroth's method through a systematic review and meta-analysis. (2) Methods: Four databases were included in the search: PubMed, Cochrane Library, Web of Science, and Google Scholar. The following keywords were used: "Schroth exercise", "idiopathic scoliosis", "Cobb angle", "angle of trunk rotation", and "quality of life". Only articles written in English that met the following criteria were included in our study: subjects who had idiopathic scoliosis, the Schroth method was applied, and Cobb angle or angle of trunk rotation or quality of life as outcomes. (3) Results: Ten randomized controlled trials were included in this study. The effect size of the Schroth exercise ranged from almost moderate to large, for the outcomes used: Cobb angle (ES = -0.492, p ˂ 0.005); ATR (ES = -0.471, p = 0.013); QoL (ES = 1.087, p ˂ 0.001). (4) Conclusions: The current meta-analysis indicates that the Schroth method has a positive effect on subjects with idiopathic scoliosis.

Effects of Schroth method and core stabilization exercises on idiopathic scoliosis: a systematic review and meta-analysis

PURPOSE

Conservative approaches such as Schroth exercises and core stabilization exercises showed effective results in the treatment of idiopathic scoliosis. This study aimed to critically evaluate the magnitude effect of Schroth and core stabilization exercises using a systematic review and meta-analysis.

METHODS

This study has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The following three databases were searched for articles collection: Web of Science, PubMed, and Google Scholar. The key search terms were: Schroth exercise, core exercise, idiopathic scoliosis, Cobb angle, angle of trunk rotation, and quality of life. The articles included in our study was limited to original articles written only in English that met the following inclusion criteria: (1) Participants with idiopathic scoliosis; (2) Schroth exercises and core stabilization exercises used as interventions; (3) Cobb angle or angle of trunk rotation or quality of life used as outcome measures.

RESULTS

Thirteen studies were included. Depending on the outcome measured, the magnitude effect of Schroth and core stabilization exercises ranged from small to almost large as follows: Cobb angle (SMD = - 0.376, p ˂ 0.001); angle of trunk rotation (SMD = - 0.268, p = 0.104); quality of life (SMD = 0.774, p = 0.002). By subgroup analysis, Schroth method showed a larger effect size than core stabilization exercises.

CONCLUSION

The current systematic review and meta-analysis indicates that both Schroth method and core stabilization exercises have a positive effect in subjects with idiopathic scoliosis. Subgroup analysis showed that the Schroth method had a larger effect size than the core stabilization exercises.

Effects of trunk posture on cardiovascular and autonomic nervous systems: A pilot study

Objective: Although regular and moderate physical activity has been shown to improve the cardiovascular and autonomic nervous systems, little has been done to study the effects of postural changes in the movement on the heart and autonomic nervous system. To uncover changes in cardiac function and autonomic nerves induced by different underlying posture transitions and explore which trunk postures lead to chronic sympathetic activation. Therefore, this study investigated the effects of trunk posture on the cardiovascular and autonomic nervous systems. Methods: Twelve male subjects (age 24.7 ± 1.3) underwent this study. The non-invasive cardiac output NICOM monitoring equipment and the FIRSTBEAT system are used to dynamically monitor seven trunk postures in the sitting position simultaneously (neutral position, posterior extension, forward flexion, left lateral flexion, right lateral flexion, left rotation, right rotation). Each posture was maintained for 3 min, and the interval between each movement was 3 min to ensure that each index returned to the baseline level. Repeated analysis of variance test was used to compare and analyze the differences in human cardiac function, heart rate variability index, and respiratory rate under different postures. Results: Compared with the related indicators of cardiac output in a neutral trunk position: the cardiac index (CI) was significantly reduced in forwarding flexion and left rotation (3.48 ± 0.34 vs. 3.21 ± 0.50; 3.48 ± 0.34 vs. 3.21 ± 0.46, Δ L/(min/m2)) (p = 0.016, p = 0.013), cardiac output decreased significantly (6.49 ± 0.78 vs. 5.93 ± 0.90; 6.49 ± 0.78 vs. 6.00 ± 0.96, Δ L/min) (p = 0.006, p = 0.014), the stroke volume (stroke volume)decreased significantly (87.90 ± 15.10 vs. 81.04 ± 16.35; 87.90 ± 15.10 vs. 79.24 ± 16.83, Δ ml/beat) (p = 0.017, p = 0.0003); heart rate increased significantly in posterior extension (75.08 ± 10.43 vs. 78.42 ± 10.18, Δ beat/min) (p = 0.001); left rotation stroke volume index (SVI) decreased significantly (47.28 ± 7.97 vs. 46.14 ± 8.06, Δ ml/m2) (p = 0.0003); in the analysis of HRV-related indicators, compared with the neutral trunk position, the LF/HF of the posterior extension was significantly increased (1.90 ± 1.38 vs. 3.00 ± 1.17, p = 0.037), and the LF/HF of the forward flexion was significantly increased (1.90 ± 1.38 vs. 2.85 ± 1.41, p = 0.041), and the frequency-domain index LF/HF of right rotation was significantly increased (1.90 ± 1.38 vs. 4.06 ± 2.19, p = 0.008). There was no significant difference in respiratory rate (p > 0.05). Conclusion: A neutral trunk is the best resting position, and deviations from a neutral trunk position can affect the cardiovascular and autonomic nervous systems, resulting in decreased stroke volume, increased heart rate, and relative activation of sympathetic tone.

Physiotherapy Interventions for Preventing Spinal Curve Progression in Adolescent Idiopathic Scoliosis: A Systematic Review

Adolescent idiopathic scoliosis (AIS) is an abnormal curvature of the spine that appears in late childhood or adolescence. The aim of this systematic review was to present and synthesize the most relevant therapeutic advice and evidence on the efficacy of physiotherapy exercises for preventing the growth of spinal curvature caused by adolescent idiopathic scoliosis. "Adolescent idiopathic scoliosis," "exercise," "Cobb angle," and "physiotherapy" were the sole keywords used for the published research. Using these keywords and a combination of them, electronic resources such as PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), Elton B. Stephens Company (EBSCO) host, and ScienceDirect (Elsevier) were searched. The search was restricted to studies that were conducted in English between 2010 and 15 January 2022 that were controlled, randomized, and non-randomized. Studies were selected based on their titles and abstracts, with the exception of any that did not pertain to the study's goals. The Cobb angle was the important outcome measure. For each intervention, the Cobb angle's mean change score, the difference between the final and baseline scores, was determined. Nine studies were evaluated to be of outstanding quality out of a total of 20 studies that were reviewed for eligibility. With an exercise regimen of at least seven weeks, controls on lowering the Cobb angle in patients with AIS would provide encouraging outcomes. It also shows that bracing can strengthen the Cobb angle compared to exercise in the community. However, long-term orthotic activity ultimately results in trunk resistance and muscle loss in the center of the back. The combination of techniques and treatment methods seems to have better results in treating scoliosis, particularly using exercises involving the Schroth and scientific exercise approach to scoliosis (SEAS).

Kinesiophobia and its association with treatment choice in individuals with idiopathic scoliosis

BACKGROUND

Previous studies have reported increased kinesiophobia in adults with degenerative scoliosis or adolescents who have undergone spinal surgery. However, little is known about the phenomenon of kinesiophobia among adolescents with idiopathic scoliosis (IS).

OBJECTIVES

The aim of this study was to investigate levels of kinesiophobia and its association with treatment choice in IS.

METHODS

The study included 98 IS patients with a mean age of 14 years and 20 healthy controls. Participants with IS were divided into groups based on treatment conditions, as follows: (1) untreated (n= 33); (2) treated with exercise (n= 32); and (3) treated with a brace (n= 33). Kinesiophobia was measured using the Tampa Scale for Kinesiophobia (TSK). Comparisons were made between four groups.

RESULTS

Untreated participants with IS were found to have greater kinesiophobia than healthy controls (p< 0.001). Participants treated with a brace (p= 0.046) and exercise (p= 0.064) had similar kinesiophobia levels as the healthy control group.

CONCLUSIONS

Kinesiophobia was found to be higher in adolescents with IS compared to healthy peers. Brace or exercise treatment both had a positive impact on kinesiophobia. These findings should be considered when organizing rehabilitation programs to achieve the best results for adolescents with IS.

Guidelines for the conservative treatment of spinal deformities - Questionnaire for a Delphi consensus

Background

Spinal deformity is the oldest disease known to humankind. Many types of treatment methods, including both conservative and surgical, are in use.

Objective

We aimed to validate a published guideline protocol based on the conservative treatment of spinal deformities.

Method

A modified Delphi technique was used with a questionnaire sent out to professionals worldwide regarding the conservative treatment of spinal deformities.

Results

Our study was completed after two rounds. A strong level of agreement of 80% and more (consensus cut-off point) was achieved in most questions in the first round. Some statements were below this margin, and they were sent to the participants via email in the second round for re-evaluation. Consensus was achieved in almost all of the statements in the second round. Only two items did not reach the cut-off point but were close to this value.

Conclusion

This proposed Guideline Protocol was approved by the participants using the Delphi method and can be used as a valid tool for the conservative treatment of spinal deformities.

Clinical implications

A conservative treatment guideline in spinal deformity management, will provide consistency in treatment and will facilitate comparability with surgery. It will be useful in determining the cost-effectiveness of treatment and in choosing the right patient for the right method of treatment. This guideline might help in this context, and may also create a systematic method for clinicians to use as a reference in both research and clinical practice.

Light-Convolution Dense Selection U-Net (LDS U-Net) for Ultrasound Lateral Bony Feature Segmentation

Scoliosis is a widespread medical condition where the spine becomes severely deformed and bends over time. It mostly affects young adults and may have a permanent impact on them. A periodic assessment, using a suitable modality, is necessary for its early detection. Conventionally, the usually employed modalities include X-ray and MRI, which employ ionising radiation and are expensive. Hence, a non-radiating 3D ultrasound imaging technique has been developed as a safe and economic alternative. However, ultrasound produces low-contrast images that are full of speckle noise, and skilled intervention is necessary for their processing. Given the prevalent occurrence of scoliosis and the limitations of scalability of human expert interventions, an automatic, fast, and low-computation assessment technique is being developed for mass scoliosis diagnosis. In this paper, a novel hybridized light-weight convolutional neural network architecture is presented for automatic lateral bony feature identification, which can help to develop a fully-fledged automatic scoliosis detection system. The proposed architecture, Light-convolution Dense Selection U-Net (LDS U-Net), can accurately segment ultrasound spine lateral bony features, from noisy images, thanks to its capabilities of smartly selecting only the useful information and extracting rich deep layer features from the input image. The proposed model is tested using a dataset of 109 spine ultrasound images. The segmentation result of the proposed network is compared with basic U-Net, Attention U-Net, and MultiResUNet using various popular segmentation indices. The results show that LDS U-Net provides a better segmentation performance compared to the other models. Additionally, LDS U-Net requires a smaller number of parameters and less memory, making it suitable for a large-batch screening process of scoliosis without a high computational requirement.

Effects of a Home-Based Exercise Intervention (E-Fit) on Bone Density, Muscle Function, and Quality of Life in Girls with Adolescent Idiopathic Scoliosis (AIS): A Pilot Randomized Controlled Trial

Background: Adolescent idiopathic scoliosis (AIS) patients have lower physical activity levels than normal adolescents, and there is an association with poorer bone and muscle health. This study evaluated the effects of a home-based exercise intervention (E-Fit) on bone mineral density (BMD), muscle function, and quality of life (QoL) in AIS-affected girls. Methods: A total of 40 AIS females aged 11 to 14 years were randomly assigned to the E-Fit or control group. The E-Fit group performed modified 7-min high-intensity interval training (HIIT) 5 days per week for 6 months. Outcome measures including BMD using dual-energy X-ray absorptiometry (DXA), muscle strength and endurance tests, physical activity levels, and QoL using self-reported questionnaires were assessed at baseline and at 6-month and 12-month follow-up. Results: In total, 14 patients in the E-Fit and 16 in the control group completed the study. The E-Fit group showed a marginally significant interaction effect in the whole body areal BMD at the 6- (p = 0.096) and 12-month follow-ups (p = 0.085). The left arm lean mass in the E-Fit group showed a statistically significant interaction effect between the 6- and 12-month follow-ups (p = 0.046). The E-Fit group showed improvements in physical activity participation, as measured by the Modified Baecke Questionnaire (MBQ), with a significant interaction effect in work index (p = 0.043), sport index (p = 0.050), and total score (p = 0.016) from baseline to the 12-month follow-up. Improvement on self-image were noted in E-Fit group across time. Conclusions: The present results provided some evidence to support the positive benefits of E-Fit for bone health and muscle function in AIS girls.

Low Body Mass Index Levels and Idiopathic Scoliosis in Korean Children: A Cross-Sectional Study

BACKGROUND

The prevalence of idiopathic scoliosis is rapidly increasing in Korean children, but research on the disorder is limited compared to that in other countries. Accordingly, in the present study, we aimed to investigate the relationship between idiopathic scoliosis and body mass index (BMI) levels in Korean children.

METHODS

This cross-sectional study enrolled elementary school students and middle school first graders in the Capital Area in Korea. The participants underwent body composition measurements and screening for idiopathic scoliosis. Idiopathic scoliosis was defined as a Cobb angle of ≥10°. The students were classified into three groups-the severely underweight (SUW: BMI < 16 kg/m2) group, the underweight group (UW: 16 ≤ BMI < 18.5 kg/m2), and the normal weight group (NW: 18.5 ≤ BMI < 25 kg/m2) to compare the risk of idiopathic scoliosis across BMI levels.

RESULTS

The final cohort comprised 1375 participants. The odds ratio (OR) of idiopathic scoliosis was 0.69 (95% confidence interval (CI): 0.50-0.94) and 0.66 (95% CI: 0.49-0.89) for the UW and the NW groups, respectively, with the SUW group as the reference. This shows that the risk decreased significantly by 31% and 34% in the UW and the NW groups, respectively. After controlling for age and sex, the corresponding ORs were 0.72 (95% CI: 0.52-0.98) and 0.70 (95% CI: 0.51-0.96), and the risk significantly decreased by 28% and 30% in the UW and the NW groups, respectively.

CONCLUSIONS

Low body weight is closely associated with spinal deformity and idiopathic scoliosis.

Validation of Scolioscan Air-Portable Radiation-Free Three-Dimensional Ultrasound Imaging Assessment System for Scoliosis

To diagnose scoliosis, the standing radiograph with Cobb's method is the gold standard for clinical practice. Recently, three-dimensional (3D) ultrasound imaging, which is radiation-free and inexpensive, has been demonstrated to be reliable for the assessment of scoliosis and validated by several groups. A portable 3D ultrasound system for scoliosis assessment is very much demanded, as it can further extend its potential applications for scoliosis screening, diagnosis, monitoring, treatment outcome measurement, and progress prediction. The aim of this study was to investigate the reliability of a newly developed portable 3D ultrasound imaging system, Scolioscan Air, for scoliosis assessment using coronal images it generated. The system was comprised of a handheld probe and tablet PC linking with a USB cable, and the probe further included a palm-sized ultrasound module together with a low-profile optical spatial sensor. A plastic phantom with three different angle structures built-in was used to evaluate the accuracy of measurement by positioning in 10 different orientations. Then, 19 volunteers with scoliosis (13F and 6M; Age: 13.6 ± 3.2 years) with different severity of scoliosis were assessed. Each subject underwent scanning by a commercially available 3D ultrasound imaging system, Scolioscan, and the portable 3D ultrasound imaging system, with the same posture on the same date. The spinal process angles (SPA) were measured in the coronal images formed by both systems and compared with each other. The angle phantom measurement showed the measured angles well agreed with the designed values, 59.7 ± 2.9 vs. 60 degrees, 40.8 ± 1.9 vs. 40 degrees, and 20.9 ± 2.1 vs. 20 degrees. For the subject tests, results demonstrated that there was a very good agreement between the angles obtained by the two systems, with a strong correlation (R2 = 0.78) for the 29 curves measured. The absolute difference between the two data sets was 2.9 ± 1.8 degrees. In addition, there was a small mean difference of 1.2 degrees, and the differences were symmetrically distributed around the mean difference according to the Bland-Altman test. Scolioscan Air was sufficiently comparable to Scolioscan in scoliosis assessment, overcoming the space limitation of Scolioscan and thus providing wider applications. Further studies involving a larger number of subjects are worthwhile to demonstrate its potential clinical values for the management of scoliosis.

The effects of exercise therapy on adolescent idiopathic scoliosis: An overview of systematic reviews and meta-analyses

BACKGROUND

Exercise therapy was suggested as an appealing treatment option for Adolescent Idiopathic Scoliosis (AIS) patients with less side effects, lower economic costs, and more psychological benefits. Nevertheless, no unanimous findings about the efficacy of exercise therapy have been obtained from previous systematic reviews and/or meta-analyses.

OBJECTIVE

To provide an overview of previous systematic reviews and/or meta-analyses on the effectiveness of exercise therapy on AIS treatment.

METHODS

Systematic searches in Medline, Eric, CINAHL, Embase, SPORTDiscus, PsycINFO, and the Cochrane Library for systematic reviews and/or meta-analyses of randomized controlled trials (RCTs), non-randomized comparison studies (NRS) or observational studies using exercise as an intervention, and with outcome measures including Cobb angle, angle of trunk rotation (ATR), and quality of life. The methodological quality of the review articles was evaluated by A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist.

RESULTS

Ten systematic reviews and meta-analyses were included. The quality of most of the review articles is moderate with a mean score of 6/11 on the AMSTAR scale. Overall, there is increasing evidence showing the efficacy of exercise therapy on reducing the Cobb angle and angle of trunk rotation, and improving perceived quality of life.

CONCLUSION

Exercise therapy was found to have potential benefits to treat physiological and psychological aspects of AIS patients. However, the findings were not conclusive given that some reviews relied on data from the trials with potential risk of bias and significant heterogeneity. More high-quality research is still needed to verify these findings.

Does curve pattern impact on the effects of physiotherapeutic scoliosis specific exercises on Cobb angles of participants with adolescent idiopathic scoliosis: A prospective clinical trial with two years follow-up

Background

Current clinical evidence suggests that a well-planned physiotherapeutic scoliosis specific exercise (PSSE) program is effective for scoliosis regression.

Objectives

We investigated the effect of curve patterns on Cobb angles with PSSE.

Methods

This was a non-randomized prospective clinical trial that recruited participants with adolescent idiopathic scoliosis between January and June 2017. Participants were grouped by curve pattern into major thoracic and major lumbar groups. An outpatient-based PSSE program was conducted with the following schedule of intensive exercise: ≥ 1 session of supervised PSSE per month and > 30min of home exercise 5 days/week in the first 6 months, after which exercise frequency was reduced to 1 session of supervised PSSE every three months and > 30min of home exercise 5 days/week until 2 years after study initiation. Radiographic Cobb angle progressions were identified at the 1, 1.5 and 2-year follow-ups. A mixed model analysis of variance (ANOVA) was performed to examine the differences in Cobb angles between groups at four testing time points. The two-tailed significance level was set to 0.05.

Results

In total, 40 participants were recruited, including 22 with major thoracic curves (5 males and 17 females; mean age 13.5±1.8 years; Cobb angle 18–45 degrees) and 18 with major lumbar curves (7 males and 11 females; mean age 12.7±1.7 years; Cobb angle 15–48 degrees). Curve regressions, namely the reduction of Cobb angles between 7 to 10 degrees were noted in 9.1% of participants in the major thoracic group; reductions of 6 to 13 degrees were noted in 33.3% of participants in the major lumbar group at the 2-year follow-up. Repeated measurements revealed a significant time effect (F_2.2,79.8 = 4.1, p = 0.02), but no group (F_2.2,79.8 = 2.3, p = 0.1) or time × group (F_1,37 = 0.97, p = 0.3) effects in reducing Cobb angles after 2 years of PSSE. A logistic regression analysis revealed that no correlation was observed between curve pattern and curve regression or stabilization (OR: 0.2, 95% CI: 0.31–1.1, p = 0.068) at the 2-year follow-up.

Conclusion

This was the first study to investigate the long-term effects of PSSE in reducing Cobb angles on the basis of major curve location. No significant differences in correction were observed between major thoracic and major lumbar curves. A regression effect and no curve deterioration were noted in both groups at the 2-year follow-up.

Trial registration

ChiCTR1900028073.

Fiber Type-Specific Morphological and Cellular Changes of Paraspinal Muscles in Patients with Severe Adolescent Idiopathic Scoliosis

Background

Paraspinal muscle (PSM) has been suggested to have a role in adolescent idiopathic scoliosis (AIS). Few studies have investigated the fiber type-specific changes of PSM in detail.

Material/Methods

Bilateral multifidus muscles were harvested from the apical vertebra level (T7–T10) of 12 AIS patients and 6 control individuals. Immunohistological staining was performed to evaluate the muscle fiber type composition, fiber type-specific cross-sectional area (CSA), myonuclei density, and the total and activated satellite cell (SC) density. The correlations between these characteristics and curve initiation/severity were analyzed.

Results

In comparison with the PSM in convexity and the control group, PSM in concavity showed a significant reduction of CSA (concavity, 2601.1±574.1 μm²; convexity, 3732.1±545.1 μm²; control, 3426.5±248.4 μm²), myonuclei density (concavity, 2.0±0.3 myonuclei/fiber; convexity, 2.5±0.4 myonuclei/fiber; control, 2.2±0.2 myonuclei/fiber), and activated SC density (concavity, 0.7±0.4 cells/100 fibers; convexity, 1.5±0.7 cells/100 fibers; control, 1.2±0.3 cells/100 fibers) for fiber type I. The Cobb angle was positively correlated with the bilateral ratio of CSA (convexity/concavity) for both fiber types. The apical vertebral translation was positively correlated with bilateral difference of myonuclei density (type I), total SC density (types I and II), and activated SC density (type I).

Conclusions

The fiber type-specific pathological changes on the concave side seemed to be more severe. Some fiber type-specific characteristics (CSA, myonuclei density, total/activated SC density) were closely associated with curve severity. More attention should be paid to PSM physiotherapy treatment on the concave side.

Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review

Background

Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity with reported complications including pain, mental health concern and respiratory dysfunction. The scoliosis-specific exercise (SSE) is prescribed throughout pubertal growth to slow progression although effects are unclear. This review aims to establish the effectiveness of SSE for alleviating AIS in terms of reducing Cobb angle, improving trunk asymmetry and quality of life (QoL). Additionally, it aims to define the effects of age, skeletal maturity, curve magnitude and exercise compliance on the outcomes of SSE.

Methods

A systematic reviewed was conducted to net SSE articles. Searched databases included PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL and Google scholar. The quality of study was critically appraised according to the PEDro scale.

Results

A total of ten trials with an average PEDro score of 6.9/10 were examined in this study. Two randomized controlled trials (RCTs) and two clinical controlled trials suggested that SSE alone and with bracing or traditional exercise had clinical significance in reducing Cobb angle more than 5°. One RCT specifically implicated no comparable effects between bracing and SSE in prevention of curve progression for moderate scoliosis. There was insufficient evidence to support the positive effects of SSE on improving truck asymmetry (n = 4) and QoL (n = 3). Five studies evaluated the interaction effects of age (n = 2), skeletal maturity (n = 1) and curve magnitude (n = 2) with SSE in reducing Cobb angle yet without drawing any firm conclusions.

Conclusions

Insufficient evidence is available to prove that SSE with or without other conservative treatments can reduce Cobb angle, improve trunk balance and QoL. The interaction effects of age, skeletal maturity, curve magnitude, and exercise compliance with SSE in reducing Cobb angle are not proven. Future studies should investigate the relationship of influencing factors and SSE in treating AIS but not only testing its effectiveness.

Trial registration

INPLASY202050100.