A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis.
Spine deformity
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.
10.1007/s43390-023-00665-2
The Effect of Schroth Method on Postural Control and Balance in Patients with Adolescent Idiopathic Scoliosis: A Literature Review.
Advances in experimental medicine and biology
The objective of this review was to offer new information on the effectiveness of Schroth method on postural control and balance in patients with adolescent idiopathic scoliosis (AIS). PubMed, EBSCO, and Google Scholar databases were searched from June 2022 to August 2022 for prospective controlled trials and randomized controlled trials related to effects of Schroth exercises on postural control and balance in patients with AIS. The key words AIS, Schroth, balance, postural control, and proprioception were used. Studies written in English language, in the last decade were included. Seven studies were included in the review, with a total of 244 study subjects. Three studies investigated the effectiveness of Schroth exercises on balance and postural control. Two studies included investigated the effectiveness of Schroth method in combination with additional treatments of bracing and hippotherapy, while two other studies investigated effectiveness of Schroth when compared with Pilates and proprioceptive neuromuscular facilitation (PNF). The treatment duration varied from a week to 6 months. From the findings of this review, it is supported that Schroth method can have positive effects on balance and postural control in AIS patients. Further investigation is necessary.
10.1007/978-3-031-31986-0_45
The relationship between physical activity, structural deformity, and spinal mobility in adolescent idiopathic scoliosis patients.
Spine deformity
PURPOSE:Adolescent idiopathic scoliosis (AIS) patients experience structural spinal deformity, but the impact of AIS on physical activity is not widely studied. Reports of physical activity levels between children with AIS and their peers are mixed. This study sought to characterize the relationship between spinal deformity, spinal range of motion, and self-reported physical activity in AIS patients. METHODS:Patients aged 11-21 completed self-reported measures of physical activity using the HSS Pedi-FABS and PROMIS Physical Activity questionnaires. Radiographic measures were obtained from standing biplanar radiographic imaging. Surface topographic (ST) imaging data was obtained using a whole-body ST scanning system. Hierarchical linear regression models analyzed the relationship between physical activity, ST, and radiographic deformity while controlling for age and BMI. RESULTS:149 patients with AIS (mean age 14.5 ± 2.0 years, mean Cobb angle 39.7° ± 18.9°) were included. In the hierarchical regression predicting physical activity from Cobb angle, no factors were significant predictors of physical activity. When predicting physical activity from ST ROM measurements, age and BMI served as covariates. No covariates or ST ROM measurements were significant predictors of physical activity levels for either activity measure. CONCLUSIONS:Physical activity levels of patients with AIS were not predicted by levels of radiographic deformity or surface topographic range of motion. Although patients may experience severe structural deformity and range of motion limitations, these factors do not appear to be associated with decreased physical activity level utilizing validated patient activity questionnaires. LEVEL OF EVIDENCE:Level II.
10.1007/s43390-023-00702-0
[Risk factors associated with structural postural changes in the spinal column of children and adolescents].
Sedrez Juliana Adami,da Rosa Maria Izabel Zaniratti,Noll Matias,Medeiros Fernanda da Silva,Candotti Claudia Tarragô
Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo
OBJECTIVE:To investigate the association between behavioral risk factors, specifically postural habits, with the presence of structural changes in the spine of children and adolescents. METHODS:59 students were evaluated through the self-reporting Back Pain and Body Posture Evaluation Instrument e and the spine panoramic radiographic examination. The spine curvatures were classified, based on Cobb' angle, as normal or altered in the saggital plane and as normal or scoliotic in the frontal plane. Data were analyzed using SPSS 18.0, from descriptive statistics and chi-square association test (α=0,05). RESULTS:The prevalence of postural alterations was 79.7% (n=47), of which 47.5% (n=28) showed frontal plane alterations and 61% (n=36) sagital plane alterations. Significant association was found between the presence of thoracic kyphosis and female gender, practice of physical exercise only once or twice a week, sleep time greater than 10 hours, inappropriate postures to sit on the bench and sit down to write, and transport of school supplies. Lumbar lordosis was associated with improperly transportation of school backpack (asymmetric); and scoliosis was associated with the practice of competitive sport and sleep time greater than 10 hours. CONCLUSIONS:Lifestyle may be associated with postural alterations. It is important to develop health policies in order to reduce the prevalence of postural alterations with a reduction of associated risk factors.
10.1016/j.rpped.2014.11.012
Progression of trunk imbalance in adolescent idiopathic scoliosis with a thoracolumbar/lumbar curve: is it predictable at the initial visit?
Hwang Chang Ju,Lee Choon Sung,Lee Dong-Ho,Cho Jae Hwan
Journal of neurosurgery. Pediatrics
OBJECTIVE Progression of trunk imbalance is an important finding during follow-up of patients with adolescent idiopathic scoliosis (AIS). Nevertheless, no factors that predict progression of trunk imbalance have been identified. The purpose of this study was to identify parameters that predict progression of trunk imbalance in cases of AIS with a structural thoracolumbar/lumbar (TL/L) curve. METHODS This study included 105 patients with AIS and a structural TL/L curve who were followed up at an outpatient clinic. Patients with trunk imbalance (trunk shift ≥ 20 mm) at the initial visit were excluded. All patients were followed up for more than 2 years. Patients were divided into the following groups according to progression of trunk imbalance: 1) Group P, trunk shift ≥ 20 mm at the final visit and degree of progression ≥ 10 mm; and 2) Group NP, trunk shift < 20 mm at the final visit or degree of progression < 10 mm. Radiological parameters included Cobb angle, upper end vertebrae and lower end vertebrae (LEV), LEV tilt, disc wedge angle between LEV and LEV+1, trunk shift, apical vertebral translation, and apical vertebral rotation (AVR). Each parameter was compared between groups. Radiological parameters were assessed at every visit using whole-spine standing anteroposterior radiographs. RESULTS Among the 105 patients examined, 13 showed trunk imbalance with progression ≥ 10 mm at the final visit (Group P). Multivariate logistic regression analysis identified a lower Risser grade (p = 0.002) and a greater initial AVR (p = 0.020) as predictors of progressive trunk imbalance. A change in LEV tilt during follow-up was associated with trunk imbalance (p = 0.001). CONCLUSIONS Risser grade and AVR measured at the initial visit may predict progression of trunk imbalance. Surgeons should consider the risk of progressive trunk imbalance if patients show skeletal immaturity and a greater AVR at the initial visit.
10.3171/2017.6.PEDS17313
Risk of Scoliosis Progression in Nonoperatively Treated Adolescent Idiopathic Scoliosis Based on Skeletal Maturity.
Journal of pediatric orthopedics
BACKGROUND:Hand radiographs for skeletal maturity staging are now frequently used to evaluate remaining growth potential for patients with adolescent idiopathic scoliosis (AIS). Our objective was to create a model predicting a patient's risk of curve progression based on modern treatment standards. METHODS:We retrospectively reviewed all AIS patients presenting with a major curve <50 degrees, available hand radiographs, and complete follow up through skeletal maturity at our institution over a 3-year period. Patients with growth remaining underwent rigid bracing of curves >25 degrees, whereas patients between 10 and 25 degrees were observed. Treatment success was defined as reaching skeletal maturity with a major curve <50 degrees. Four risk categories were identified based on likelihood of curve progression. RESULTS:Of 609 AIS patients (75.4% female) presenting with curves over 10 degrees and reaching skeletal maturity at most recent follow up, 503 (82.6%) had major thoracic curves. 16.3% (82/503) of thoracic curves progressed into surgical treatment range. The highest risk group (Sanders 1 to 6 and curve 40 to 49 degrees, Sanders 1 to 2 and curve 30 to 39) demonstrate a 30% success rate with nonoperative treatment. This constitutes an 111.1 times (95% confidence interval: 47.6 to 250.0, P<0.001) higher risk of progression to surgical range than patients in the lowest risk categories (Sanders 1 to 8 and curve 10 to 19 degrees, Sanders 3 to 8 and curve 20 to 29 degrees, Sanders 5 to 8 and curve 30 to 39 degrees). CONCLUSIONS:Skeletal maturity and curve magnitude have strong predictive value for future curve progression. The results presented here represent a valuable resource for orthopaedic providers regarding a patient's risk of progression and ultimate surgical risk. LEVEL OF EVIDENCE:Level III-retrospective cohort study.
10.1097/BPO.0000000000001929
Scoliosis and Prognosis-a systematic review regarding patient-specific and radiological predictive factors for curve progression.
Lenz Maximilian,Oikonomidis Stavros,Harland Arne,Fürnstahl Philipp,Farshad Mazda,Bredow Jan,Eysel Peer,Scheyerer Max Joseph
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
INTRODUCTION:Idiopathic scoliosis, defined as a > 10° curvature of the spine in the frontal plane, is one of the most common spinal deformities. Age, initial curve magnitude and other parameters define whether a scoliotic deformity will progress or not. Still, their interactions and amounts of individual contribution are not fully elaborated and were the aim of this systematic review. METHODS:A systematic literature search was conducted in the common databases using MESH terms, searching for predictive factors of curve progression in adolescent idiopathic scoliosis ("adolescent idiopathic scoliosis" OR "ais" OR "idiopathic scoliosis") AND ("predictive factors" OR "progression" OR "curve progression" OR "prediction" OR "prognosis"). The identified and analysed factors of each study were rated to design a top five scale of the most relevant factors. RESULTS:Twenty-eight investigations with 8255 patients were identified by literature search. Patient-specific risk factors for curve progression from initial curve were age (at diagnosis < 13 years), family history, bone mineral status (< 110 mg/cm in quantitative CT) and height velocity (7-8 cm/year, peak 11.6 ± 1.4 years). Relevant radiological criteria indicating curve progression included skeletal maturity, marked by Risser stages (Risser < 1) or Sanders Maturity Scale (SMS < 5), the initial extent of the Cobb angle (> 25° progression) and curve location (thoracic single or double curve). DISCUSSION:This systematic review summarised the current state of knowledge as the basis for creation of patient-specific algorithms regarding a risk calculation for a progressive scoliotic deformity. Curve magnitude is the most relevant predictive factor, followed by status of skeletal maturity and curve location.
10.1007/s00586-021-06817-0
Effects of 3D Postural Correction and Abdominal Muscle Contraction on the Symmetry of the Transverse Abdominis and Spinal Alignment in Patients with Idiopathic Scoliosis.
International journal of environmental research and public health
This study aimed to investigate the effectiveness of 3D postural correction (3DPC) using corrective cushions (CCs) and abdominal muscle contraction (AMC) on the thickness symmetry of the transversus abdominis (TrA) and spinal alignment in patients with idiopathic scoliosis (IS). In the first experiment, ultrasound measurements were taken of the TrA thickness on both the convex and concave sides of the lumbar curve in the supine position during AMC and non-AMC without 3DPC, and during AMC and non-AMC with 3DPC using CCs, in 11 IS patients. In the second experiment, 37 IS patients participated in a four-week 3DPC exercise program that aimed to maintain TrA thickness symmetry based on the results of the first experiment. The study found that TrA thickness symmetry significantly increased after 3DPC using CCs and combined with AMC ( < 0.05). Additionally, the Cobb angles and trunk rotation angles showed significant decreases, and trunk expansion showed a significant increase ( < 0.05). These results indicate that the simultaneous application of 3DPC and AMC is the most effective way to achieve TrA thickness symmetry in IS patients. Therefore, 3DPC and AMC should be considered as crucial elements in exercise interventions for IS patients.
10.3390/ijerph20065016
Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis. A systematic review.
Ceballos Laita Luis,Tejedor Cubillo Cristina,Mingo Gómez Teresa,Jiménez Del Barrio Sandra
Archivos argentinos de pediatria
The objective of this study was to determine the effects of corrective, therapeutic exercise techniques on subjects with adolescent idiopathic scoliosis. A systematic review was conducted by searching the Cochrane Library Plus, Pubmed, PEDro, and SCOPUS databases. Studies in patients diagnosed with adolescent idiopathic scoliosis that considered corrective, therapeutic exercise as an independent outcome measure and symptoms, functional capacity, Cobb's angle and/or other angles or body asymmetries as dependent outcome measures were included. A total of 9 controlled clinical trials that carried out corrective, therapeutic exercise were included. Corrective, therapeutic exercise appears to have positive effects by reducing symptoms and improving function, as well as various angles and body asymmetries. However, further studies with better methodological quality are required to confirm these outcomes and determine the best therapeutic exercise intervention.
10.5546/aap.2018.eng.e582
Regional disparity in epidemiological characteristics of adolescent scoliosis in China: Data from a screening program.
Frontiers in public health
Objective:We investigated regional disparities in rates of scoliosis among adolescents in western and eastern China and the dominant factors underlying these disparities. Methods:This cross-sectional study used data from a school scoliosis screening program conducted in two typical areas: Yangpu District of Shanghai (eastern China) and Tianzhu Tibetan Autonomous County of Gansu Province (western China), during October 2020 to February 2021. Participants included adolescents aged 12-16 years (4,240 in Shanghai and 2,510 in Gansu Province). School scoliosis screening data were obtained on age, sex, height, weight and BMI, and region as well. We screened angles of trunk rotation in level of proximal thoracic (T1-T4), main thoracic (T5-T12), and lumbar (T12-L4) by the forward bend test with scoliometer. An angle of trunk rotation ≥5° was used as the criterion to identify suspected scoliosis. Results:The proportion of suspected scoliosis was lower in Shanghai (6.9%) than in Gansu (8.6%). Angle of trunk rotation tended to increase with age in Shanghai, peaking at 15 years, but decreased with age in Gansu, and bottomed at 15 years. The angle of trunk rotation in the proximal thoracic, main thoracic, and lumbar part of the spine appeared to be larger in Gansu adolescents and in Shanghai female adolescents. Age was a relevant factor in angle trunk rotation in regression models and interacted with region as well. Conclusion:We found regional and age- and sex-related disparities in rates of suspected scoliosis.
10.3389/fpubh.2022.935040
Benefits on pain and mental health of manual therapy for idiopathic scoliosis: A meta-analysis.
Frontiers in endocrinology
Background:Idiopathic scoliosis (IS) is a common spinal disorder. Although several studies have reported the benefits of manual therapy for patients with IS in improving pain, anxiety, depression, and spinal disorders, the efficacy of manual therapy in the management of IS remain controversial. Therefore, this review was conducted to assess effects of manual therapy in the management of IS, primarily on pain and mental health of the patients and secondarily on their spinal disorders. Methods:Six electronic databases were searched for randomized controlled trials of manual therapy in the management of IS. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale. The meta-analysis was conducted depending on different outcomes and control therapies using Review Manager version 5.3 software. Results:Seventeen studies were included in the present review. The PEDro scores of the included studies ranged from 5-7 points. The aggregated results indicated that Tuina (a traditional Chinese manipulation technique) had valuable improvement effects on pain (standardized mean difference (SMD), 0.92; 95% confidence interval (CI), 0.59 to 1.25; <0.00001), negative emotions (SMD, 0.82; 95% CI, 0.51 to 1.13; <0.00001), and disability (SMD, 1.29; 95% CI, 0.39 to 2.19; =0.005). For the radiographic outcomes including the Cobb angle and vertebral rotation, Tuina, especially when combined with other conservative therapies, showed potential complementary effects for patients with IS. Conclusions:Tuina, as a complementary and alternative therapy, should be considered for the effective management of patients with IS, especially for the improvement of their pain and mental health. More randomized controlled trials are recommended to validate the current evidence. Systematic review registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42020165220.
10.3389/fendo.2022.1038973
Brain oscillatory activity in adolescent idiopathic scoliosis.
Scientific reports
Pathophysiology of Adolescent Idiopathic Scoliosis (AIS) is not yet completely understood. This exploratory study aims to investigate two aspects neglected in clinical practice: a defective postural central nervous system control in AIS, and alterations of body schema due to scoliosis spinal deformities. We recorded EEG data and balance data in four different standing positions in 14 adolescents with AIS and in 14 controls. A re-adaptation of the Image Marking Procedure (IMP) assessed body schema alterations on the horizontal (Body Perception Indices (BPIs)) and vertical direction (interacromial and bisiliac axes inclinations). Our results revealed no differences in balance control between groups; higher EEG alpha relative power over sensorimotor areas ipsilateral to the side of the curve and a significant increase of theta relative power localized over the central areas in adolescents with AIS. The difference in BPI shoulder and BPI waist significantly differed between the two groups. The inclinations of the perceived interacromial axes in adolescents with AIS was opposite to the real inclination. Increased theta activity and alpha lateralization observed may be a compensatory strategy to overcome sensorimotor dysfunction mirrored by altered body schema. Scoliosis onset might be preceded by sensorimotor control impairments that last during curve progression.
10.1038/s41598-022-19449-1
Prevalence and determinants of adolescent idiopathic scoliosis from school screening in Huangpu district, Shanghai, China.
American journal of translational research
OBJECTIVE:To identify the prevalence of adolescent idiopathic scoliosis (AIS) and potential disease-related factors in children aged 11 to 16 years in the Huangpu district, Shanghai, China. METHODS:A total of 10,731 children (5,518 boys and 5,213 girls) were screened in the year of 2019. The screening process included a bending forward test and scoliometer measurements. The children who were deemed to be at risk for scoliosis from the screening were referred for a X-ray examination to confirm the diagnosis. Data from basic and clinical characteristics of the screened children were collected. RESULTS:214 children (138 girls and 76 boys, P<0.05) were diagnosed with scoliosis with a prevalence of 2.00%. The mean angel was 15.61°. The groups with the highest prevalence were girls aged 14 and boys aged 15. CONCLUSION:The prevalence of AIS in Huangpu district, Shanghai, China is 2.00% and is moderatley high, and it can occur more often in female children.
Characteristics of the pelvic axial rotation in adolescent idiopathic scoliosis: a comparison between major thoracic curve and major thoracolumbar/lumbar curve.
Wang Zhi-Wei,Wang Wei-Jun,Sun Ming-Hui,Liu Zhen,Zhu Ze-Zhang,Zhu Feng,Qiu Xu-Sheng,Qian Bang-Ping,Wang Shou-Feng,Qiu Yong
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:As the biomechanical foundation of the spine, the pelvis was found to display rotation in the transverse plane in adolescent idiopathic scoliosis (AIS). However, the possible factors influencing the pelvic axial rotation (PAR) and its mechanism in patients with AIS remain unclear. PURPOSE:To characterize the PAR in AIS patients with right major thoracic (MT) or major left thoracolumbar/lumbar (TL/L) curve and to explore the associated influencing factors and probable mechanism of compensation by analyzing the association between PAR and other spinal radiographic parameters. STUDY DESIGN:Retrospective study. PATIENT SAMPLE:All patients with the primary diagnosis of AIS from January 2008 to November 2009 were retrieved from our scoliosis database. OUTCOME MEASURES:Age, Cobb angle, and apex rotation of the main curve and the compensatory curve, curve flexibility, and PAR. METHODS:One-hundred thirty-two patients with right MT (14.7±1.8 years, 48±6.9°) and 83 patients with left major TL/L (14.7±1.5 years, 46±6.6°) were retrospectively reviewed. On standing full-spine posteroanterior radiographs, the PAR was quantified by the left/right hemi-pelvis width ratio (L/R ratio); then the subjects in both MT and major TL/L groups were divided into two subgroups: L/R ratio ≤1 (pelvis rotated to the right, R-PAR group); and L/R ratio >1 (pelvis rotated to the left, L-PAR group). Comparisons of all variables were performed between the L- and R-PAR subgroups; correlation and regression analysis were carried out to identify the influencing factors of PAR. RESULTS:The majority of the MT and major TL/L patients (75.8% vs. 60.2%) displayed right pelvic rotation, which was in the same direction as the thoracic curve. The incidence of R-PAR was greater in the MT patients than the major TL/L ones (p=.016). Lumbar flexibility in MT patients with R-PAR was greater than in MT patients with L-PAR (0.96±0.27 vs. 0.81±0.33, p=.038), which was contrary to the findings in the major TL/L patients (L-PAR>R-PAR, 0.79±0.15 vs. 0.70±0.22, p=.024). In the MT patients with R-PAR, the L/R ratio showed significant positive correlations with the lumbar Cobb angle (r=0.424) as well as with the apex rotation (r=0.488), which was further identified as an influencing factor (R=0.418) of the PAR. Significant positive correlations between L/R ratio and thoracic apex rotation (r=0.361) also were detected. CONCLUSION:The majority of AIS patients with right MT or left major TL/L curves were found to have PAR to the right, in the same direction as the thoracic curve. The lumbar flexibility and apex rotation significantly influenced the PAR direction and magnitude. Moreover, the pelvis might be involved in compensation for the MT deformity through its connection with the lumbar spine.
10.1016/j.spinee.2013.10.036
Don't forget the pelvis: accounting for pelvic rotation in the preoperative assessment of adolescent idiopathic scoliosis.
Journal of spine surgery (Hong Kong)
BACKGROUND:Accurate radiographic assessment of adolescent idiopathic scoliosis (AIS) is crucial to achieving surgical correction, yet pelvic rotation may alter measurements. In Lenke Type 1/2 AIS patients, we conducted a pilot study to assess how pelvic rotation (i.e., the patient's position in the X-ray scanner) affected sagittal, coronal, and rotational measurements. METHODS:A retrospective, pilot study of Type 1/2 AIS patients was undertaken. Demographics and three-dimensional (3D) SterEOS imaging were obtained. Measurements were compared between two scenarios: (I) radio plane-patient's natural position in the scanner; and (II) patient plane-patient's position after correcting to the transverse plane. Sagittal, coronal, and rotational measurements were compared, including: thoracic kyphosis (TK), lumbar lordosis (LL), main thoracic (MT) and thoracolumbar/lumbar (TL-L) Cobb, and apical vertebral rotation (AVR) in the proximal thoracic (PT), MT, and TL/L regions. RESULTS:Of 15 patients, average age was 15.7 years and 67% were female. Average baseline pelvic obliquity was 4.0 mm and pelvis rotation was 5.1°. Significant differences were seen between the radio patient plane, respectively, in the following three measurements: TK, LL, and AVR: (I) TK (T1-12: 36.5° 32.8°, P=0.003; T4-12: 28.4° 22.7°, P<0.001); (II) LL (L1-5: 46.6° 42.8°, P=0.002; L1-S1: 58.2° 55.1°, P=0.003); (III) AVR (PT-AVR: 4.0° 8.2°, P=0.003; MT-AVR: -14.8° -10.5°, P=0.004; TL/L-AVR: (4.5° 8.7°, P=0.003). No significant differences were seen in coronal cobb angles. CONCLUSIONS:After accounting for pelvic rotation, sagittal and rotational measurements were significantly altered. These results have implications for measurement accuracy, surgical decision-making, and postoperative monitoring.
10.21037/jss-20-675
Leg length discrepancy in scoliotic patients.
D'Amico Moreno,Roncoletta Piero,Di Felice Francesca,Porto Daniele,Bellomo Rosagrazia,Saggini Raoul
Studies in health technology and informatics
The aetiological aspects as well as postural attitude implications represent an open question in scoliosis evaluation and treatment. Leg length discrepancy (LLD) is often recognised in scoliotic patients, but surprisingly still controversial is the use of underfoot wedge corrections in order to compensate pelvis tilt. In fact, literature reports conflicting results on the efficacy of LLD equalization also given the argued uncertainty of LLD clinical assessment and limitations related to X-ray measurements. Moreover concern is about anatomic and functional LLD and associated estimation of the pelvic torsion. In such a topic, a significant helpful tool has been demonstrated to be 3D kinematic optoelectronic measurements and other useful data obtained from force platforms and/or baropodographic systems. 135 (94.4%) out of 143 Scoliotic patients sample (av. age 16.4±10.2 Y range 4-66 Y), have been found to improve posture when LLD was corrected. The 143 patients showed a mean lower limb discrepancy of μ=10.2±5.2mm associated to a mean main scoliotic curve μ=16.4°±9.4° Cobb (frontal plane), mean Spinal offset μ=7.5±5.5mm and mean Global offset μ=10.1±7.1mm. The applied paired t-test comparison (indifferent vs. corrected orthostasis) showed significant (p < 0.05) postural improvements could be obtained in the whole or in a part of the considered postural parameters, after the application of suitable under-foot wedge. The present investigation confirm results of a previous study demonstrating the efficacy of under-foot wedge use in leg asymmetry correction, posture re-balancing and spine deformities reduction, pointing out the significant contribution of the 3D opto-electronic measurement approach in the critical process of assessing the correct under-foot wedge size, therapy planning and monitoring.
Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice.
International journal of environmental research and public health
Due to the multifactorial etiology of scoliosis, a comprehensive treatment plan is essential for conservative management. Physiotherapeutic scoliosis-specific exercise (PSSE) methods have lately gained popularity for the conservative treatment of scoliosis. The aim of this study was to analyze the PSSE methodologies used for conservative treatment of adolescent idiopathic scoliosis (AIS), as well as their effectiveness. The study was based on an extended literature search conducted in the PubMed, Google Scholar, PEDro, eLABA, and BioMed Central databases. A total of 123 articles were selected for this study (including articles overviewed in systematic reviews and meta-analyses) after applying the inclusion criteria. The study revealed that inappropriate management of AIS could result in serious health problems. Conservative interventions that aid in stabilizing spine curvature and improving esthetics are preferred for scoliosis treatment. Bracing has traditionally been the mainstay of treatment, but growing evidence suggests that PSSE physiotherapy allows effective management of idiopathic adolescent scoliosis. Currently, there are the following PSSE physiotherapy schools in Europe: Schroth, SEAS, BSPTS, FED, FITS, Lyon, Side Shift, and DoboMed. The methodologies of these schools are similar, in that they focus on applying corrective exercises in three planes, developing stability and balance, breathing exercises, and posture awareness. Although high-quality research supporting the effectiveness of PSSE physiotherapy in the treatment of AIS is lacking, existing evidence indicates that PSSE physiotherapy helps to stabilize spinal deformity and improve patients' quality of life. Among the abovementioned methodologies, Schroth is the most widely studied and has been proven to be effective. However, both SEAS and BSPTS effectively stabilize and even reduce the Cobb angle of scoliosis. Data supporting the validity of other methodologies are very limited. Only the Schroth method significantly reduces the angle of trunk rotation, while both SEAS and Schroth methods greatly improve the quality of life indicators. In any case, the available evidence is insufficient to confirm the advantage of one specific physiotherapy technique over others.
10.3390/ijerph19159240
Corrective exercise-based therapy for adolescent idiopathic scoliosis: Systematic review and meta-analysis.
Gámiz-Bermúdez Francisca,Obrero-Gaitán Esteban,Zagalaz-Anula Noelia,Lomas-Vega Rafael
Clinical rehabilitation
OBJECTIVE:to analyze the efficacy of Corrective exercise-based therapy in the improvement of deformity and quality of life in adolescent idiopathic scoliosis. DATA SOURCES:PubMed Medline, Scopus, Web of Science (WOS), Physiotherapy Evidence Database, CINAHL Complete and SciELO, until June 2021. REVIEW METHODS:Randomized controlled trials was selected, including participants diagnosed with adolescent idiopathic scoliosis, in which the experimental group received Corrective exercise-based therapy. Two authors independently searched the scientific literature in the data sources, extracted the data and assessed the risk of bias. A pairwise meta-analysis using the random-effects model was performed. RESULTS:Eight randomized controlled trials providing data from 279 adolescent idiopathic scoliosis patients were included. Seven randomized controlled trials including 236 patients showed moderate-quality evidence for a medium effect (SMD = -0.52, 95% CI -0.96 to -0.1), favoring corrective exercise-based therapy for spinal deformity reduction. Corrective exercise-based therapy was better than no intervention (SMD = -0.59, 95% CI -1.18 to -0.01) but similar to other intervention (SMD = -0.2, 95% CI -0.67 to 0.27), and a medium effect was found (SMD = -0.51, 95% CI -0.89 to -0.13) when corrective exercise-based therapy was used with other therapies. Four studies including 151 patients showed low-quality evidence of a large effect of Corrective exercise-based therapy on Scoliosis Research Society measurement (SRS-22) total score improvement (SMD = 1.16, 95% CI 0.36 to 1.95). CONCLUSION:In mild and moderate adolescent idiopathic scoliosis patients, corrective exercise-based therapy could be used to reduce spinal deformity and to improve quality of life as isolated treatment or as coadjuvant treatment combined with other therapeutic resources.
10.1177/02692155211070452
Complications of single growing rod constructs in the treatment of severe early-onset scoliosis: a lesson relearned.
Spine deformity
PURPOSE:Early-onset scoliosis (EOS) is one of the most challenging areas of orthopedic management. Previous studies have reported that EOS patients were associated with high risk of complications following growth-friendly surgery. This study was performed to evaluate the complications of single traditional growing rods (TGRs) in the treatment of EOS. METHODS:In a retrospective chart review study, medical records of all EOS patients treated with single TGRs between 2006 and 2018 were analyzed. Patients under the age of 10 at the time of surgery who had at least 24 months of follow-up were included. Intra- and post-operative complications included both device-related and disease-related complications. Statistical analysis was performed with SPSS. RESULTS:A total of 35 patients with a mean age of 5.7 ± 2.1 years with the mean follow-up duration of 33.3 ± 9.1 months were included in the final analysis. Of the 35 participants, 27 children (77.1%) experienced at least one complication. A total of 61 complications were observed, giving rise to 1.7 complications per patient. An unplanned surgical procedure was needed to manage 42 of the 61 complications (68.8%). Thirty-five cases of implant failure, 11 cases of deep infection, and 2 cases of junctional kyphosis were identified. CONCLUSION:It seems that even in the setting that the use of dual TGRs is not possible, the use of single TGRs as the only therapeutic modality should be minimized due to high rate of complications even as a bridge treatment. LEVEL OF EVIDENCE:Therapeutic level III.
10.1007/s43390-022-00554-0
Curve type, flexibility, correction, and rotation are predictors of curve progression in patients with adolescent idiopathic scoliosis undergoing conservative treatment : a systematic review.
The bone & joint journal
AIMS:The aim of this study was to review the current evidence surrounding curve type and morphology on curve progression risk in adolescent idiopathic scoliosis (AIS). METHODS:A comprehensive search was conducted by two independent reviewers on PubMed, Embase, Medline, and Web of Science to obtain all published information on morphological predictors of AIS progression. Search items included 'adolescent idiopathic scoliosis', 'progression', and 'imaging'. The inclusion and exclusion criteria were carefully defined. Risk of bias of studies was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. In all, 6,286 publications were identified with 3,598 being subjected to secondary scrutiny. Ultimately, 26 publications (25 datasets) were included in this review. RESULTS:For unbraced patients, high and moderate evidence was found for Cobb angle and curve type as predictors, respectively. Initial Cobb angle > 25° and thoracic curves were predictive of curve progression. For braced patients, flexibility < 28% and limited in-brace correction were factors predictive of progression with high and moderate evidence, respectively. Thoracic curves, high apical vertebral rotation, large rib vertebra angle difference, small rib vertebra angle on the convex side, and low pelvic tilt had weak evidence as predictors of curve progression. CONCLUSION:For curve progression, strong and consistent evidence is found for Cobb angle, curve type, flexibility, and correction rate. Cobb angle > 25° and flexibility < 28% are found to be important thresholds to guide clinical prognostication. Despite the low evidence, apical vertebral rotation, rib morphology, and pelvic tilt may be promising factors. Cite this article: 2022;104-B(4):424-432.
10.1302/0301-620X.104B4.BJJ-2021-1677.R1
Supine correction index as a predictor for brace outcome in adolescent idiopathic scoliosis.
The bone & joint journal
AIMS:The aim of this study was to assess the ability of morphological spinal parameters to predict the outcome of bracing in patients with adolescent idiopathic scoliosis (AIS) and to establish a novel supine correction index (SCI) for guiding bracing treatment. METHODS:Patients with AIS to be treated by bracing were prospectively recruited between December 2016 and 2018, and were followed until brace removal. In all, 207 patients with a mean age at recruitment of 12.8 years (SD 1.2) were enrolled. Cobb angles, supine flexibility, and the rate of in-brace correction were measured and used to predict curve progression at the end of follow-up. The SCI was defined as the ratio between correction rate and flexibility. Receiver operating characteristic (ROC) curve analysis was carried out to assess the optimal thresholds for flexibility, correction rate, and SCI in predicting a higher risk of progression, defined by a change in Cobb angle of ≥ 5° or the need for surgery. RESULTS:The baseline Cobb angles were similar (p = 0.374) in patients whose curves progressed (32.7° (SD 10.7)) and in those whose curves remained stable (31.4° (SD 6.1)). High supine flexibility (odds ratio (OR) 0.947 (95% CI 0.910 to 0.984); p = 0.006) and correction rate (OR 0.926 (95% CI 0.890 to 0.964); p < 0.001) predicted a lower incidence of progression after adjusting for Cobb angle, Risser sign, curve type, menarche status, distal radius and ulna grading, and brace compliance. ROC curve analysis identified a cut-off of 18.1% for flexibility (sensitivity 0.682, specificity 0.704) and a cut-off of 28.8% for correction rate (sensitivity 0.773, specificity 0.691) in predicting a lower risk of curve progression. A SCI of greater than 1.21 predicted a lower risk of progression (OR 0.4 (95% CI 0.251 to 0.955); sensitivity 0.583, specificity 0.591; p = 0.036). CONCLUSION:A higher supine flexibility (18.1%) and correction rate (28.8%), and a SCI of greater than 1.21 predicted a lower risk of progression. These novel parameters can be used as a guide to optimize the outcome of bracing. Cite this article: 2022;104-B(4):495-503.
10.1302/0301-620X.104B4.BJJ-2021-1220.R1
To tether or fuse? Significant equipoise remains in treatment recommendations for idiopathic scoliosis.
Spine deformity
PURPOSE:Vertebral body tethering (VBT) continues to grow in interest from both a patient and surgeon perspective for the treatment of scoliosis. However, the data are limited when it comes to surgeon selection of both procedure type and instrumented levels. This study sought to assess surgeon variability in treatment recommendation and level selection for VBT versus posterior spinal fusion (PSF) for the management of scoliosis. METHODS:Surgeon members of the Pediatric Spine Study Group and Harms Study Group were queried for treatment recommendations and proposed upper instrumented vertebra (UIV) and lower instrumented vertebra (LIV) selection for PSF and VBT based on 17 detailed clinical vignettes. Responses were subdivided in each clinical vignette according to surgeon experience and treatment recommendations with assessment of intra-rater reliability. Binomial distribution tests were used to establish equipoise, selecting p < 0.10 to indicate the presence of a treatment choice with consensus set > 70% agreement. For treatment choice, responses were assessed first for consensus on the decision to proceed with PSF or VBT. RESULTS:Thirty-five surgeons with varied experience completed the survey with 26 surgeons (74%) completing the second follow-up survey. Overall, VBT was the recommended treatment by 47% of surgeons, ranging by clinical vignette. Consensus in treatment recommendation was present for 6 clinical vignettes including 3 for VBT and 3 for PSF, with equipoise present for the remaining 11. Of the 17 vignettes, 12 demonstrated moderate intra-observer reliability including the 3 consensus vignettes for VBT. Sanders stage ≤ 3 and smaller curve magnitude were related with VBT recommendation but neither age nor curve flexibility significantly influenced the decision to recommend VBT. Surgeons with high VBT volume, ≥ 11 VBT cases/year, were more likely to recommend VBT than those with low volumes (0-10 cases per year (p < 0.0001)). High VBT volume surgeons demonstrated consensus in VBT recommendation for Lenke 5/6 curves (75% mean recommendation). High VBT volume surgeons had a significantly higher VBT recommendation rate for Lenke 1A, 2A curves (71.8% vs 48.0%, p = 0.012), and Lenke 3 curves (62% vs 26.9%, p = 0.023). Equipoise was present for all vignettes in low volume surgeons. In addition, high VBT volume surgeons trended toward including more instrumented levels than low VBT volume surgeons (7.17 vs 6.69 levels). CONCLUSION:Significant equipoise is present among pediatric spine surgeons for treatment recommendations regarding VBT and PSF. Surgeon-, patient-, and curve-specific variables were identified to influence treatment recommendations, including surgeon experience, curve subtype, deformity magnitude, and skeletal maturity. This study highlights the need for continued research in identifying the optimal indications for VBT and PSF in the treatment of pediatric spinal deformity.
10.1007/s43390-022-00497-6
Analysis of the prevalence of asymmetry and muscle tone disorders in the first year of life among youth with idiopathic scoliosis: A retrospective case-control study.
Journal of back and musculoskeletal rehabilitation
BACKGROUND:Not much is known about developmental motor disorders in the first year of life of children diagnosed with idiopathic scoliosis (IS). OBJECTIVE:This study aimed to compare the occurrence of asymmetry or muscle tone disorders in the first year of life in adolescents with IS and their healthy counterparts. METHODS:The parents of adolescents with IS and without scoliosis completed a survey on the occurrence of asymmetry, abnormal muscle tone, and physiotherapy in their children in the first year of life. Pearson's chi square test and Cramer's coefficient were used. RESULTS:The final analysis included 527 surveys completed by parents of adolescents with idiopathic scoliosis (150) and without scoliosis (377). A significantly higher frequency of asymmetry (p= 0.001) and muscle tone disorders (p= 0.001) was noted in adolescents with idiopathic scoliosis. The results also revealed a significant association between scoliosis and asymmetry (p= 0.001), as well as muscle tone (p= 0.001). CONCLUSIONS:Developmental asymmetry or improper muscle tone in the first year of life could be considered a potential factor in the development of scoliosis; however, this hypothesis should be confirmed in future studies. Infants diagnosed with developmental disorders require systematic observation.
10.3233/BMR-171075
Clinical Validation of the Differences Between Two-Dimensional Radiography and Three-Dimensional Computed Tomography Image Measurements of the Spine in Adolescent Idiopathic Scoliosis.
World neurosurgery
OBJECTIVE:The purpose of this study was to investigate differences between measurements of spine on two-dimensional (2D) radiography and three-dimensional (3D) computed tomography (CT) images taken of patients with adolescent idiopathic scoliosis. METHODS:Standard preoperative CT images and posteroanterior (PA) and lateral radiography images were collected prospectively from 43 patients with adolescent idiopathic scoliosis in whom selective spinal fusions were performed. The parameters of interest were the thoracic Cobb angle, lumbar Cobb angle, T4-T12 kyphosis angle, and L1-S1 lordosis (LL) angle. The parameters were measured using 3 separate methods: 3D measurement of CT images (3D measurement), 2D measurement of radiography images (2D measurement), and 2D measurement of radiography images generated by the projection of CT images (2D XP measurement). Significant differences among the results were assessed by comparison T test. RESULTS:The mean difference between the 2D and 2D XP measurements for the thoracic Cobb, lumbar Cobb, T4-T12 kyphotic, and L1-S1 lordotic angles was 8.38°, 7.67°, 8.77°, and 10.18°, respectively. The mean difference between the 2D XP and 3D measurements was -2.81°, -2.78°, -1.29°, and -2.36°, respectively. The mean difference between the 2D and 3D measurements was 5.16°, 4.51°, 6.49°, and 7.37°, respectively. The results showed significant differences (P < 0.05) among the spinal parameters measured using the 2D, 2D XP, and 3D measurement methods on both the coronal and sagittal plane. CONCLUSIONS:Significant differences among the 2D, 2D XP, and 3D measurement methods were observed on both the sagittal plane and coronal plane of the scoliotic spines as a result of variations in posture during imaging and differences in measurement methods.
10.1016/j.wneu.2022.06.128
Effect of Short-Term 3-Dimensional Schroth Exercises In Adolescent Idiopathic Scoliosis: An Observational Study.
Journal of manipulative and physiological therapeutics
OBJECTIVE:The purpose of this study was to examine how a short-term Schroth exercise camp affects pain intensity, angle of trunk rotation (ATR), postural recovery, trunk muscle endurance, flexibility, dynamic balance, body image, perception of cosmetic deformity, and health-related quality of life in individuals with adolescent idiopathic scoliosis (AIS). METHODS:A single-group pretest-posttest design was conducted. Forty-five individuals between the ages of 10 and 18 years who were diagnosed with AIS were included in the study. ATR with scoliometer, postural symmetry changes with Anterior Trunk Symmetry Index and Posterior Trunk Symmetry Index, trunk muscle endurance with straight plank and side plank durations, dynamic balance with Y Balance Test, cosmetic deformity perceptions with the Walter Reed Visual Assessment Scale, and health-related quality of life with the Scoliosis Research Society 22-item questionnaire. The participants engaged in a short-term Schroth exercise camp involving 4.5 hours of corrective exercises per day for 7 days. Above mentioned assessments were done on the first and last day of the exercise camp. RESULTS:After the Schroth exercise camp, participants showed decreased ATR, improved postural symmetry ratio, and greater trunk muscle endurance and dynamic balance scores. There were also improvements in cosmetic deformity perception and health-related quality of life (P < .05). CONCLUSION:This preliminary study suggests that a short-term Schroth exercise camp could have a beneficial effect for adolescents with AIS. Although the results of this study should be considered preliminary, the initial findings seem to be promising and repeatable.
10.1016/j.jmpt.2022.02.001
Risk Factors for Lateral Translation in Residual Adolescent Idiopathic Scoliosis with a Thoracolumbar/Lumbar Curve.
Spine surgery and related research
Introduction:Although lateral vertebral translation is associated with inducing curve progression and pain, no study has analyzed risk factors for lateral slip in patients with residual adolescent idiopathic scoliosis (AIS). This study aimed to investigate risk factors for lateral slip in patients with residual AIS. Methods:We included 42 preoperative patients with residual AIS with a thoracolumbar/lumbar (TL/L) curve (3 male, 39 female; age 41.9±18.2 years, TL/L Cobb angle 55.5±10.0°). All patients were >20 years and had been diagnosed with AIS during their adolescence. Lateral slip was defined as more than a 6-mm slip on coronal CT images. Results:Patients were divided into slip (n=22) and nonslip (n=20) groups. Significant differences were observed in age, TL/L Cobb angle, TL/L curve flexibility, lumbar lordosis, thoracolumbar kyphosis, apical vertebral rotation, apical vertebral translation, and L3 and L4 tilt between the groups. Multivariate analyses and receiver operating characteristic curves found that only older age was a significant risk factor for lateral slip (odds ratio: 1.214; 95% confidence interval: 1.047-1.407; =0.010), with a cutoff value of 37 years old. Conclusions:Older age, especially >37 years, is a risk factor for lateral slip in patients with residual AIS. These findings suggest that surgery for residual AIS should be considered before patients are in their mid-30s to avoid lateral translation.
10.22603/ssrr.2021-0176
Cervical and thoracic/lumbar motion and muscle strength in surgically treated adolescent idiopathic scoliosis patients.
Journal of back and musculoskeletal rehabilitation
BACKGROUND:To date, only one study assessed the spinal mobility and muscle strength of patients who were treated either with fusion or brace treatment. OBJECTIVE:The aim of this retrospective study was to evaluate the range of motion (ROM) and strength of the cervical and thoracic/lumbar spine in patients who underwent spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) in comparison to healthy individuals. METHODS:Patients (n= 28) who were treated surgically for AIS were included in the study. An age and gender matched control group (n= 22) was included that consisted of healthy individuals. DAVID® Lumbar/Thoracic Extension, Lumbar/Thoracic Rotation, and Cervical Extension/Lateral Flexion devices were used to measure cervical and lumbar/thoracic ROM as well as muscle strength. RESULTS:Significant differences were observed between groups in all ROM measurements except thoracic/lumbar sagittal flexion ROM measurement (p= 0.198). There were significant differences between groups in terms of muscle strength, except thoracic lumbar left rotation strength (p= 0.081). CONCLUSIONS:The findings of the current study demonstrated that cervical and thoracic/lumbar range of motion, as well as muscle strength, were significantly decreased in surgically treated adolescent idiopathic scoliosis patients compared to healthy counterparts. However, trunk (thoracic/lumbar) flexion range of motion and trunk left rotation muscle strength were not significantly different.
10.3233/BMR-210303
Moiré topography as a screening and diagnostic tool-A systematic review.
PloS one
Diagnostic investigation can be carried out using non-radiological and non-contact methods. Moiré topography (MT) seems to be a viable alternative to radiographic research in evaluating the spine and/or trunk deviations. The aim of this systematic review was to analyze the current knowledge regarding the reliability and validity of Moiré topography as a screening and diagnostic tool. The systematic review was performed from 2010 until March 2021 in the PubMed, EBSCO, Web of Science, and Scopus databases, according to the eligibility criteria. This review fulfilled the following criteria according to the PICO system: population (children and adolescents), intervention (MT measurement), comparison (repeated MT measurements, MT compared to Cobb angle or scoliometer), outcome (reliability and validity of MT). Eight studies fulfilled the inclusion criteria for further analysis. All the studies were assessed to be of high quality. Included studies found that MT had high repeatability and high intraobserver and interobserver correlation, and correlation between MT parameters and radiographic Cobb angle ranged from moderate to high. The authors reported difficulty in defining the cut-off values for MT parameter (Surface Trunk Rotation-STR), and unsatisfactory sensitivity and specificity of MT examination. The studies did not reveal the advantage of MT as a screening method in the detection of idiopathic scoliosis in comparison to radiograph. Based on the evidence from eight studies, the results indicated moderate evidence for reliability and validity of Moiré topography as a screening and diagnostic tool. There is still no strong evidence for the accuracy of MT.
10.1371/journal.pone.0260858
Spinal sagittal alignment and postoperative adding-on in patients with adolescent idiopathic scoliosis after surgery.
Orthopaedics & traumatology, surgery & research : OTSR
INTRODUCTION:Surgery for patients with adolescent idiopathic scoliosis (AIS) may change spinal sagittal alignment, and postoperative adding-on may affect spinal sagittal balance after reconstruction. This study was to investigate the effect of surgery on spinal sagittal alignment and the relationship between postoperative adding-on and spinal sagittal balance in patients with AIS. HYPOTHESIS:The hypothesis of this study was that the effect of surgery on AIS was associated with recovery of the spinal sagittal plane and that presence of postoperative adding-on might affect the spinal sagittal balance. Materials and methods This retrospective study enrolled 22 patients who received surgical treatment. Clinical, imaging and follow-up data were analyzed. RESULTS:After surgery, T1 slope (T1S) and thoracic kyphosis (TK) were significantly (P<0.05) lower in patients with postoperative adding-on (16.73°±6.12° for T1S and 28.95°±11.3° for TK) than those without adding-on (24.82°±8.59° for T1S and 40.29°±12.08° for TK). At the last follow-up, cervical lordosis (CL), T1S, and TK were significantly (P<0.05) lower in patients with adding-on (3.05°±11.41° for CL, 22.12°±3.68° for T1S, and 37.89°±8.97° for TK) than those without adding-on (15.94°±°13.6 for CL, 28.86°±4.26° for T1S, and 47.64°±7.1° for TK). The Cobb angle was significantly (19.65°±8.69° vs. 50.66°±11.46°; P<0.001) decreased after compared with that before surgery. At the final follow-up, the Cobb angle (26.48°±9.61° vs. 19.65°±8.69°, P<0.001), T1S (24.87°±5.11° vs. 20.04°±8.13°), and TK (41.88°±9.45° vs 33.53°±12.71°) all significantly (P<0.01) increased compared with those immediately after surgery. The Cobb angle significantly (26.48°±9.61° vs. 50.66°±11.46°, P<0.001) decreased while CL, T1S, and TK all significantly (8.32°±13.67° vs 2.47°±14.42° for CL, T1S 24.87°±5.11° vs. 21.28°±5.88° for T1S, and 41.88°±9.45° vs. 33.13°±10.97° for TK, P<0.05) increased at the final follow-up compared with those before surgery. DISCUSSION:Surgery affects spinal sagittal alignment, and postoperative adding-on may affect spinal sagittal balance after reconstruction. Surgery as the ultimate approach for AIS has good effects but may result in some side effects. LEVEL OF PROOF:III, retrospective cohort study.
10.1016/j.otsr.2022.103352
Computerized-Assisted Scoliosis Diagnosis Based on Faster R-CNN and ResNet for the Classification of Spine X-Ray Images.
Computational and mathematical methods in medicine
In order to reduce the subjectivity of preoperative diagnosis and achieve accurate and rapid classification of idiopathic scoliosis and thereby improving the standardization and automation of spinal surgery diagnosis, we implement the Faster R-CNN and ResNet to classify patient spine images. In this paper, the images are based on spine X-ray imaging obtained by our radiology department. We compared the results with the orthopedic surgeon's measurement results for verification and analysis and finally presented the grading results for performance evaluation. The final experimental results can meet the clinical needs, and a fast and robust deep learning-based scoliosis diagnosis algorithm for scoliosis can be achieved without manual intervention using the X-ray scans. This can give rise to a computerized-assisted scoliosis diagnosis based on X-ray imaging, which has strong potential in clinical utility applied to the field of orthopedics.
10.1155/2022/3796202
The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. METHODS:Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. RESULTS:The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. CONCLUSION:The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.
10.1007/s00586-022-07131-z
Analysis of Posture Parameters in Patients with Idiopathic Scoliosis with the Use of 3D Ultrasound Diagnostics-Preliminary Results.
International journal of environmental research and public health
(1) Background: Idiopathic scoliosis occurs in 2 to 4% of children between 10 and 16 years of age. Due to the harmfulness of radiological examination, non-invasive devices, including the 3D ultrasound technology and Scolioscan apparatus, are more and more frequently used for postural diagnostics. The aim of the study was to analyze the parameters of posture in patients with idiopathic scoliosis with the use of 3D ultrasound diagnostics. (2) Methods: The study included 20 girls, aged 10 to 16 years, with double-curve idiopathic scoliosis (the value of primary curve ranged from 25-50°), types I and II according to King-Moe classification. On the basis of X-ray scan, the Cobb angle of primary and secondary curves was assessed, the skeletal maturity was evaluated with the Risser test, and the type of scoliosis was determined. The girls participated in a 3-week rehabilitation program. The examinations were performed before and after therapy. A scoliometer was used for measurements. Each of the participants underwent individual therapy. The three-plane approach to asymmetric exercises was based largely on positions that included primary curve correction with hypercorrection of the secondary curve. (3) Results: After the therapy, values of trunk rotation angles and the angle of scoliotic curvature of secondary curve were significantly lower than before the therapy, except for the value of the primary curve angle. The parameters measured by X-ray were significantly and positively related to the results obtained with the scoliometer and the scolioscan. (4) Conclusions: The application of therapy that takes into account summing parameters may prevent the deterioration of the secondary curve when treating patients with idiopathic scoliosis. The observed correlations between the parameters of the radiological examination, the scoliometer, and the scolioscan prove the possibility of their interchangeable application in the assessment of effects of the therapy. Three-dimensional ultrasound diagnostics may become an alternative to radiological examination in assessing the treatment effects of patients with idiopathic scoliosis.
10.3390/ijerph19084750
A comparison of the reliability and vulnerability of 3D sterEOS and 2D EOS when measuring the sagittal spinal alignment of patients with adolescent idiopathic scoliosis.
Spine deformity
PURPOSE:An essential component of making the diagnosis of adolescent idiopathic scoliosis (AIS) is standing anteroposterior and lateral radiographs. Two-dimensional (2D) radiographs inevitably fail to reflect every plane of the three-dimensional (3D) deformity in scoliosis. We have tested the hypothesis that there is no difference in the assessment of the sagittal plane deformity when measured with either 2D or 3D EOS radiography. METHODS:A retrospective radiographic analysis was performed on patients diagnosed with AIS, with subdivided into three groups according to the coronal angular deformity (mild group: 45°-69°, moderate group: 70°-89°, and severe group: 90° +). The sagittal parameters were compared between manual measurement with 2D sterEOS and those made using computer-aided 3D reconstruction. RESULTS:Fifty-two patients were included in each group. The inter-study reliability when measuring the thoracic Kyphosis (TK) and lumbar lordosis (LL) between the two study modalities was excellent in mild group (ICC: 0.90, 95% CI 0.82 ~ 0.94 and ICC: 0.84, 95% CI 0.74 ~ 0.91), excellent in TK and fair in LL in moderate group (ICC: 0.76, 95% CI 0.61 ~ 0.85 and ICC: 0.70, 95% CI 0.53 ~ 0.81), and fair in TK and LL in severe group, respectively (ICC: 0.74, 95% CI 0.57 ~ 0.84 and ICC: 0.65, 95% CI 0.46 ~ 0.84). A Bland-Altman plot showed proportional bias in TK measurements in each group and LL in moderate group, which means the measured value is underestimated in 2D method when the angle is small. CONCLUSION:3D sterEOS is less vulnerable to the influence of coronal plane than 2D EOS in evaluating the sagittal spinal parameters of patients with a coronal deformity exceeding 70°. LEVEL OF EVIDENCE: 4:
10.1007/s43390-022-00499-4
Semi-automatic ultrasound curve angle measurement for adolescent idiopathic scoliosis.
Yang De,Lee Timothy Tin-Yan,Lai Kelly Ka-Lee,Lam Tsz-Ping,Chu Winnie Chiu-Wing,Castelein René Marten,Cheng Jack Chun-Yiu,Zheng Yong-Ping
Spine deformity
PURPOSE:Using X-ray to evaluate adolescent idiopathic scoliosis (AIS) conditions is the clinical gold standard, with potential radiation hazards. 3D ultrasound has demonstrated its validity and reliability of estimating X-ray Cobb angle (XCA) using spinous process angle (SPA), which can be automatically measured. While angle measurement with ultrasound using spine transverse process-related landmarks (UCA) shows better agreed with XCA, its automatic measurement is challenging and not available yet. This research aimed to analyze and measure scoliotic angles through a novel semi-automatic UCA method. METHODS:100 AIS subjects (age: 15.0 ± 1.9 years, gender: 19 M and 81 F, Cobb: 25.5 ± 9.6°) underwent both 3D ultrasound and X-ray scanning on the same day. Scoliotic angles with XCA and UCA methods were measured manually; and transverse process-related features were identified/drawn for the semi-automatic UCA method. The semi-automatic method measured the spinal curvature with pairs of thoracic transverse processes and lumbar lumps in respective regions. RESULTS:The new semi-automatic UCA method showed excellent correlations with manual XCA (R = 0.815: thoracic angles R = 0.857, lumbar angles R = 0.787); and excellent correlations with manual UCA (R = 0.866: thoracic angles R = 0.921, lumbar angles R = 0.780). The Bland-Altman plot also showed a good agreement against manual UCA/XCA. The MADs of semi-automatic UCA against XCA were less than 5°, which is clinically insignificant. CONCLUSION:The semi-automatic UCA method had demonstrated the possibilities of estimating manual XCA and UCA. Further advancement in image processing to detect the vertebral landmarks in ultrasound images could help building a fully automated measurement method. LEVEL OF EVIDENCE:Level III.
10.1007/s43390-021-00421-4
Lumbopelvic postural differences in adolescent idiopathic scoliosis: A pilot study.
Gait & posture
BACKGROUND:A primary etiology of adolescent idiopathic scoliosis (AIS) is currently unknown, but poor postural control of the spinal extensor musculature has been identified as an AIS risk factor. Identifiable postural differences would aid in advancing the precise postural behaviors that should be modified during Physiotherapy Scoliosis Specific Exercise (PSSE) to help limit the progression of AIS. RESEARCH QUESTION:Are there any determinable differences in lumbopelvic posture or range of motion between subjects with AIS and controls? METHODS:This prospective cohort pilot study consisted of 53 subjects (27 AIS and 26 control) aged 11-17 years. Subjects had their lumbopelvic posture assessed and monitored using the ViMove DorsaVi sensor package. All subjects underwent a live assessment to obtain initial lumbopelvic (LP) range of motion (ROM) measurements. Subjects were then monitored while continuing with normal activities of daily living (ADLs) for 12 h. With an alpha level of 0.05, nonparametric analyses were performed for each variable via a Mann-Whitney U-test. RESULTS:During the live assessment, controls exhibited a significantly greater anterior pelvic tilt ROM in the sitting position than the AIS group (p = 0.0433). When compared to female controls, females with AIS had a sitting pelvic tilt ROM that was significantly more retroverted (p = 0.0232) and less anteverted (p = 0.0010). During ADLs, female controls exhibited a higher total number of extension events than their female with AIS (p = 0.0263). These associations did not strengthen with greater spinal deformity. SIGNIFICANCE:This work demonstrates postural differences between patients with AIS and controls. Further study is necessary to determine why patients with AIS adopt these postures, and if PSSEs can be utilized to limit the progression of AIS.
10.1016/j.gaitpost.2022.01.002
Three-dimensional corrective exercise therapy for idiopathic scoliosis: study protocol for a prospective non-randomized trial.
BMC musculoskeletal disorders
BACKGROUND:Although physiotherapeutic scoliosis-specific exercises (PSSEs) with or without other conservative treatments may improve scoliotic deformities, the evidence is insufficient. Three-dimensional corrective exercises (TDCEs) for scoliosis are based on the theory of PSSEs and are characterized by a combination of outpatient treatment and home-based exercise. This study aims to evaluate the effectiveness of TDCEs for idiopathic scoliosis (IS). METHODS:The participants will be divided into two age- and sex-matched groups: an experimental group (EG) treated with three-dimensional corrective exercise therapy (TDCET) and a control group (CG) receiving generalized exercise therapy. In each arm, mild and moderate IS cases will be reclassified based on the Cobb angle and biopsy results. The primary endpoint is the change in the largest Cobb angle; the secondary endpoints are the sagittal index, forced vital capacity, peak oxygen uptake, and peak oxygen uptake. Sixty-six patients with mild IS and 78 patients with moderate IS will be included. DISCUSSION:This study is the first controlled trial to systematically assess the effectiveness of TDCEs for IS. In addition to TDCET including three-dimensional corrective exercises, family rehabilitation and basic body awareness therapy may help patients adopt supportive attitudes and appropriate behaviours, thus enhancing their compliance with exercises and achieving better outcomes. TRIAL REGISTRATION:The study protocol was registered at www.clinicaltrials.gov (number identifier: NCT04539522 ). Registered on August 27, 2020.
10.1186/s12891-022-05057-7
Does exercise therapy improve pulmonary function in patients with Adolescent Idiopathic Scoliosis?
Physiotherapy theory and practice
INTRODUCTION:Exercise therapy is frequently used for treating patients with Adolescent Idiopathic Scoliosis (AIS) however no previous review has evaluated the effect of exercise therapy on pulmonary function in this population. OBJECTIVE:To systematically analyze the literature on the effect of exercise therapy on pulmonary function in patients with AIS. METHODS:A systematic electronic database search (CINAHL, Embase, Medline, Web of Science) was conducted. Manual searches of key reviews and studies were also conducted. Studies that included exercise-based interventions to improve pulmonary function in patients with AIS and reported pre- and post-intervention pulmonary function test scores were included. Test scores were compared using standardized mean difference (SMD) between intervention and control groups in randomized control trials (RCT) and mean ± SD between pre- and post-intervention in prospective intervention studies (PI). Methodological quality was assessed using a modified Downs and Black checklist. RESULTS:Fifteen studies met the inclusion criteria (six RCTs and nine PIs). Results indicated the positive effect of exercise-based therapy on lung volumes (FVC/VC) and FEV in patients with AIS. CONCLUSION:Exercise therapy has a positive effect on lung volumes in patients with AIS. The quality of many studies was only 'fair,' therefore more suitably powered higher level clinical trials are required.
10.1080/09593985.2022.2034198
Reliability and validity of Chinese version of brace questionnaire for adolescent idiopathic scoliosis: A cross-sectional study.
Medicine
ABSTRACT:There is an increasing concern about the impact of bracing on the quality of life (QoL) of patients with adolescent idiopathic scoliosis (AIS). However, up to now, few multidimensional questionnaires on this impact are available in China. This study aimed to evaluate the reliability and validity of the Chinese version of Brace Questionnaire (C-BrQ).The BrQ was translated from Greek into Chinese with proper cross-cultural adaptation.An observational, cross-sectional study in Chinese patients with AIS was conducted to measure the temporal stability of C-BrQ using the intraclass correlation coefficient (ICC). The effects of ceiling and floor were evaluated and the reliability was verified by examining the internal consistency. The C-BrQ domains were compared with the domains in Chinese version of Scoliosis Research Society-22 Outcomes Questionnaire (C-SRS-22) using Pearson correlation coefficient to assess the concurrent validity.A total of 208 patients were included in the study. The results of test-retest reliability for each dimension of C-BrQ were desirable. The floor or ceiling effects were not demonstrated in the C-BrQ and C-SRS-22. Satisfactory internal consistency was found in all the C-BrQ domains. Most C-BrQ and C-SRS-22 domains showed satisfactory correlation coefficients, except when vitality and school activity in C-BrQ were compared with self-image, mental health, and management satisfaction in C-SRS -22, respectively.C-BrQ is reliable in evaluating the QoL of AIS patients receiving brace treatment.
10.1097/MD.0000000000026965
Role of differentially expressed LBX1 in Adolescent Idiopathic Scoliosis (AIS) paraspinal muscle phenotypes and muscle-bone crosstalk through modulating myoblasts.
Studies in health technology and informatics
AIS is three-dimensional spinal deformity with unclear etiopathogenesis. LBX1 is so far the only multi-centers validated AIS predisposing gene. The imbalance of posterior paraspinal muscles is an important factor in AIS etiopathogenesis. It is poorly understood how LBX1 contributes to the abnormal paraspinal muscles and onset/progression of AIS. We aimed to evaluate the expression of LBX1 in paraspinal muscles at the concave and convex side in AIS, and whether alternation of LBX1 expression could affect myoblastsactivities and potentially influence muscle-bone interaction via myokines expression. Paraspinal muscles from AIS and age- and curvature-matched congenital scoliosis (CS) patients were collected for fiber types analysis. Biopsies were also subjected to qPCR to validate expression of myogenic markers, selected myokines and LBX1. Human skeletal muscle myoblast (HSMM) was used for LBX1 loss-of-function study in vitro. Muscle fiber types analysis showed type I and type IIX/IIAX fibers proportion were significantly different between AIS concave and convex but not in two sides of CS. LBX1, myogenic markers and one myokine were significantly imbalanced in AIS but not in CS. Loss-of-function study showed knockdown of LBX1 could inhibit myogenic markers expression and myokines as well. This study provides new insight into the association between imbalanced paraspinal muscle and potential muscle-bone crosstalk in AIS patients and the biological function of predisposing gene LBX1. Further investigation with appropriate animal models is warranted to explore if asymmetric expression of LBX1 could result in distinct muscle phenotypes and bone qualities thus affect the progression of spine curvature in AIS.
10.3233/SHTI210425
Disordered leptin and ghrelin bioactivity in adolescent idiopathic scoliosis (AIS): a systematic review and meta-analysis.
Wang Qi,Wang Chi,Hu Wenhao,Hu Fanqi,Liu Weibo,Zhang Xuesong
Journal of orthopaedic surgery and research
BACKGROUND:Adolescents with scoliosis consistently demonstrate lower body weight, lean muscle mass, and bone mineral density than healthy adolescent counterparts. Recent studies have focused on understanding how leptin and ghrelin signaling may play a role in adolescent idiopathic scoliosis (AIS). In our current study, we aim to evaluate the serum levels of leptin, soluble leptin receptor (sOB-R), and ghrelin in AIS patients through systematic review and meta-analysis. METHODS:We conducted our systematic review by searching the keywords in online databases including PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to January 2020. Inclusion criteria were studies that measure leptin, soluble leptin receptor (sOB-R), and ghrelin levels in AIS patients. Selection of studies, assessment of study quality, and data extraction were performed by two reviewers independently. Then, data was analyzed to calculate the mean difference and 95% confidence interval (CI). RESULTS:Seven studies concerning leptin/sOB-R and three studies concerning ghrelin were qualified for meta-analysis (one study concerning both leptin and ghrelin). Serum leptin of patients with AIS were significantly lower when compared with healthy controls, with the weighted mean difference (WMD) of - 0.95 (95% CI - 1.43 to - 0.48, p < 0.0001) after reducing the heterogeneity using six studies for meta-analysis, while sOB-R and ghrelin level was significantly higher in AIS group when compared with control group, with the WMD of 2.64 (95% CI 1.60 to 3.67, p < 0.001) and 1.42 (95% CI 0.48 to 2.35, p = 0.003), respectively. CONCLUSION:Our current meta-analysis showed that serum level of leptin in AIS patients was significantly lower when compared with control subjects, while serum sOB-R and ghrelin levels were significantly higher in AIS patients. More clinical studies are still required to further validate the predictive value of leptin or ghrelin for the curve progression for AIS patients.
10.1186/s13018-020-01988-w
The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial.
PloS one
OBJECTIVES:The purpose of this study was to compare the efficacy of two different types of exercise methods in patients with adolescent idiopathic scoliosis. METHODS:In total, 28 subjects with adolescent idiopathic scoliosis with a mild curve magnitude (10°-26°) were randomly divided into two groups: the Schroth group (n = 14) and the core group (n = 14). The patients in the Schroth group were treated with supervised Schroth exercises, and the patients in the core group were treated with supervised core stabilization exercises; both groups performed the exercises for three days per week for a total of 10 weeks, and both were given additional traditional exercises to perform. Assessment included Cobb angle (Radiography), trunk rotation (Adam's test), cosmetic trunk deformity (Walter Reed Visual Assessment Scale), spinal mobility (Spinal Mouse), peripheral muscle strength (Biodex System 4-Pro), and quality of life (Scoliosis Research Society-22 questionnaire). RESULTS:It was found that patients in the Schroth group showed greater improvement in Cobb angles, thoracic trunk rotation angle, cosmetic trunk deformity, spinal mobility, and quality of life than those in the core group (p<0.05), except for in lumbar trunk rotation angle. Peripheral muscle strength improvement was greater in the core group than in the Schroth group (p<0.05). CONCLUSION:Schroth exercises are more effective than core stabilization exercises in the correction of scoliosis and related problems in mild adolescent idiopathic scoliosis, and core stabilization exercises are more effective than Schroth exercises in the improvement of peripheral muscle strength. TRIAL REGISTRATION:NCT04421157.
10.1371/journal.pone.0249492
Effect of curve location on the severity index for adolescent idiopathic scoliosis: a longitudinal cohort study.
Vergari Claudio,Skalli Wafa,Abelin-Genevois Kariman,Bernard Jean Claude,Hu Zongshan,Cheng Jack Chun Yiu,Chu Winnie Chiu Wing,Assi Ayman,Karam Mohammad,Ghanem Ismat,Bassani Tito,Galbusera Fabio,Sconfienza Luca Maria,Brayda-Bruno Marco,Courtois Isabelle,Ebermeyer Eric,Vialle Raphael,Langlais Tristan,Dubousset Jean
European radiology
OBJECTIVES:Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder in children. A severity index was recently proposed to identify the stable from the progressive scoliosis at the first standardized biplanar radiographic exam. The aim of this work was to extend the validation of the severity index and to determine if curve location influences its predictive capabilities. METHODS:AIS patients with Cobb angle between 10° and 25°, Risser 0-2, and no previous treatment were included. They underwent standing biplanar radiography and 3D reconstruction of the spine and pelvis, which allowed to calculate their severity index. Patients were grouped by curve location (thoracic, thoracolumbar, lumbar). Patients were followed up until skeletal maturity (Risser ≥ 3) or brace prescription. Their outcome was compared to the prediction made by the severity index. RESULTS:In total, 205 AIS patients were included; 82% of them (155/189, 95% confidence interval [74-90%]) were correctly classified by the index, while 16 patients were unclassified. Positive predictive ratio was 78% and negative predictive ratio was 86%. Specificity (78%) was not significantly affected by curve location, while patients with thoracic and lumbar curves showed higher sensitivity (≥ 89%) than those with thoracolumbar curves (74%). CONCLUSIONS:In this multicentric cohort of 205 patients, the severity index was used to predict the risk of progression from mild to moderate scoliosis, with similar results of typical major curve types. This index represents a novel tool to aid the clinician and the patient in the modulation of the follow-up and, for progressive patients, their decision for brace treatment. KEY POINTS:• The severity index of adolescent idiopathic scoliosis has the potential to detect patients with progressive scoliosis as early as the first exam. • Out of 205 patients, 82% were correctly classified as either stable or progressive by the severity index. • The location of the main curve had small effect on the predictive capability of the index.
10.1007/s00330-021-07944-4
Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study.
Yılmaz Hurriyet,Zateri Coskun,Kusvuran Ozkan Aslihan,Kayalar Gulseren,Berk Haluk
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:Studies have shown that adolescent idiopathic scoliosis (AIS) prevalence varies between 0.35% and 5.2% and it is generally accepted as an average of 2%-3% in children under age 16. There are a few narrow-scope studies based on school screening performed on the epidemiology of AIS in Turkey. Prevalence rates reported by these studies are lower than reported in neighboring countries. Of note, they were conducted in single cities, generally based on small sample size, and are different from each other in terms of methodology and age groups. The present study was conducted based on a large population in 85 schools of 40 provinces in Turkey. PURPOSE:The aim of this study was to determine the prevalence of AIS in Turkey. Secondary outcomes were to determine age, gender, curve distribution, using standard tests, and radiological verification. STUDY DESIGN:A cross-sectional epidemiological study. PATIENT SAMPLE:The sample size was calculated to estimate the prevalence of AIS in children aged 10-15 years in Turkey. OUTCOME MEASURES:Adams' forward bending test, angle of trunk rotation measurement, and posture analysis were used to screen. Students who had an angle of trunk rotation greater than or equal to five (≧5°) with scoliometer measurement or who had a positive forward bending test were referred to the mobile X-ray unit located in the school-yard on screening day. Their diagnosis was confirmed using Cobb angles of greater than or equal to 10 (≧10°). METHODS:Medical personnel, mobile radiological tools, and logistical support needed during fieldwork were provided by the Directorate General for Health Research, Ministry of Health Republic of Turkey. Spine and posture were examined in upright standing position. Examiners looked for shoulder asymmetries, scapular prominence, unequal waist, and lower limb length discrepancy. Potential scoliosis diagnosis was verified with onsite radiographic examination. Cases with a Cobb angle of ≧10° detected in any region were accepted as scoliosis. The direction and location of scoliosis were determined according to the Scoliosis Research Society terminology criteria. RESULTS:A total of 16,045 students were reached whose informed consent forms were signed by their parents. The prevalence of AIS was found to be 2.3% (female, 3.1%; male, 1.5%). Radiological confirmation rate was 98.8%; 256 (69.3%) of 369 adolescents with scoliosis had a single curvature and 108 (29.3%) had a double curvature. The most common single curve type was a lumbar curve. In all, 90.5% of cases with AIS had a mild (range of 10°-19°) Cobb angle. CONCLUSIONS:The prevalence of AIS was 2.3% in Turkey. This prevalence rate was considerably higher than the values in previous regional studies conducted in Turkey; however, it was close to generally accepted averages in the literature. One of the strongest aspects of the study was that radiologic confirmation of each suspected case was made during the screening.
10.1016/j.spinee.2020.01.008
Controversies with nonoperative management for adolescent idiopathic scoliosis: Study from the APSS Scoliosis Focus Group.
Cheung Jason Pui Yin,Cheung Prudence Wing Hang,Shigematsu Hideki,Takahashi Shinji,Kwan Mun Keong,Chan Chris Yin Wei,Chiu Chee Kidd,Sakai Daisuke,
Journal of orthopaedic surgery (Hong Kong)
PURPOSE:To determine consensus among Asia-Pacific surgeons regarding nonoperative management for adolescent idiopathic scoliosis (AIS). METHODS:An online REDCap questionnaire was circulated to surgeons in the Asia-Pacific region during the period of July 2019 to September 2019 to inquire about various components of nonoperative treatment for AIS. Aspects under study included access to screening, when MRIs were obtained, quality-of-life assessments used, role of scoliosis-specific exercises, bracing criteria, type of brace used, maturity parameters used, brace wear regimen, follow-up criteria, and how braces were weaned. Comparisons were made between middle-high income and low-income countries, and experience with nonoperative treatment. RESULTS:A total of 103 responses were collected. About half (52.4%) of the responders had scoliosis screening programs and were particularly situated in middle-high income countries. Up to 34% obtained MRIs for all cases, while most would obtain MRIs for neurological problems. The brace criteria were highly variable and was usually based on menarche status (74.7%), age (59%), and Risser staging (92.8%). Up to 52.4% of surgeons elected to brace patients with large curves before offering surgery. Only 28% of responders utilized CAD-CAM techniques for brace fabrication and most (76.8%) still utilized negative molds. There were no standardized criteria for brace weaning. CONCLUSION:There are highly variable practices related to nonoperative treatment for AIS and may be related to availability of resources in certain countries. Relative consensus was achieved for when MRI should be obtained and an acceptable brace compliance should be more than 16 hours a day.
10.1177/2309499020930291
Adolescent idiopathic scoliosis 3D vertebral morphology, progression and nomenclature: a current concepts review.
Labrom Fraser R,Izatt Maree T,Claus Andrew P,Little J Paige
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:There has been a recent shift toward the analysis of the pathoanatomical variation of the adolescent idiopathic scoliosis (AIS) spine with the three dimensions, and research of level-wise vertebral body morphology in single anatomical planes is now replete within the field. In addition to providing a precise description of the osseous structures that are the focus of instrumented surgical interventions, understanding the anatomical variation between vertebral bodies will elucidate possible pathoaetiological mechanisms of the onset of scoliotic deformity. METHODS:This review aimed to discuss the current landscape of AIS segmental vertebral morphology research and provide a comprehensive report of the typical patterns observed at the individual vertebral level. RESULTS:We have detailed how these vertebrae are typically characterised by lateral wedging to the convexity, have a marked degree of anterior overgrowth, are rotated towards the convexity, have inherent gyratory mechanical torsion created within them and are associated with pedicles on the concave side being narrower, longer and more laterally angled. For the most part, these findings are most pronounced at and around the apex of a scoliotic curve, with these deformations reducing towards junctional vertebrae. We have also summarised a nomenclature defined by the Scoliosis Research Society, highlighting the need for more consistent reporting of these level-wise dimensional anatomical changes. CONCLUSION:Finally, we emphasised how a marked degree of heterogeneity exists between the included investigations, namely in scoliotic curve-type inclusion, imaging modality and timepoint of analysis within scoliosis' longitudinal development, and how improvement in these study design characteristics will enhance ongoing research.
10.1007/s00586-021-06842-z
Providence nighttime bracing is effective in treatment for adolescent idiopathic scoliosis even in curves larger than 35°.
Simony Ane,Beuschau Inge,Quisth Lena,Jespersen Stig Mindedahl,Carreon Leah Yaccat,Andersen Mikkel Osterheden
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Since 2006, the Providence nighttime brace has been used for a conservative treatment for scoliosis. Previous studies comparing the outcomes after full-time bracing and nighttime bracing have reported a comparable outcome with curves < 35°. The aim of this study was to report the outcome after treatment in a cohort of adolescent idiopathic scoliosis patients, with curves between 20° and 45°. METHODS:One hundred and twenty-four patients with adolescent idiopathic scoliosis were included in this study with Cobb > 20°, remaining growth potential and no previous scoliosis treatment. Providence nighttime treatment, 8 h nightly, was initiated. Treatment was continued until 2 years post-menarcheal for females and until 6-month growth arrest for males. The patients were evaluated using standing radiographs during treatment and 6 and 12 months after termination of bracing. RESULTS:One hundred and twenty-four patients were included; 80 patients terminated brace treatment and were available for follow-up. Mean in-brace correction was 82%, and curve progression was observed in 9 patients. Brace treatment was success full in 89% of the patients, 88% of the patients braced with curves 20°-29°, 93% of the patients braced with 30°-39° and 77% of the patients braced with curves 40°-45°. Five of the 80 AIS patients were referred to surgery: 4 due to progression and 1 due to cosmetic concerns. CONCLUSIONS:Providence nighttime braces are an effective treatment for adolescent idiopathic scoliosis patients. This study reports a success rate of 89%, and the results are comparable to full-time treatment with the Boston brace. In-brace correction is crucial in part-time bracing, and we recommend at least 70% curve correction, if part-time bracing should be considered. These slides can be retrieved under Electronic Supplementary Material.
10.1007/s00586-019-06077-z
A three-dimensional analysis of scoliosis progression in non-idiopathic scoliosis: is it similar to adolescent idiopathic scoliosis?
Bachmann Keith R,Yaszay Burt,Bartley Carrie E,Bastrom Tracey P,Reighard Fredrick G,Upasani Vidyadhar V,Newton Peter O,
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
PURPOSE:To evaluate the three-dimensional (3D) characteristics of spine deformity in patients with non-idiopathic scoliosis compared with those observed in patients with adolescent idiopathic scoliosis (AIS). METHODS:A retrospective chart review was conducted to identify patients with non-idiopathic scoliosis. Twenty-eight patients with neural axis (NA) abnormalities (Chiari 1, syrinx) and 20 patients with connective tissue disorder (CTD) (Marfan's, Beal's, Ehlers-Danlos syndrome, mixed) were identified. The 3D parameters of the coronal, sagittal, and axial plane were compared with 284 AIS patients with a similar range of coronal deformity. RESULTS:The average coronal curve was similar between all three groups (AIS 48 ± 15°, CTD 43 ± 22°, and NA 49 ± 18°; p = 0.4). The NA patients had significantly greater 3D thoracic kyphosis (20 ± 18° vs 10 ± 15°, p = 0.001) and less thoracic apical vertebral rotation (- 5 ± 18° vs - 12 ± 10°, p = 0.003) when compared with AIS. The CTD group's 3D thoracic kyphosis (p = 0.7) and apical vertebral rotation (p = 0.09) did not significantly differ from AIS. Significant negative correlations were found in all three groups between thoracic kyphosis and coronal curve magnitude (AIS r = - 0.49, CTD r = - 0.772, NA r = -0.677, all p < 0.001). CONCLUSIONS:Scoliotic patients with NA abnormalities have a more kyphotic, less-rotated 3D profile than patients with AIS, while scoliosis patients with CTD have 3D features similar to AIS. Irrespective of the underlying diagnosis, however, greater scoliotic curves were associated with a greater loss of intersegmental kyphosis, suggesting a similar biomechanical pathophysiology for curve progression.
10.1007/s00381-019-04239-4
Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis.
Park Yulhyun,Ko Jin Young,Jang Joon Young,Lee Seungeun,Beom Jaewon,Ryu Ju Seok
Scientific reports
There have been many studies on adolescent idiopathic scoliosis related abnormal muscle contractions of the spine. However, previous studies using surface electromyography to investigate paraspinal muscle asymmetry are controversial, lacking in clarity of results, and hindered by methodological limitations. The purpose of this study was to investigate the relationship between imbalance factors including surface electromyography activity according to the scoliosis curve type and leg length discrepancy and adolescent idiopathic scoliosis curve types. Seventy-nine patients with scoliosis were prospectively enrolled and were divided into five types: single thoracic, thoracolumbar, lumbar, double thoracic, and double major. Cobb angle and structural variables were measured. Surface electromyography examinations were conducted at the 7th, 12th thoracic erector spinae, 3rd lumbar erector spinae, and multifidus muscles during the superman position keeping prone spinal extension to lift the arms and legs off the floor. Whole spine radiographs were obtained to measure the Cobb angle, coronal imbalance, pelvic height and angle, and femoral head height. In the double major, thoracolumbar, and lumbar types, the mean root mean squared (RMS) EMG amplitudes were significantly higher on the convex side than the concave side (P < 0.005). In the DM type, the mean RMS EMG amplitudes of ES and ES where the apex was located were significantly higher at the convex side than those of the concave side (P < 0.005, effect size (Cohen's d) for ES/ES: 0.517/0.573). The TL and L types showed a similar pattern. The mean RMS EMG amplitudes of the ES concave side and Mu and ES concave sides were significantly lower than those of the convex side in the TL and L types, respectively (P < 0.008, effect size (Cohen's d) for ES/Mu/ES: 0.960/0.264/0.448). Conversely, there were no significant differences in the single thoracic and double thoracic types. All structural variables (coronal imbalance, pelvic height and angle, and femur head height) were higher in the lumbar type, but only coronal imbalance was significantly different (P < 0.05). Different patterns of asymmetry of paraspinal muscles and structural variables were described based on the curvature of the spine. L type showed that EMG activity was asymmetric in the paraspinalis muscles where the apex was located and that structural asymmetry, such as coronal imbalance was significantly greater than other types. DM type showed similar paraspinalis asymmetry pattern to the ST type but there was no structural asymmetry in DM and ST types. TL type has the features of both thoracic and lumbar origins. Understanding these could contribute to the management in correcting scoliosis.
10.1038/s41598-021-96882-8
Thoracic Morphology and Bronchial Narrowing Are Related to Pulmonary Function in Adolescent Idiopathic Scoliosis.
The Journal of bone and joint surgery. American volume
BACKGROUND:In adolescent idiopathic scoliosis (AIS), lung function impairment is not necessarily related to the coronal spinal deformity. Recently, right-sided bronchial narrowing has been reported in thoracic AIS. The aim of this study was to describe the relation of chest and spinal deformity parameters, bronchial narrowing, and lung volumes with pulmonary function in preoperative AIS. METHODS:Spinal radiographs, low-dose computed tomographic (CT) scans of the spine including the chest, and pulmonary function tests were retrospectively collected for 85 preoperative patients with thoracic AIS in 2 centers and were compared with 14 matched controls. Three-dimensional lung and airway reconstructions were acquired. Correlation analysis was performed in which radiographic spinal parameters, CT-based thoracic deformity parameters (rib-hump index [RHi], spinal penetration index, endothoracic hump ratio, hemithoracic-width ratio), lung volume asymmetry, and bronchial cross-sectional area were compared with percent-of-predicted spirometry results. RESULTS:Forty-one patients (48%) had a percent-of-predicted forced expiratory volume in 1 second (FEV1%) or percent-of-predicted forced vital capacity (FVC%) of <65%, and 17 patients (20%) had obstructive lung disease. All thoracic deformity parameters correlated significantly with FEV1% and FVC%; RHi was found to be the best correlate (rs = -0.52 for FEV1% and -0.54 for FVC%). Patients with AIS with impaired pulmonary function had hypokyphosis, a larger rib hump, increased spinal and thoracic rotation, a narrower right hemithorax, and increased intrusion of the spine into the chest. Spinal intrusion correlated with right-sided bronchial narrowing, relative right lung volume loss, and decreased FEV1% and FVC%. Multivariate regression including spinal and thoracic deformity parameters, lung volume asymmetry, and airway parameters could explain 57% of the variance in FEV1% and 54% of the variance in FVC%. CONCLUSIONS:Chest intrusion by the endothoracic hump is related to right-sided bronchial narrowing and lung function loss in preoperative AIS. The findings support the theory that ventilatory dysfunction in thoracic AIS is not only restrictive but frequently has an obstructive component, especially in patients with hypokyphosis. RHi is the most predictive chest parameter for lung function loss. LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
10.2106/JBJS.20.01714
Comparison of two periods of Schroth exercises for improving postural stability indices and Cobb angle in adolescent idiopathic scoliosis.
Journal of back and musculoskeletal rehabilitation
BACKGROUND:Adolescents with idiopathic scoliosis present postural instability when compared with healthy subjects. Although Schroth exercises therapy (SET) is broadly utilized, its effect on postural stability is still not clear. OBJECTIVES:To compare the two treatment periods of the SET for improving the postural stability indices and Cobb angle, and to examine the correlation between the Cobb angle and stability indices in adolescent idiopathic scoliosis (AIS). METHODS:Twenty girls aged 10-16 years with AIS (study group) and 20 age-matched girls without AIS (control group) were examined. The Biodex Balance System was used to evaluate the overall stability index (OSI), anteroposterior index (APSI), and mediolateral stability index (MLSI) in the study group before SET and one and three months after the therapy. A plain X-ray was used to measure the Cobb angle before and three months after SET. Stability indices and Cobb angle were measured only once for the control group. RESULTS:One-way repeated-measures ANOVA revealed that the three-month duration of SET was the most effective for improving OSI, APSI, and MLSI (p< 0.001). The significant proximities of OSI, APSI, and MLSI to the normal values post three months of SET were 29.65%, 24.07, and 20% respectively. The MLSI was robust and correlated with the Cobb angle (r= 0.85) three months post intervention. CONCLUSION:Stability indices and Cobb angles were highly improved after three months of SET compared to one month among AIS patients. The MLSI is the most substantial index correlated with the Cobb angle.
10.3233/BMR-200342
Curve severity and apical vertebral rotation and their association with curve flexibility in adolescent idiopathic scoliosis.
Mohanty S P,Pai Kanhangad M,Gullia A
Musculoskeletal surgery
PURPOSE:To determine the association between coronal Cobb's angle and Nash-Moe index in patients with adolescent idiopathic scoliosis. We also attempted to determine whether apical vertebral derotation depended upon the curve flexibility. OVERVIEW OF LITERATURE:The three-dimensional nature of adolescent idiopathic scoliosis (AIS) is well established. Knowledge of all components of this complex deformity is essential to formulate effective treatment strategies. Though the importance of quantifying all the components of the deformity, in AIS, has been analysed in detail, very few studies have been done to ascertain the relationship between the coronal plane deformity and apical vertebral rotation. METHODS:Digitalised standing and supine stretch anteroposterior (AP) radiographs of 158 patients with AIS were analysed. The standing and supine stretch AP radiographs were compared to calculate the percentage reduction of Cobb's angle to determine curve flexibility. The derotation of the apical vertebra on application of traction was also noted. The one-way repeated ANOVA was used to determine the association between Cobb's angle and Nash-Moe index. The independent sample t test was used to determine whether a statistically significant difference was present, in the age of the patient, severity of the curve and percentage reduction of Cobb's angle between those curves that derotated and those that did not, when stretched. RESULTS:The one-way repeated ANOVA revealed an association between Cobb's angle and Nash-Moe index on the standing and supine AP stretch radiographs (P < 0.01). The Independent sample t-test showed a statistically significant difference in percentage reduction of Cobb's angle between those curves that derotated compared to those that did not, on stretch (P < 0.01). CONCLUSIONS:This study demonstrates that there is an association between apical vertebral rotation and the coronal plane deformity. It also demonstrates that flexible curves derotate to a greater extent compared to rigid curves, when stretched.
10.1007/s12306-020-00660-0
Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS).
Journal of clinical medicine
Adolescents with idiopathic scoliosis (AIS) often receive conservative treatments aiming to prevent progression of the spinal deformity during puberty. This study aimed to explore patient adherence and secondary outcomes during the first 6 months in an ongoing randomised controlled trial of three treatment interventions. Interventions consisted of physical activity combined with either hypercorrective Boston brace night shift (NB), scoliosis-specific exercise (SSE), or physical activity alone (PA). Measures at baseline and 6 months included angle of trunk rotation (ATR), Cobb angle, International Physical Activity Questionnaire short form (IPAQ-SF), pictorial Spinal Appearance Questionnaire (pSAQ), Scoliosis Research Society (SRS-22r), EuroQol 5-Dimensions Youth (EQ-5D-Y) and Visual Analogue Scale (EQ-VAS). Patient adherence, motivation, and capability in performing the intervention were reported at 6 months. The study included 135 patients (111 females) with AIS and >1-year estimated remaining growth, mean age 12.7 (1.4) years, and mean Cobb angle 31 (±5.3). At 6 months, the proportion of patients in the groups reporting high to very high adherence ranged between 72 and 95%, while motivation ranged between 65 and 92%, with the highest proportion seen in the NB group ( = 0.014, = 0.002). IPAQ-SF displayed significant between group main effects regarding moderate activity (F = 5.7; = 0.004; η = 0.10), with a medium-sized increase favouring the SSE group compared to NB. Walking showed significant between group main effects, as did metabolic equivalent (MET-min/week), with medium (F = 6.8, = 0.002; η = 0.11, and large (F = 8.3, = < 0.001, η = 0.14) increases, respectively, for the SSE and PA groups compared to NB. From baseline to 6 months, ATR showed significant between group medium-sized main effects (F = 1.2, = 0.019, η = 0.007) favouring the NB group compared to PA, but not reaching a clinically relevant level. In conclusion, patients reported high adherence and motivation to treatment, especially in the NB group. Patients in the SSE and PA groups increased their physical activity levels without other clinically relevant differences between groups in other clinical measures or patient-reported outcomes. The results suggest that the prescribed treatments are viable first-step options during the first 6 months.
10.3390/jcm10214967
Schroth exercises improve health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients.
Gao Ang,Li Jun-Yu,Shao Rui,Wu Tong-Xuan,Wang Yong-Qiang,Liu Xiao-Guang,Yu Miao
Chinese medical journal
BACKGROUND:Finding an optimal treatment strategy for adolescent idiopathic scoliosis (AIS) patients remains challenging because of its intrinsic complexity. For mild to moderate scoliosis patients with lower skeletal growth potential (Risser 3-5), most clinicians agree with observation treatment; however, the curve progression that occurs during puberty, the adolescent period, and even in adulthood, remains a challenging issue for clinicians. The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential (Risser 3-5) and moderate scoliosis (Cobb angle 20°-40°). METHODS:From 2015 to 2017, data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed. Forty-three patients underwent Schroth exercise were classified as Schroth group, and 21 patients underwent observation were classified as observation group. Outcomes were measured by health-related quality of life (HRQOL) and radiographic parameters. HRQOL was assessed using the visual analog scale (VAS) scores for back, Scoliosis Research Society-22 (SRS-22) patient questionnaire. Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays. The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy. The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient (ICC). The paired t test was used to examine HRQOL and radiographic parameters. Clinical relevance between C2-C7 sagittal vertical axis (SVA) and thoracic kyphosis was analyzed using Spearman correlation. RESULTS:In Schroth group, VAS back score, SRS-22 pain, and SRS-22 self-image domain were significantly improved from pre-treatment 3.0 ± 0.8, 3.6 ± 0.5, and 3.5 ± 0.7 to post-treatment 1.6 ± 0.6 (t = 5.578, P = 0.013), 4.0 ± 0.3 (t = -3.918, P = 0.001), and 3.7 ± 0.4 (t = -6.468, P < 0.001), respectively. No significant improvements of SRS-22 function domain (t = -2.825, P = 0.088) and mental health domain (t = -3.174, P = 0.061) were observed. The mean Cobb angle decreased from 28.9 ± 5.5° to 26.3 ± 5.2° at the final follow-up, despite no statistical significance was observed (t = 1.853, P = 0.102). The mean C2-C7 SVA value decreased from 21.7 ± 8.4 mm to 17.0 ± 8.0 mm (t = -1.224 P = 0.049) and mean T1 tilt decreased from 4.9 ± 4.2 ° to 3.5 ± 3.1° (t = 2.913, P = 0.011). No significant improvement of radiographic parameters and HRQOL were observed in observation group. CONCLUSIONS:For AIS patients with a Risser 3-5 and a Cobb angle 20°-40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS.
10.1097/CM9.0000000000001799
Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis.
Martínez-Llorens J,Ramírez M,Colomina M J,Bagó J,Molina A,Cáceres E,Gea J
The European respiratory journal
Adolescent idiopathic scoliosis (AIS) can lead to ventilatory restriction, respiratory muscle weakness and exercise limitation. However, both the causes and the extent of muscle dysfunction remain unclear. The aim of our study is to describe muscle weakness and its relationship to lung function and tolerance to exercise in AIS patients. Lung and muscle function, together with exercise capacity, were assessed in 60 patients with pronounced spinal deformity (>40 degrees) and in 25 healthy volunteers. Patients with AIS had only mild to moderate abnormal ventilatory patterns, the most frequent of which were restrictive abnormalities. The function of respiratory and limb muscles and exercise capacity were below normal limits in AIS patients, and were significantly lower than in controls. Exercise capacity was found to correlate with the function of inspiratory, expiratory, upper limb and lower limb muscles which, in addition, were reciprocally interrelated. Multivariate analysis showed that lower limb muscle function is the main contributor to exercise intolerance. There appeared to be no connection between spinal deformity and lung function, muscle function or exercise capacity. We conclude that AIS patients show generalised muscle dysfunction which contributes to the reduction in their exercise capacity, even in the absence of severe ventilatory impairment.
10.1183/09031936.00025509
Adolescent idiopathic scoliosis.
Cheng Jack C,Castelein René M,Chu Winnie C,Danielsson Aina J,Dobbs Matthew B,Grivas Theodoros B,Gurnett Christina A,Luk Keith D,Moreau Alain,Newton Peter O,Stokes Ian A,Weinstein Stuart L,Burwell R Geoffrey
Nature reviews. Disease primers
Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.
10.1038/nrdp.2015.30
Leg length discrepancy and adolescent idiopathic scoliosis: clinical and radiological characteristics.
Buyukaslan Ahsen,Abul Kadir,Berk Haluk,Yilmaz Hurriyet
Spine deformity
PURPOSE:This retrospective study aimed to present the clinical and radiological features of functional scoliosis due to LLD and LLD concurrent with AIS; it also aimed to define their relationships for differentiating functional scoliosis due to LLD and LLD concurrent with AIS. METHODS:This study was conducted as a single-center retrospective comparative study on 47 scoliosis patients with diagnosed LLD, aged 10-18 years. Cases with a diagnosis of structural LLD were divided into two groups according to the presence or absence of concurrent AIS. Data on demographics and the angle of trunk rotation on a sacral basis (ATR) were recorded. Limb length was clinically measured with a tape measure and clinical LLD (C-LLD) scoliometer test. Cobb angle, axial rotation, pelvic obliquity, and radiological LLD (R-LLD) were obtained from standing spine radiographs and measured by two blinded orthopedic spine surgeons. RESULTS:The prevalence of LLD was 6.7% in scoliosis patients in our study population. Cobb angle and apical rotation were higher in the LLD concurrent with AIS group than in the LLD group (p ≤ 0.05). The C-LLD results were strongly correlated with both C-LLD (r = 0.651; p = 0.000) and ATR (r = 0.688; p = 0.000). CONCLUSION:LLD may develop as a result of adaptive changes due to scoliosis, or a concurrent condition to scoliosis. Cobb angle and apical rotation are the features that differentiate AIS from functional scoliosis in patients with LLD. The C-LLD scoliometer test can be an effective, practical, and useful method for measuring C-LLD, but its validity and reliability should be determined. TRIAL REGISTRATION:This study was retrospectively registered at ClinicalTrials.gov (number: NCT04713397, date of registration: 01/14/2021). LEVEL OF EVIDENCE:III.
10.1007/s43390-021-00417-0
The Impact of the Derotational Mobilization of Manual Therapy According to Kaltenborn-Evjenth on the Angle of Trunk Rotation in Patients with Adolescent Idiopathic Scoliosis--Pilot Study, Direct Observation.
Wnuk Bartosz,Blicharska Irmina,Błaszczak Edward,Durmała Jacek
Ortopedia, traumatologia, rehabilitacja
BACKGROUND:The use of manual therapy in the treatment of scoliosis has been controversial. Scientific reports do not clearly indicate its effectiveness or harmfulness. The aim of this study was to determine the effectiveness of passive and active derotation techniques of manual therapy according to Kaltenborn-Evjent on the reduction of the angle of trunk rotation in patients with idiopathic scoliosis. MATERIAL AND METHODS:The study enrolled 33 female patients from the Department of Rehabilitation who were diagnosed with adolescent idiopathic scoliosis. The patients were divided into two groups according to the curve location (SRS classification). Group A consisted of 17 women, aged 14.±2.4 years, with single-curve scoliosis in the thoracolumbar segment and group B was composed of 16 women, aged 15±2.24 years, with double-curve scoliosis in the thoracic and lumbar segments. In both groups, the angle of trunk rotation, the magnitude of thoracic kyphosis and lumbar lordosis were measured twice, before and after each session of derotation techniques. RESULTS:Both groups demonstrated a positive impact of active and passive derotation techniques on the angle of trunk inclination. The greatest difference was observed after a session of active derotation in the patients with lumbar scoliosis. The angle of trunk rotation decreased on average by 4.5°±1.14°. No correlations were found between the curve angle values and the degree of thoracic derotation after the application of these techniques. CONCLUSION:Derotational mobilization techniques may be a valuable complement to scoliosis treatment methods as they increase their effectiveness.
10.5604/15093492.1173376
Feasibility and effects of 6-month home-based digitally supported E-Fit program utilizing high-intensity interval exercises in girls with adolescent idiopathic scoliosis: a randomized controlled pilot study.
Studies in health technology and informatics
Adolescent idiopathic scoliosis (AIS) patients have lower physical activities when compared with healthy controls, and are associated with lower bone mineral density (BMD), muscle strength and poorer quality of life (QoL). We aimed to assess the feasibility and effects of 6-month home-based digitally supported E-Fit comprised of high-intensity interval exercises for AIS patients. 40 AIS girls aged 11-14 were randomly assigned to E-Fit or control group. E-Fit group participated in an online 6-month home-based exercise program. At baseline, 6-months and 12-months follow-up, BMD using dual-energy X-ray absorptiometry, muscle functions, physical activity using Modified Baecke Questionnaire (MBQ), and QoL using Scoliosis Research Society-22 (SRS-22r) and feedback questionnaire were investigated. 14 in E-Fit and 16 in control group completed the study. Both groups had similar baseline characteristics. At 6-months, E-Fit group showed better improvement and significant interaction effect in left femoral neck bone mineral content (p=0.021) and isometric curl up test (p=0.04). Left arm lean mass showed better improvement between 6-months and 12-months follow-up (p=0.046) and whole-body areal BMD had significant interaction effect at 12-months follow-up (p=0.077). Improvement on self-image, work and sports participation were noted in E-Fit group across time. 70% of E-Fit participants were positive towards domestic application via online platform. E-Fit showed some benefits on bone health, muscle functions, physical activity and QoL measures. Current study indicated some potential physical and psychological benefits of E-Fit for AIS girls. E-Fit was feasible to conduct online at home and might have value of promoting exercise habits among relatively inactive AIS girls.
10.3233/SHTI210466
The effect of Pilates exercise training for scoliosis on improving spinal deformity and quality of life: Meta-analysis of randomized controlled trials.
Medicine
BACKGROUND:It remains unclear if Pilates is conducive to reducing spinal deformity and improving patients' quality of life (QOL) with scoliosis. The aim of this study was to systematically review the published evidence to determine whether Pilates exercise training is an efficacious therapy for scoliosis. METHODS:Searches was conducted in Medline, Embase, PubMed, Scopus, CINAHL, Physiotherapy Evidence Database (PEDro), Cochrane library, Baidu Scholar, and Green Medical to identify randomized studies that tested the effect of Pilates exercise training on Cobb angle, pain level, trunk range of motion (ROM), angle of trunk rotation, and QOL in idiopathic scoliosis. Separate meta-analyses were performed on the endpoints of these outcome measures. The PEDro scale was used to assess the methodological quality of the included studies. RESULTS:This review included 10 randomized controlled trials (n = 359). PEDro scores ranged from 3 to 10, with the mean score across all articles being 5.3/10 and judged to be of fair quality. The results indicated that Pilates exercises was effective in reducing Cobb angle (standardized mean difference [SMD] = 1.23, 95% confidence interval [CI] = 0.11-2.35), angle of trunk rotation (SMD = 1.37, 95% CI = 1.01-1.73), and pain level (SMD = 2.78, 95% CI = 1.55-4.01), as well as improving trunk ROM (SMD = 1.23, 95% CI = 0.45-2.00), and QOL (SMD = 3.05, 95% CI = 2.59-3.51) in patients with scoliosis. CONCLUSION:Pilates exercise training may reduce the Cobb angle and trunk rotation, relieve pain, increase trunk ROM, and improve QOL for patients with scoliosis. Due to the poor quality of the evidence, however, these results should be interpreted with caution.
10.1097/MD.0000000000027254
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.
Lau Rufina Wing-Lum,Cheuk Ka-Yee,Ng Bobby Kin-Wah,Tam Elisa Man-Shan,Hung Alec Lik-Hang,Cheng Jack Chun-Yiu,Hui Stanley Sai-Chuen,Lam Tsz-Ping
International journal of environmental research and public health
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- ( = 0.096) and 12-month follow-ups ( = 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 ( = 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 ( = 0.043), sport index ( = 0.050), and total score ( = 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.
10.3390/ijerph182010899
Safety and effectiveness of minimally invasive scoliosis surgery for adolescent idiopathic scoliosis: a retrospective case series of 84 patients.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:The aim of this study was to retrospectively evaluate a prospective series of patients with adolescent idiopathic scoliosis (AIS) who were treated with minimally invasive scoliosis surgery (MISS) technique with a minimum follow-up more than 1 year. MATERIALS AND METHODS:We retrospectively analyzed the prospectively collected data of 84 patients with AIS treated with MIS technique using two or three coin hole size incisions and a muscle-splitting approach. The clinical and radiological data such as the correction of deformity, coronal and sagittal profile and record of the perioperative morbidity of the patients were analyzed. RESULTS:The mean primary Cobb angle was corrected from 59.8° preoperatively to 18.6° postoperatively with a mean correction of 68.9% (p < 0.001). The mean kyphosis at T2 to T12 was maintained within normal range with an increase from 31.2° preoperatively to 35.3° postoperatively (p < 0.001). The 30-day perioperative complication rate was 7.14% with one deep infection and five cases of hemothorax. The mean operation time was 312.8 min; mean estimated blood loss was 846.6 ml (range 420-2800); and mean length of stay was 8.5 days (range 5 to 14). All data of postoperative SRS-22 questionnaire were significantly improved (p < 0.001). CONCLUSION:MISS used for AIS provides adequate correction in both planes and acceptable rate of perioperative complications, with a low estimated blood loss and short length of stay. Considering all the positives, the application of MISS technique for AIS seems meaningful and can become a valid alternative to posterior approach in the routine use. These slides can be retrieved under Electronic Supplementary Material.
10.1007/s00586-019-06172-1
The effectiveness of core stabilization exercise in adolescent idiopathic scoliosis: A randomized controlled trial.
Gür Gözde,Ayhan Cigdem,Yakut Yavuz
Prosthetics and orthotics international
BACKGROUND:Core stabilization training is used to improve postural balance in musculoskeletal problems. OBJECTIVES:The purpose of this study was to investigate the effectiveness of stabilization training in adolescent idiopathic scoliosis. STUDY DESIGN:A randomized controlled trial, pretest-posttest design. METHODS:In total, 25 subjects with adolescent idiopathic scoliosis were randomly divided into two groups: stabilization group ( n = 12) and control group ( n = 13). The stabilization group received core stabilization in addition to traditional rehabilitation, and the control group received traditional rehabilitation for 10 weeks. Assessment included Cobb's angle on radiograph, apical vertebral rotation in Adam's test, trunk asymmetry (Posterior Trunk Symmetry Index), cosmetic trunk deformity (Trunk Appearance Perception Scale), and quality of life (Scoliosis Research Society-22 questionnaire). RESULTS:Inter-group comparisons showed significantly greater improvements in the mean change in lumbar apical vertebral rotation degree and the pain domain of Scoliosis Research Society-22 in the stabilization group than those in the control group ( p < 0.05). No significant differences were observed for other measurements between the groups; however, trends toward greater improvement were observed in the stabilization group. CONCLUSION:Core stabilization training in addition to traditional exercises was more effective than traditional exercises alone in the correction of vertebral rotation and reduction of pain in adolescent idiopathic scoliosis. Clinical relevance Stabilization exercises are more effective in reducing rotation deformity and pain than traditional exercises in the conservative rehabilitation of adolescent idiopathic scoliosis. These improvements suggest that stabilization training should be added to rehabilitation programs in adolescent idiopathic scoliosis.
10.1177/0309364616664151
Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review.
Fan Yunli,Ren Qing,To Michael Kai Tsun,Cheung Jason Pui Yin
BMC musculoskeletal disorders
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 .
10.1186/s12891-020-03517-6
Does Curve Regression Occur During Underarm Bracing in Patients with Adolescent Idiopathic Scoliosis?
Clinical orthopaedics and related research
BACKGROUND:Successful brace treatment entails good control of scoliosis with avoidance of surgery. However, achieving curve regression may be an even better radiological result than prevention of curve progression for patients with adolescent idiopathic scoliosis. Vertebral remodeling may occur with well-fitted braces. Better in-brace curve correction may influence the likelihood of vertebral remodeling and the chance of curve regression. Only a few reports have evaluated curve regression with brace treatment, and the factors associated with these events are unknown. QUESTIONS/PURPOSES:(1) What changes in curvature are observed with brace treatment for adolescent idiopathic scoliosis? (2) What factors are associated with curve improvement? (3) What factors are associated with curve deterioration? (4) Is curve regression associated with improvements in patient-reported objective outcome scores? METHODS:Between September 2008 and December 2013, 666 patients with adolescent idiopathic scoliosis underwent underarm brace treatment and were followed until skeletal maturity at 18 years old. Among these patients, 80 were excluded because of early discontinuation of brace treatment (n = 66) and loss to follow-up (n = 14). Hence, 586 patients were included in this study, with a mean brace-wear duration of 3.8 ± 1.5 years and post-weaning follow-up duration of 2.0 ± 1.1 years. The mean age at baseline was 12.6 ± 1.2 years. Most patients were female (87%, 507 of 586) and up to 53% (267 of 507) of females were post-menarche. Bracing outcomes were based on changes in the Cobb angle measured out of brace. These included curve regression, as indicated by at least a 5° reduction in the Cobb angle, curve progression, as indicated by at least a 5° increase in the Cobb angle, and unchanged, as indicated by a change in the Cobb angle of less than 5°. We studied the pre-brace and supine Cobb angles, curve flexibility (pre-brace Cobb angle - supine Cobb angle / pre-brace Cobb angle x 100%), correction rate (pre-brace Cobb angle - in-brace Cobb angle / pre-brace Cobb angle x 100%), location of apical vertebrae, apical ratio (convex vertebral height/concave vertebral height), change in the major curve Cobb angle, and apical ratio post-bracing. The refined 22-item Scoliosis Research Society questionnaire was used for patient-reported outcomes and is composed of five domains (function, pain, appearance, mental health and satisfaction with treatment). Its minimum clinically important difference, based on a scale from 0 to 5, has been quoted as 0.2 for pain, 0.08 for activity and 0.98 for appearance domains. Mental health has no quoted minimum clinically important difference for the adolescent idiopathic scoliosis population. Satisfaction with treatment is described based on improvement or deterioration in domain scores. Intergroup differences between bracing outcomes were evaluated with the Kruskal Wallis test. Univariate analyses of bracing outcomes were performed with a point-biserial correlation coefficient for continuous variables and Pearson's chi-square test for categorical variables. Multivariate logistic regression models were created for improved and deteriorated outcomes. P values < 0.05 were considered significant. RESULTS:In all, 17% of patients (98 of 586) had an improved angle and 40% of patients (234 of 586) had curve deterioration. In patients who improved, the mean reduction in the Cobb angle was 9 ± 4°, while in patients who deteriorated, the mean increase in the Cobb angle was 15 ± 9°, and this was maintained at the latest post-brace weaning follow-up. Despite a trend for patients with curve regression to have higher baseline flexibility and correction rate, after controlling for age, Risser staging, radius and ulnar grading, and Sanders staging, we found no clinically important differences with increased correction rate or flexibility. We did find that improvement in the Cobb angle after bracing was associated with reduced apical ratio (odds ratio [OR] 0.84 [95% CI 0.80 to 0.87]; p < 0.001). Curve progression was associated with younger age (OR 0.71 [95% CI 0.55 to 0.91]; p = 0.008), pre-menarche status (OR 2.46 [95% CI 1.31 to 4.62]; p = 0.005), and increased apical ratio (OR 1.24 [95% CI 1.19 to 1.30]; p < 0.001) but no clinically important differences were observed with less flexible curves and reduced correction rate. Improvements in scores of the refined 22-item Scoliosis Research Society domains of function (mean difference on a scale from 0 to 5: 0.2; p = 0.001 versus 0.1; p < 0.001) and pain (mean difference on a scale from 0 to 5: 0.2; p = 0.020 versus 0.0; p = 0.853) were greater in the post-brace improvement group than in the deterioration group and fulfilled the minimum clinically important difference threshold. The appearance domain did not fulfill the minimum clinically important difference. Satisfaction with treatment domain score minimally improved with the curve regression group (mean difference on a scale from 0 to 5: 0.2) but deteriorated in the curve progression group (mean difference on a scale from 0 to 5: -0.4). CONCLUSIONS:Curve regression occurs after underarm bracing and is associated with superior patient-reported outcome scores. This possible change in Cobb angle should be explained to patients before and during bracing. Whether this may help improve patients' duration of brace-wear should be addressed in future studies. Patients with well-fitting braces may experience curve improvement and possible vertebral remodeling. Those braced at a younger age and with increased vertebral wedging are more likely to have curve progression. LEVEL OF EVIDENCE:Level III, therapeutic study.
10.1097/CORR.0000000000000989
Physiotherapeutic scoliosis-specific exercises performed immediately after spinal manipulative therapy for the treatment of mild adolescent idiopathic scoliosis: study protocol for a randomized controlled pilot trial.
Wang Li,Wang Chun,Youssef Ahmed S A,Xu Jiang,Huang Xiaolin,Xia Nan
Trials
BACKGROUND:Spinal manipulative therapy is commonly used in the treatment of adolescent idiopathic scoliosis. Some therapists also rely on physiotherapeutic scoliosis-specific exercise (PSSE). Combining these two modalities seems reasonable, but the effectiveness of this combination has never been rigorously tested. Here, a protocol for a pilot study is proposed to determine the feasibility of conducting a larger randomized trial. The pilot study was designed to test the hypothesis that spinal manipulative therapy followed by PSSE is more effective than PSSE alone in improving the Cobb angle, sensorimotor integration, the angle of trunk rotation (ATR), body symmetry, and quality of life. METHODS:The protocol describes a randomized controlled pilot trial with 40 subjects divided into study and control groups. Both groups will receive 8 weeks of PSSE, but the study group will also receive spinal manipulative therapy during the first 2 weeks before PSSE. The primary outcome will be an estimate of the feasibility of conducting a full-scale experiment. The influencing factors will be the time to complete enrollment, the recruitment rate, subject retention, and adherence to the treatment allocations. The secondary outcomes that will be used to assess the efficacy of treatment will include the Cobb angle, somatosensory evoked potentials, ATR, three-dimensional postural parameters, and scores on the 22-item Scoliosis Research Society outcomes questionnaire. The Cobb angle will be measured at baseline and at the end of 8 weeks of training. The somatosensory evoked potentials will be measured at baseline and at the end of 2 weeks of training. The ATR, three-dimensional postural parameters, and scores on the 22-item Scoliosis Research Society outcomes questionnaire will be measured at baseline and at 2 weeks, 4 weeks, and 8 weeks of treatment. DISCUSSION:This study will inform the design of a future full-scale trial. The outcomes will provide preliminary data about the efficacy of the combination of spinal manipulative therapy and exercise in treating scoliosis. TRIAL REGISTRATION:Prospectively registered at Chinese clinical trial registry, ChiCTR1900027037 . Registered on 29 October 2019. http://www.chictr.org.cn/edit.aspx?pid=44954&htm=4.
10.1186/s13063-020-05000-y
Does static trunk motion analysis reflect its true position during daily activities in adolescent with idiopathic scoliosis?
Pesenti Sébastien,Prost Solène,Pomero Vincent,Authier Guillaume,Roscigni Lionel,Viehweger Elke,Blondel Benjamin,Jouve Jean-Luc
Orthopaedics & traumatology, surgery & research : OTSR
INTRODUCTION:Adolescent idiopathic scoliosis is common condition in pediatric orthopedics that is generally analyzed with standard radiographs. However, the conditions under which the radiographs are made are completely different than the position that patients use during day-to-day activities. We hypothesized that the trunk's static position differs from its dynamic one. The aim of this study was to determine differences between the trunk's static and dynamic positions using motion analysis in adolescents with idiopathic scoliosis. PATIENTS AND METHODS:This prospective, single-center study enrolled adolescents with idiopathic scoliosis who were scheduled to undergo surgical correction. The day before the surgery, radiographs were made and motion analysis was performed (static and dynamic acquisitions). Various parameters were measured on the radiographs and motion analysis, including the coronal vertical axis (CVA), sagittal vertical axis (SVA) and coronal shoulder tilt. RESULTS:The study enrolled 62 patients with a mean age of 15.5 years. There was a significant correlation between the radiographic measurements and the static motion analysis results for most parameters. Conversely, dynamic measurements of CVA, SVA and coronal shoulder tilt were not correlated to their static measurements (R=0.229; 0.198 and -0.109 respectively, all p>0.05). The static coronal shoulder tilt was opposite to the one found during walking (-0.9° vs. 0.5°, p=0.031). DISCUSSION:Our study is the first to compare the trunk's static position with its dynamic position during walking in a cohort of adolescents with idiopathic scoliosis. Motion analysis provides new information about the trunk's dynamic positions. Based on our findings, radiographic analysis only partially captures the spinal alignment and cannot be used to draw reliable conclusions about the trunk's dynamic balance.
10.1016/j.otsr.2019.12.023
Nighttime bracing with the Providence thoracolumbosacral orthosis for treatment of adolescent idiopathic scoliosis: A retrospective consecutive clinical series.
Davis Leigh,Murphy Joshua S,Shaw Kenneth A,Cash Kaitlin,Devito Dennis P,Schmitz Michael L
Prosthetics and orthotics international
BACKGROUND::Orthotic treatment for adolescent idiopathic scoliosis is a mainstay in nonoperative treatment to prevent progressive spinal deformity. OBJECTIVE::To determine the effectiveness of the Providence orthosis in the treatment of adolescent idiopathic scoliosis. STUDY DESIGN::Retrospective review. METHODS::Patients treated with a Providence orthosis for adolescent idiopathic scoliosis were reviewed. Inclusion criteria included the following: age of 10-18 years; curve magnitude of 25°-40°; Risser stage of 0-2; and, if female, <1 year post menarche at the time of brace initiation. Failure was defined as curve magnitudes progressing >5° or to >45° or surgery. Radiographs and clinical information were recorded and compared between treatment success and failure cohorts. RESULTS::56 patients (51 female and 5 male; average of 12.26 years) were identified with average of 2.21-year follow-up and a 57.1% success rate for preventing curve progression. Factors associated with successful treatment included curve apex T10 and caudal and Risser sign ⩾ 1. Multivariate analysis identified Risser ⩾ 1 and curve apex T10 and caudal as independent predictors of successful treatment. CONCLUSION::The Providence nighttime orthosis can be an effective treatment for adolescent idiopathic scoliosis. Curve Apex at T10 or caudal was an independent predictors of treatment success. CLINICAL RELEVANCE:This study identifies variables associated with treatment success using the Providence nighttime orthosis in a consecutive series of adolescent idiopathic scoliosis patients. This information provides the foundation for identifying ideal patients for nighttime bracing to guide clinical treatment.
10.1177/0309364618792727
Asymmetric biomechanical characteristics of the paravertebral muscle in adolescent idiopathic scoliosis.
Liu Yuzeng,Pan Aixing,Hai Yong,Li Wenjing,Yin Li,Guo Ruijun
Clinical biomechanics (Bristol, Avon)
BACKGROUND:We sought to assess the biomechanical properties of the paravertebral muscles in adolescent idiopathic scoliosis patients with Lenke Type 1, 2, or 3 (Lenke 1-3) curves. METHODS:The MyotonPro® and shear wave elasticity imaging system were used to assess the biomechanical features of the thoracic paravertebral muscles on concave and convex side in adolescent idiopathic scoliosis patients with Lenke 1-3 curves. The Cobb angle of the main curve was measured using the anteroposterior whole spine radiograph in the standing position. FINDINGS:A total of 40 adolescent idiopathic scoliosis patients with a mean Cobb angle of 66.49° (SD 32.8°) were included in this study. Muscle tone, stiffness and Deborah number on the concave side was significantly greater than that on the convex side. Relaxation time was significantly longer on the convex side than on the concave side. No statistically significant difference in muscle elasticity was observed between the concave side and the convex side (P > 0.05). Pearson correlation analysis demonstrated that stiffness on the concave side was moderately positively correlated with the Cobb angle (P < 0.05, r = 0.582); the Deborah number on both sides and the relaxation time on the concave side showed a moderate negative correlation with the Cobb angle (P < 0.05, r = -0.632; r = -0.432; r = -0.611). INTERPRETATION:Concave paravertebral muscle tone and stiffness were greater than those on convex side in adolescent idiopathic scoliosis patients. The asymmetric biomechanical characteristics of paravertebral muscles are closely related to the severity of scoliosis.
10.1016/j.clinbiomech.2019.03.013
Is brace treatment unnecessary for cases of adolescent idiopathic scoliosis above Risser sign 3?
Kawasaki Sachiko,Shigematsu Hideki,Tanaka Masato,Suga Yuma,Yamamoto Yusuke,Tanaka Yasuhito
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
BACKGROUND:Skeletally mature cases of adolescent idiopathic scoliosis with mild curves are generally considered to have a low risk of deterioration. Previous reports have indicated that brace treatment in these cases has a high success rate; however, it is unclear whether brace treatment is necessary. The purpose of this study was to determine the incidence of adolescent idiopathic scoliosis progression during one year of follow-up in cases with a Risser sign ≥3, which were not treated with a brace, and to identify risk factors for progression. METHODS:This retrospective, single center study included 54 cases of adolescent idiopathic scoliosis presenting to a university hospital in Japan between 2008 and 2017, with a Risser sign ≥3, which were not treated with brace treatment and had at least 2 years of follow-up data. The primary outcome was adolescent idiopathic scoliosis progression, defined as a deterioration in the Cobb angle of ≥ 6. Statistical analyses were performed to identify patient characteristics that were associated with progression. RESULTS:The mean age of the 54 included cases was 14.1 years, and the male to female ratio was 8:46. Scoliosis progressed in 8 (14.8%) cases within 2 years of follow-up. Female patients with progression were more likely to have recently gone through menarche than those without progression (p < 0.01). There was a slight statistical difference in age (p < 0.05), but no significant differences in sex, Risser-sign Stage, initial Cobb angle or main curve between adolescent patients with and without progression. CONCLUSIONS:We recommend brace treatment for cases of adolescent idiopathic scoliosis with a Risser sign ≥ 3 who have recently gone through menarche.
10.1016/j.jos.2020.01.007
The end of being a straight child: an autoethnography of coping with adolescent idiopathic scoliosis.
Grantham Weronika,Jespersen Ejgil,Płaszewski Maciej
Disability and rehabilitation
PURPOSE:In the field of research on adolescent idiopathic scoliosis, the personal dimension is undervalued. Even the most comprehensive and current recommendations focus on biomedical issues and are entirely based on quantitative studies. Reports and narratives presenting people's preferences, values, views, and opinions, especially of those affected by this health condition, are not considered in those reports. This article's aim is to present personal experiences of scoliosis screening, diagnosis, and treatment, to contribute to the discussion. METHODS:This is an evocative narrative autoethnography study, which allows focusing on the personal story of the author's experiences of adolescent idiopathic scoliosis management, connecting it to the rehabilitation context. RESULTS:Experiences of non-person-centred rehabilitation resulted in stigmatisation, distress, and emotional upset, including anxiety and fear. In contrast, person-centred therapeutic relationship involved more positive outcomes of care, such as becoming an engaged co-responsible and active partner in rehabilitation. CONCLUSIONS:It is strongly suggested to promote biographical research into the personal experiences of all aspects of adolescent idiopathic scoliosis, to identify patients' preferences and values more clearly. Furthermore, screening, diagnosis and treatment processes should be reviewed in terms of person-centredness, to ensure they are responsive to young people's needs in the vulnerable time of puberty. IMPLICATIONS FOR REHABILITATION Adolescent idiopathic scoliosis, including the treatment, and even the diagnosis, may be stigmatising and may lead to emotional and psychosocial harms Adolescent idiopathic scoliosis screening, diagnosis and treatment processes need to be person-centred, recognising young people's needs for privacy and support in the vulnerable time of puberty Emotional support from therapists ought to be part of the professional relationship based upon being with another person An explication of experiences of living with adolescent idiopathic scoliosis should be considered as a legitimate contribution to the practical and scientific understanding of this health condition.
10.1080/09638288.2019.1624989