Effectiveness of Bracing Alone in Idiopathic Scoliosis before 6 Years of Age

Heath-related quality of life and functional outcomes in patients with congenital or juvenile idiopathic scoliosis after an average follow-up of 25 years: a cohort study

BackgroundSurgical outcomes of adolescent idiopathic scoliosis (AIS) patients have been well studied. However, few studies have examined the surgical outcomes of young adult idiopathic scoliosis (YAdIS) patients. This study analyzed and compared the surgical outcomes of young adult (19-30 years) and adolescent (10-18 years) idiopathic scoliosis patients.MethodsThis is a retrospective, comparative two-center study. Reviewed data of consecutive AIS and YAdIS patients who had undergone posterior spinal deformity surgery (n=56) by two spine surgeons from 2010 to 2014. Inclusion criteria were age between 10 to 30 years and preoperative coronal Cobb angle >40o. We excluded patients with previous correction surgery. Demographic data (age at time of surgery, gender, body mass index (BMI)), surgical data (preoperative diagnosis, number of levels fused, blood loss, duration of surgery, peri- and postoperative complications, duration of surgery, length of stay, revision surgery, and final follow-up) and radiographic data collected, reviewed, and analyzed. The groups were divided as AIS (n=29) and YAdIS (n=27).ResultsPatients’ gender, BMI, average preoperative main coronal curve (YAdIS 53o vs. AIS 570), and follow-up intervals were not statistically different between groups. Statistically significant for YAdIS patients were more levels fused (10.6 vs. 8.9, p=0.02) and more intraoperative blood loss (872 ml vs. 564 ml, p=0.02) were statistically significant. Not significant between the groups were duration of surgery (p>0.05), perioperative complications (p=0.14), and length of stay (p=0.11). At mean 21 months follow-up, patients in both groups had a significant correction of their main coronal curve (YAdIS 21o vs. 53o, p<0.001, and AIS, 19o vs. 57o, p<0.01). YAdIS had a lower percentage correction of their curves (61% vs. 68%, p=0.03). Three YAdIS (11.1%) and no AIS (0%) patients had additional surgery, p=0.07. YAdIS had more distal fusion levels at L4 or below.ConclusionsYAdIS patients had a greater number of levels fused, higher blood losses, and lower major Cobb correction versus AIS patients.

The involvement of the brain motor system in idiopathic scoliosis remains unclear. In this paper, we question whether the functional connectivity (FC) of the central motor circuitry is abnormal in adolescent idiopathic scoliosis (AIS) and whether it can be modified by flexion of the lower extremities. Functional magnetic resonance imaging (fMRI) in 18 patients with a right thoracic idiopathic curve greater than 30° (mean angle 49.4°, mean age 15.3 years, 4 males) and 22 healthy controls (mean age 18.2 years, 4 males) was explored using a 3T MR scanner. We measured their resting-state fMRI: (a) with extended lower extremities; (b) with semiflexion of the left lower extremity and extended right lower extremity, with hip abduction. Decreased FC between the secondary motor area (SMA) and postcentral cortex, pallidum and cuneus, postcentral gyrus and cerebellum, putamen and temporal lateral neocortex was observed in AIS. This pathological connectivity was reversed by lower extremity semiflexion. The FC between cortical and subcortical motor structures is significantly decreased in AIS. The decreased FC of the SMA, basal ganglia, cuneus (a hub structure), and cerebellum indicates the functional impairment of structures involved in regulating muscular tone. FC impairment in patients with AIS appears to be a reaction to the pathological condition. This pathological pattern flexibly reacts to changes in the positioning of the lower extremities, showing that the functional impairment of brain motor circuitry in AIS is reversible. We suggest that the reactivity of cerebral activity leading to brain activity normalization could be used for a rehabilitation program for patients with AIS.

An initial examination of functional assessment scores in scoliosis and kyphosis populations. Examination of scores from the Pediatric Outcomes Data Collection Instrument for patients with idiopathic scoliosis, congenital scoliosis, and congenital kyphosis, comparing scores with those of children without orthopedic disabilities. Little information has been presented regarding performance of scoliosis patients on the Pediatric Outcomes Data Collection Instrument. A total of 102 patients with adolescent idiopathic scoliosis, 47 with congenital scoliosis without kyphosis, and 9 with congenital kyphosis completed the Pediatric Outcomes Data Collection Instrument. Responses were compared with those from a "normal" population. Subgroup analyses were performed for patients with adolescent idiopathic scoliosis. A P value <0.05 was considered statistically significant. Scores in Transfers, Sports, Comfort, and Happiness were significantly lower than "normal" in adolescent idiopathic scoliosis. In congenital scoliosis without kyphosis, scores in all categories except Happiness were significantly lower than "normal." All category scores were significantly lower than "normal" in congenital kyphosis. In adolescent idiopathic scoliosis, age and curve location did not influence Comfort scores. Comfort scores were significantly lower than "normal" for all curve locations and for all ranges of Cobb angle. Happiness scores were significantly lower in adolescent idiopathic scoliosis patients with Cobb angles >50 degrees who had not received surgery when compared with either patients who had received surgery or patients with Cobb angles <50 degrees. These findings provide some normative values for the Pediatric Outcomes Data Collection Instrument for three specific diagnoses. Patients with adolescent idiopathic scoliosis, congenital scoliosis, and congenital kyphosis gave responses significantly different from "normal" children. Pain appeared to be a common finding with these diagnoses.

Study DesignRetrospective study.PurposeTo identify the incidence of congenital cardiac abnormalities in patients who had scoliosis and underwent surgical treatmentfor scoliosis.Overview of LiteratureCongenital and idiopathic scoliosis (IS) are associated with cardiac abnormalities. We sought to establish and compare the incidence of congenital cardiac abnormalities in patients with idiopathic and congenital scoliosis (CS) who underwentsurgical treatment for scoliosis.MethodsNinety consecutive scoliosis patients, who underwent surgical correction of scoliosis, were classified as CS (55 patients, 28 female [51%]) and IS (35 patients, 21 female [60%]). The complete data of the patients, including medical records, plain radiograph and transthoracic echocardiography were retrospectively assessed.ResultsWe found that mitral valve prolapse was the most common cardiac abnormality in both patients with IS (nine patients, 26%) and CS (13 patients, 24%). Other congenital cardiac abnormalities were atrial septal aneurysm (23% of IS patients, 18% of CS patients), pulmonary insufficiency (20% of IS patients, 4% of CS patients), aortic insufficiency (17% of IS patients), atrial septal defect (11% of IS patients, 13% of CS patients), patent foramen ovale (15% of CS patients), dextrocardia (4% of CS patients), bicuspid aortic valve (3% of IS patients), aortic stenosis (2% of CS patients), ventricular septal defect (2% of CS patients), and cardiomyopathy (2% of CS patients).ConclusionsWe determined the increased incidence of congenital cardiac abnormalities among patients with congenital and IS. Mitral valve prolapse appeared to be the most prevalent congenital cardiac abnormality in both groups.

This was a retrospective review of posterior spinal fusion surgical procedures in patients diagnosed with adolescent idiopathic scoliosis (AIS) or neuromuscular scoliosis (NMS). The purpose was to determine if the first assistant's training experience is associated with outcomes in AIS and NMS surgical procedures. A previous study found that patients with AIS undergoing posterior spinal fusion with 2 attendings had similar operating times, blood loss, and complication rates compared with those with a resident or fellow first assistant. NMS cases are more complex than AIS cases, but to our knowledge, no previous studies have examined the impact of the first assistant's level of training on NMS outcomes. This was a single-center retrospective review of 200 patients, 120 with AIS and 80 with NMS, undergoing primary posterior spinal fusion. Minimum follow-up was 2 years. For each diagnosis group, cases assisted by junior orthopedic residents were compared with those assisted by orthopedic fellows. NMS cases were more complex and had higher complication rates than AIS cases (P < 0.05). AIS and NMS cases were similarly distributed among the fellow and junior resident groups (P = 0.63). AIS cases in the fellow and junior resident groups had similar operating times, estimated blood loss (EBL), complications, lengths of stay, and reoperation rates (P > 0.05). In NMS cases, the fellow group had shorter operating times (320 ± 73 min vs. 367 ± 104 min, P = 0.035) and greater percent correction at initial and 2-year follow-up (58 ± 15% vs. 42 ± 19%, P < 0.001). EBL, complications, lengths of stay, and reoperation rates were similar between the assistant groups in NMS cases (P > 0.05). NMS surgical procedures in which fellows serve as the first assistants were associated with shorter operating times and greater percent correction than surgical procedures with junior resident first assistants. 3.

Intraspinal anomalies are common in patients with congenital scoliosis and are a known risk factor for neurological complications. Smaller but normal-appearing spinal cords have not been described in association with congenital scoliosis, nor have they been considered to be an anomaly with a similar neurological risk. We previously reported on small spinal cords associated with Klippel-Feil syndrome. We hypothesized that patients with congenital thoracic scoliosis would similarly have smaller spinal cords as compared with normal controls, with a potentially increased risk for myelopathy. We reviewed thirty patients with congenital scoliosis (including fifteen patients with failure of vertebral formation and fifteen with failure of vertebral segmentation). All patients had adequate axial T2-weighted, digitally formatted magnetic resonance imaging scans that were suitable for cross-sectional measurement. Cross-sectional areas of the spinal cord and spinal canal at each of the twelve thoracic levels were calculated three times by a blinded observer, and the average values were compared with measurements from age-matched normal controls. We observed a significantly smaller mean cross-sectional area at all levels of the spinal cord in the study group as compared with the control group (p < 0.01). When the pathological segments were evaluated, both with and without the inclusion of the adjacent normal segments, the spinal cord was smaller for the study group (p < 0.01). Within the study group, small spinal cords were observed in patients with failed vertebral formation as well as in patients with failed vertebral segmentation, but without an identifiable difference between these two subgroups. The spinal canal was also smaller for the patients in the study group, but not in all cases. No patient showed a reduction of, or encroachment on, the space available for the spinal cord. Spinal cord size increased with age in both the study group and the control group but remained consistently smaller in the study group. Within the study group, the presence of intraspinal anomalies did not appear to influence the spinal cord size. The spinal cord is significantly smaller in patients with congenital thoracic scoliosis than in normal controls. Because small spinal cords have been reported to be associated with neurological sequelae, we advise that the diminished spinal cord size be considered an important component of intraspinal anomalies associated with congenital scoliosis.

Introduction Multiple methods are included in the management of congenital, neuromuscular, or idiopathic scoliosis in younger patients. The traditional surgical treatments, such as, in situ fusion and hemiepiphysiodesis have not addressed the thoracic deformity in three dimensions, and the results are usually insufficient and unpredictable. The objective of the VEPTR management is focused on the chest wall extensions, to provide more space for the developing lungs, and prevents progression of the scoliotic deformity. From results of studies on the effectiveness of patients with VEPTR within early onset scoliosis, we designed a retrospective case series study for clinical and radiological outcomes of VEPTR system in the management of patients with spinal deformities in congenital and neuromuscular scoliosis. Patients and Methods This is a retrospective case series study. A total of 23 patients, 15 women and 8 men, with congenital and neuromuscular scoliosis, treated with VEPTR implantation, from January 2008 to May 2014 were included. The average age for the initial insertion of VEPTR was 5 years (range, 8 months–12 years), with an average follow-up time of 26 months. Specific data for the construction of the implant were collected; the pre- and postoperative X-rays were measured by the Cobb method to evaluate the magnitude of the curve, and the total length of the system in the coronal plane before insertion of the VEPTR device, and after each elongation were measured. In addition, complications such as infection, failure of material, pressure zones, synostosis, and hemothorax were evaluated. Results Our results demonstrated that there was an improvement in the postoperative Cobb angle measurement in the coronal plane. In children with congenital scoliosis, the average correction was 13% ( p &lt; 0.001) and in neuromuscular scoliosis was an average correction of 22% ( p &lt; 0.001). Likewise, there was an increase of the thoracic length measured through the VEPTR device, developing an average elongation of 9% of the column in children with congenital scoliosis and 18% in children with neuromuscular scoliosis. In this study, complications such as device migration, costal synostosis, pressure injuries, rib fractures, hemothorax, and deep infection were identified. Conclusion The data analysis shows that the natural history of progressive spinal deformities in children with congenital and neuromuscular scoliosis was satisfactorily controlled by using the VEPTR device. This allows us to recommend the use of this implant and continue using it in the treatment of patients with these deformities.

Objectives: Scoliosis is a common spinal deformity that, in some cases, requires corrective surgery. This study aimed to compare long-term outcomes of corrective surgery in patients with idiopathic versus congenital scoliosis (CS). Methods: This cross-sectional, retrospective study was conducted on 81 adolescent patients aged 10–20 years with idiopathic (56 cases) or congenital (25 cases) scoliosis who underwent definitive corrective spinal surgery between October 2007 and December 2021. We excluded cases with &lt;24 months of follow-up and those involving patients who underwent growth-respecting spinal surgeries. Post-surgical outcomes were assessed using the Revised Scoliosis Research Society-22 questionnaire. Results: The findings indicated that the overall questionnaire score was significantly higher in patients with idiopathic scoliosis (IS) than in those with CS (P = 0.022). In addition, self-image (P = 0.023) and mental health (P = 0.015) scores were significantly better in the IS group. However, there was no significant difference between the two groups in terms of physical function (P = 0.478), pain (P = 0.376), or satisfaction with the surgery (P = 0.308). Furthermore, females with IS had significantly better self-image and mental health scores than those with CS. Conclusion: Corrective spinal surgery positively impacts patients’ quality of life, but patients with CS, especially females, may experience more psychological and social challenges.

A retrospective evaluation of screw position after double-rod anterior spinal fusion in idiopathic scoliosis using computerized tomography (CT). To evaluate screw position and complications related to screw position after double-rod anterior instrumentation in idiopathic scoliosis. Anterior instrumentation and fusion in idiopathic scoliosis is gaining widespread use. However, no studies have been published regarding the accuracy of screw placement and screw-related complications in double-rod and double-screw anterior spinal fusion and instrumentation in idiopathic thoracolumbar scoliosis surgery. CT examinations were performed after surgery in 17 patients with idiopathic scoliosis. At each instrumented level, the position of the screw and the plate relative to the spinal canal, relative to the neural foramen, and relative to the aorta was measured. Complications related to screw position were registered. A total of 189 screws in 17 patients were evaluated. Malposition occurred in 23% (16 patients) of the total number of screws. Three screws (2 patients) were partially in the spinal canal (1%). This resulted in pain in the right leg in 2 patients. However, electromyography showed no abnormalities. At three levels (3 patients), there was contact between the instrumentation and the aorta. However, no vascular complications occurred. A total of 113 screws (10 patients) were placed under fluoroscopic control and 76 screws (7 patients) were placed without use of fluoroscopy. Less screw malposition was observed in the group in which fluoroscopic control was used (19% vs. 30%, not significant). Screw placement in double-rod anterior spinal fusion in idiopathic scoliosis seems to be technically demanding, and the use of fluoroscopic control results in less frequent malposition. The risk of neurologic and vascular complications is low.

Research Article| February 01 2014 Effects of Bracing in Adolescents With Idiopathic Scoliosis AAP Grand Rounds (2014) 31 (2): 14. https://doi.org/10.1542/gr.31-2-14 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Effects of Bracing in Adolescents With Idiopathic Scoliosis. AAP Grand Rounds February 2014; 31 (2): 14. https://doi.org/10.1542/gr.31-2-14 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: braces, idiopathic scoliosis, scoliosis Source: Weinstein SL, Dolan LA, Wright JG, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013; 369(16): 1512– 1521; doi: https://doi.org/10.1056/NEJMoa1307337Google Scholar Investigators from the University of Iowa and Washington University sought to determine the effect of bracing on curve progression and rate of surgery in adolescents with idiopathic scoliosis. They conducted a multicenter (25 institutions) randomized trial of patients with scoliosis and typical indications for bracing including age, skeletal maturity, and degree of curve (Cobb angle of 20° to 40°). Both a randomized cohort (randomized to bracing or observation) and a preference cohort were enrolled. Patients in the bracing group (both those randomized and those choosing this treatment) were instructed to wear the brace at least 18 hours per day. Wear time was measured by means of a temperature logger embedded in the brace that logged the date, time, and temperature every 15 minutes. A temperature of 28°C or higher indicated that the brace was being worn. The primary outcome, treatment failure, was defined as curve progression to ≥50°. Treatment success was defined as the patient reaching skeletal maturity without this degree of curve progression. Rates of treatment success were compared between those in the bracing and observation groups. A secondary analysis was conducted to assess the impact on treatment success of the number of hours per day of wearing the brace. A total of 242 patients (age range 10–15 years) were enrolled in the study, including 116 who agreed to be randomized to bracing or observation and 126 who chose between bracing (71%) and observation (29%). The trial was stopped early due to the efficacy of bracing. The overall rate of treatment success was 72% after bracing as compared to 48% after observation (OR = 1.93; 95% CI, 1.08–3.46). Among study participants in the randomized part of the study, the rate of treatment success was 75% among those assigned to bracing as compared with 42% in those randomly assigned to observation (OR = 4.11; 95% CI, 1.85–9.16). There was a significant positive association between hours of brace wear and treatment success (P < .001). Success rate was >90% in patients who wore the brace for at least 13 hours per day and 41% in those who wore the brace for 0 to 6 hours per day. Adverse events included a rash under the brace in 12 of 146 patients (8%) who wore the brace and hospitalization for anxiety and depression in another patient who wore the brace. The authors conclude that bracing significantly reduced the progression of high-risk spinal curves and reduced the need for surgery in adolescents with idiopathic scoliosis. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. The commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Idiopathic adolescent scoliosis develops in about 3% of children. Approximately 0.3% of children progress to spinal curves greater than 20° – a... You do not currently have access to this content.

As I approached the examination room of a patient with adolescent idiopathic scoliosis (AIS), the size of the folder with her radiographs struck me. Each image represented radiation exposure to her thyroid, breast tissue, and marrow, in addition to the expense of a clinic visit and the anxiety associated with decisions about the next visit, bracing, and perhaps surgery. What if we could have predicted at her first visit whether the small curve would need intervention, and how might that have changed her treatment? AIS is the most common spinal deformity in children. In my own career, I have treated many patients with AIS. Over that time, our knowledge about AIS has grown, and we now understand it to be a complex polygenic familial disorder1. Environmental or epigenetic influences on AIS have been suggested, but to my knowledge none have been verified. The possible combinations of causative genes result in a varied clinical presentation of AIS, with multiple curve types. About 4% of patients with AIS who have mild curves ultimately require surgery, while the rest have a more benign clinical course2. The challenge lies in prospectively identifying those who will have a progressive deformity and avoiding unnecessary treatment for the remaining patients. How do we "predict" curve progression? At present, biologic markers such as menarche onset, growth velocity, skeletal maturity, and Tanner stages are helpful in this regard, but these are not useful with mild AIS in the younger age group. Multiple clinic visits and numerous radiographs remind me that my decisions have sometimes been intuitive rather than evidence-based as our understanding of "the genetics of AIS" continues to evolve. Many studies have reported AIS-associated genes, but the critical question is, which ones have a large effect that rises to clinical importance? I was grateful to be part of a genome-wide association study (GWAS) that identified 53 single nucleotide polymorphisms (SNPs), or genetic variations, that are associated with AIS when tested in a specific cohort. The inclusion criteria were (1) a diagnosis of AIS, (2) curves with a Cobb angle measurement of 10° to 24°, and (3) a Risser stage of 0 to 2. The lower Cobb angle limit meets the threshold for a diagnosis of scoliosis, and at the upper limit, the curve has declared itself by progressing to the severity where treatment is an option. SNPs can be ethnicity-specific. In one study, thousands of DNA samples were submitted from across North America. The validation study cohort ultimately included only European Caucasians, that is, those with 4 Caucasian grandparents3, since >92% of those submitting samples considered themselves to be Caucasian. Unfortunately, the small number of samples from those identifying themselves as African or Asian did not permit a statistical analysis of those cohorts. A predictive algorithm derived from the SNP markers was calculated to have a negative predictive value of 98% accuracy when identifying patients whose curves would not progress to the severity requiring intervention. This was a critical answer to my clinical conundrums. However, I was disappointed that we had insufficient numbers to predict which patients would progress to surgery. Moreover, the bench-to-bedside process is seldom smooth. For example, self-declared ethnicity can be uncertain. In retrospective testing, we found that a substantial number of self-declared Caucasians had either an African or Asian admixture of DNA, which reduced the statistical accuracy of the test. In addition, there is a generally recognized interobserver measurement variation of 5° for the Cobb angle. The Cobb angle was listed as 24° for some of the patients who submitted DNA samples, when, on review, their curves clearly exceeded that measurement. Some clinicians unsuccessfully applied the test as an off-label, unvalidated method of predicting progression to a severe scoliosis. However, the test results were not a binary yes or no—they were a probability of progression or no progression. Uncertainty can be disquieting to both the physician and the patient. Furthermore, this genetic test was designed for a specific intended-use population. Some tried to apply it in a scoliosis clinic setting where there are many patients with large curves. Applying any test to the population where it was validated is necessary. For example, if the incidence of disease A in the general population is 2%, a validation study for the test in an infectious disease clinic might find a 40% positive rate, suggesting a lack of specificity, whereas if it were tested in a sequestered healthy population, it may be that none are affected, indicating a lack of sensitivity. Finally, genetic tests for AIS often generate legitimate questions from parents, such as will my other children have AIS, or will my grandchildren have AIS? Busy spine surgeons are not genetic counselors and, unfortunately, genetic counselors know little about decision-making regarding patients with AIS. Who will be the bearer of this information? There have been revolutionary advances in DNA analysis, and more are anticipated. Current technology allows sequencing of the whole exome, the part of the genome that codes for proteins, in 24 hours, at an increasingly lower cost. Although the exome constitutes only about 1.7% of the genome, approximately 85% of genetic disorders can be identified in the exome. Preliminary investigation also has suggested that copy number variants may play an important role in AIS. New methodology may allow the identification of AIS genes with a large effect and allow molecular geneticists to understand the metabolic pathways that lead to spinal deformity and which combinations of AIS genes have the greatest prognostic value. The frequency of these causative alleles may vary among ethnic groups, but their molecular pathways may not. Thus, the use of DNA mutations could potentially enable a more precise, while societally more diverse, understanding of the causative genes using verifiable laboratory science. Answers to questions regarding AIS pathogenesis are not beyond our reach. Understanding the complex genetics of AIS will require adequate funding, a large database with qualified geneticists and bioinformatics scientists to analyze the petabytes of information that will be acquired, and a well-defined AIS phenotype that excludes early presentation of other genetic syndromes associated with spinal deformity that can be confused with early AIS. Collaboration across scientific disciplines and with spine clinicians will be necessary for success. Hopefully, the designation of "idiopathic" will become a quaint historical anachronism. In addition to providing accurate prognostic information to guide more efficient and effective AIS care, understanding molecular pathways could lead to personalized therapies that have preventive as well as therapeutic value. Clinical decision-making regarding AIS that is based on validated science will make the future better for spine surgeons and, most importantly, for our patients.

Adolescent idiopathic scoliosis (AIS) is characterized by an asymmetrical formation of the spine and ribcage. Recent work provides evidence of asymmetrical (right versus left side) paraspinal muscle size, composition, and activation amplitude in adolescents with AIS. Each of these factors influences muscle force generation. The timing of paraspinal muscle activation may also contribute to an asymmetry in the timing of forces applied to the spine. The main objectives were to determine (1) whether the timing and asymmetry of erector spinae muscle activation during a rapid bilateral arm raise task differs between adolescents with AIS and those without AIS and (2) whether the magnitude of erector spinae activation asymmetry in AIS is associated with scoliosis curve severity (Cobb angle) or skeletal development level (Risser stage). Finally, (3) we investigated potential kinematic confounders to determine whether symmetry of bilateral rapid arm movements differed between those with and without AIS, and whether any asymmetry in arm movement was associated with erector spinae activation asymmetry. All patients were made aware of the project through flyers at one outpatient spine clinic and a scoliosis rehabilitation clinic in Brisbane, Australia. They were invited between August 2022 and September 2023 to contribute if they met the selection criteria. This cross-sectional study included females with AIS who agreed to participate (n = 24, mean ± SD age of 14 ± 2 years). They all had a primary right-thoracic curve, diagnosed by an orthopaedic specialist. Twenty age- and sex-matched controls (age 13 ± 2 years) who did not have AIS were recruited from the local community. Volunteers (from either group) were excluded if they had any history of spinal surgery, neurological disorders, or musculoskeletal disorders (other than AIS). The experimental task required participants to perform a bilateral rapid arm flexion in response to a visual cue. Muscle activation was recorded using surface electrodes, placed bilaterally on the anterior deltoid and erector spinae adjacent to the C7, T9 (the curve apex for AIS), T12, and L5 vertebrae. Muscle activation onsets were determined from 6 of 10 trials with the quickest deltoid onset for each participant. A linear mixed model (with fixed factors) was used to determine whether activation asymmetry (left-right onset difference) differed between groups (AIS, control) and vertebral level (C7, T9/apex, T12, and L5). Where a group difference in onset asymmetry was identified, the relation of the Cobb angle and Risser stage with the magnitude of asymmetry was evaluated in the AIS cohort using a linear mixed model. Task kinematics, including peak angular arm movement velocity and deltoid onset relative to the light signal, were analyzed using a linear mixed model with group and side as fixed factors. Erector spinae activation timing asymmetry differed between groups at the T9/apex (mean difference 14 ± 23 ms; p < 0.01). In the AIS group, muscle activation was 6 ± 17 ms earlier on the right (convex) relative to the left side of the spine, whereas in controls, activation was 8 ± 19 ms earlier on the left relative to the right side. This difference in activation timing asymmetry between groups was explained by later activation of the T9 level erector spinae muscles on the left (concave) side of the spine in AIS compared with controls (mean group difference of left T9/apex erector spinae onset 13 ± 26 ms; p = 0.01). There were no between-group differences at other vertebral levels. Within the AIS group, no association was observed between the magnitude of the erector spinae activation asymmetry measured at T9/apex and Cobb angle or Risser stage. There were no differences between groups in either the bilateral deltoid onset relative to light or arm peak velocity. Erector spinae muscle activation is asymmetrical at the T9/apex vertebral level during a rapid bilateral arm raise task. This asymmetry was opposite between the AIS and control cohorts, with left-side activation delayed in AIS. It is well established in conditions such as cerebral palsy that muscles forces can influence bone development in children. In children with AIS, there is growing evidence of asymmetrical paraspinal muscle size, composition, and activation amplitude. Each of these factors contribute to paraspinal muscle force generation. Our findings add to what we know by identifying an asymmetry in the timing of erector spinae activation during a well-controlled, bilateral movement task. Combined with previous research, these results support further investigation into whether asymmetrical paraspinal muscle forces might contribute to the curve progression and asymmetrical bony development in AIS. This is important as muscle forces are modifiable through targeted rehabilitation.

Study DesignA retrospective study.PurposeTo compare outcomes of apical derotation with pedicle screws in idiopathic and neuromuscular scoliosis (NMS).Overview of LiteratureNo information about apical derotation in NMS with pedicle screws is available.MethodsWe performed deformity correcting surgery using pedicle screw constructs on 12 adolescent idiopathic scoliosis (AIS) patients (mean age 14.1 years) and 16 NMS patients (mean age 16.5 years). Preoperative, postoperative, and final follow-up radiographs were analyzed for Cobb's angle and pelvic obliquity, while apical rotation was measured on CT scans using the Aaro-Dahlborn method.ResultsFor AIS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 57.3°, 2.8°, and 20.4°, respectively, and postoperatively they were 16.8°, 1.1° and 14.7°, respectively, showing significant correction. For NMS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 75.6°, 13.7°, and 42.9°, respectively, and postoperatively they were 27.1°, 5.8°, and 34.1°, respectively, also showing significant correction. There were no significant differences between AIS and NMS patients Cobb's angle p=0.306, pelvic obliquity p=0.887 and apical derotation p=0.113°. There were no differences in curve severity in the three groups (AIS, NMS >80°and NMS <80°); or the correction of apical rotation (p=0.25), although less correction was achieved in the Cobb's angle in the >80 NMS group (p=0.04).ConclusionsApical axial derotation can be achieved with posterior only pedicle screw fixation in NMS without anterior release, with comparable results in idiopathic scoliosis.

Single-center, prospective study. Evaluating the responsiveness and minimal important changes (MICs) for the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) in adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AS). Despite the SRS-22 properties have been investigated in various different languages, there is still a lack of information concerning responsiveness and MIC, limiting the use of SRS-22 for clinical and research purposes. At the beginning and end of multidisciplinary rehabilitation programs, 149 subjects with mild AIS (Cobb angle <25°) and 140 subjects with moderate AS (Cobb angle <35°) completed the SRS-22. Upon completing the programs, subjects also performed the global perceived effect (GPE) scales test, which was divided to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated for all SRS-22 domains but satisfaction with management by distribution (effect size; standardized response mean) and anchor-based methods (receiver operating characteristic [ROC] curves; correlations between change scores of the SRS-22 and GPE). ROC curves were also used to compute the MICs. The effect size ranged from 1.23 to 1.50 in AIS and from 1.02 to 1.37 in AS. The standardized response mean ranged from 0.95 to 1.27 in AIS and from 0.66 to 0.90 in AS. The ROC analyses revealed the following MIC values (area under the curve; sensitivity; specificity): function, 0.70 (0.739;66;70) for AIS and 0.60 (0.842;84;76) for AS; pain, 0.70 (0.731;71;70) for AIS and 0.40 (0.817;81;70) for AS; mental health, 0.50 (0.708;83;58) for AIS and 0.55 (0.750;69;78) for AS; self-perceived image, 0.40 (0.609;79;42) for AIS and 0.60 (0.751;61;82) for AS. Correlations between change scores of the SRS-22 domains and GPE were low to moderate, ranging from -0.347 to -0.667. The SRS-22 was sensitive in detecting clinical changes in subjects with adolescent and adult scoliosis. We recommend taking the MICs provided into account when assessing patients' improvement or planning studies in these clinical contexts. 3.