Diagnosis Of Adolescent Idiopathic Scoliosis Research Articles

Sports participation reduces the progression of idiopathic scoliosis and the need for bracing. An observational study of 511 adolescents with Risser 0-2 maturation stage.

In clinics and the literature, there are doubts about the indications and contraindications of sports to support rehabilitation treatment for adolescents with idiopathic scoliosis (IS). The aim of the study is to assess sports activities' effect and frequency in a large population of adolescents with idiopathic scoliosis (IS). Retrospective observational cohort study. Tertiary referral institute specialized in the conservative treatment of scoliosis. consecutive patients in a clinical database of age ≥10, with juvenile or adolescent IS diagnosis, 11-25° Cobb curve, Risser Bone Maturity Score 0-2, no brace prescription, radiographic follow-up radiographs at 12±3 months. At 12-month follow-up, radiograph, we considered progression an increase of scoliosis curve ≥5° Cobb and failure an increase to ≥25° Cobb - need of a brace. We calculated the Relative risk (RR) to compare the outcome of participants performing sports (SPORTS) or not (NO-SPORTS). We run a logistic regression with covariate adjustment to assess the effect of sports participation frequency on the outcome. We included 511 patients (mean age 11.9±1.2, 415 females). Participants in the NO-SPORTS group showed a higher risk of progression (RR=1.57, 95% CI: 1.16-2.12, P=0.004) and failure (RR=1.85, 95% CI: 1.19-2.86, P=0.007) than participants in SPORTS. Logistic regression confirmed that the more frequent the sports activities, the less probable progression (P=0.0004) and failure (P=0.004) were. This study shows that sports activities have a protective role against progression at 12-month follow-up in adolescents with milder forms of IS. Excluding high-level sports activities, the risks of progression and failure decrease with the increase in sports frequency per week. Albeit non-specific, sports can help in the rehabilitation of patients with idiopathic scoliosis and reduce brace prescription.

Knowledge and management of adolescent idiopathic scoliosis among practising physiotherapists

It is essential for physiotherapists, who have an important role in the management of adolescent idiopathic scoliosis (AIS), to have adequate knowledge about AIS. Therefore, in this study, we aimed to evaluate the competency of a group of practicing physiotherapists in AIS in Türkiye. A total of 168 physiotherapists working in different health centers between September 2021 and December 2021 were included in the study. The data of this descriptive study were collected with the help of an online questionnaire. The online questionnaire regarding AIS consists of 20 questions prepared by the researchers after the literature review on this subject. Most of the participants were able to correctly answer the questions asked about AIS, including the definition (87.5%), the unknown etiology (72.6%), the age at which it occurs most often (81.5%), how the diagnosis of scoliosis was made (59.5%), the type of exercise recommend (61.3%), when brace can be recommended (73.8%). However, the knowledge level regarding the frequency of idiopathic scoliosis among all scoliosis cases was low (36.3%). AIS-related knowledge level scores of physiotherapists in age and years of clinical experience groups were similar (p<0.05). In addition, male physiotherapists working in a training and research hospital and dealing with a small number of AIS patients had significantly lower levels of AIS-related knowledge (p<0.05). In conclusion, with 67.5% of students able to answer >70% of the survey questions correctly, we demonstrated that the majority of practicing physiotherapists have a good level of knowledge about the definition, diagnosis, and management of AIS; however, some topics need to be improved with some theoretical and practical training after graduation. Physiotherapists need to be improved with some theoretical and practical training after graduation.

Risk factors for vertebral bridging in residual adolescent idiopathic scoliosis with thoracolumbar/lumbar curves

BackgroundAlthough vertebral bridging in residual adolescent idiopathic scoliosis (AIS) can make corrective surgery more complicated, no study has investigated the risk factors. The purpose of this research was to determine risk factors for vertebral bridging in individuals with residual AIS with thoracolumbar/lumbar (TL/L) curves. MethodsForty-two pre-operative patients with residual AIS and TL/L curves (3 males, 39 females: age 41.9 ± 18.0 years) were divided into bridging (n = 17) and non-bridging (n = 25) groups. All patients were 20 years or older with a diagnosis of AIS in adolescence. The bridging group consisted of patients with third or more degree bridging by the Nathan classification. ResultsThere were significant differences in age, absolute value of apical vertebral translation (AVT), C7 translation, and L3,4 tilt between groups. There was no significant difference in TL/L Cobb angle. Multivariate analyses and ROC curves demonstrated that older age was a significant risk factor for vertebral bridging (odds ratio [OR]: 1.08; 95% confidence interval: 1.02–1.14; P = 0.004), with a cutoff value of 38.0 years old. ConclusionsThis study indicates that patients >38 years old are at risk for vertebral bridging in residual AIS. Because of the higher risk of vertebral bridging and other degenerative changes, residual AIS patients about 40 years of age are at a critical point for treatment strategy. Because appropriate surgical time should not be missed, regular follow-up is required even after 30 years of age, especially if the patient with residual AIS has a large TL/L curve indicated for surgery.

The role of school medicine in the early detection and management of adolescent idiopathic scoliosis.

ObjectiveTo analyze the trends in scoliosis screenings over 10 years (2010 vs. 2020). To assess the management of schoolchildren with a preliminary diagnosis of adolescent idiopathic scoliosis by school medicine specialists.MethodsHistorical data were used for the year 2009/2010, and a cross-sectional study was conducted during the school year 2019/2020 on 18,216 pupils of 5th, 6th, and 8th elementary school grades. A forward bend test was used to detect clinical features of scoliosis and some positive findings were referred to orthopedists or physiatrists for further evaluation.ResultsIn the analyzed 10-year period abnormal forward bend test findings increased from 4.9 to 5.8% (by 18.4%; P < 0.001). While its prevalence escalated markedly in girls (from 5.8 to 8.3%; P < 0.001), a modest but significant decrease, from 3.8 to 3.2% (P = 0.018), was noted in boys. Most pupils had low to moderate curves, and its prevalence was some 6.5 times higher in girls (P < 0.001). The forward bend test positive predictive value was 84.7%. Discrete forward bend test aberrations were managed by school medicine specialists only.ConclusionWhile actively promoting scoliosis screening in children, we have shown that forward bend test is an acceptable tool for early adolescent idiopathic scoliosis detection in school medicine. In collaboration with other specialists and using additional diagnostic methods, school medicine specialists can ensure early detection and appropriate interventions, avoiding the potential harms of radiation exposure.

Reliability of a three-dimensional spinal proprioception assessment for patients with adolescent idiopathic scoliosis

PurposeAlthough it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal proprioception in AIS may be affected three-dimensionally, prior studies only focussed on evaluating peripheral proprioception in single plane. Therefore, this study aimed to develop a novel spinal proprioception assessment using three-dimensional motion analysis in patients with AIS.MethodsParticipants were included if they had a primary diagnosis of AIS who did not receive or failed conservative treatments. Three trunk repositioning tests involving flexion-extension, lateral-flexion, and axial-rotation were conducted. A three-dimensional kinematics of the trunk was used as the outcome measures. The proprioceptive acuity was quantified by the repositioning error. The intra-examiner and test-retest reliability were analysed by the intraclass correlation coefficient (ICC).ResultsFifty-nine patients with AIS were recruited. Regarding the trunk flexion–extension test, the single measure ICC showed moderate reliability (0.46) and the average measures ICC demonstrated good reliability (0.72). As for the trunk lateral-flexion test, the reliability of single measure and average measures ICC was moderate (0.44) and good (0.70) reliability, respectively. For the trunk axial-rotation test, the single measure ICC indicated fair reliability (0.32), while the average measures ICC showed moderate reliability (0.59).ConclusionThis is the first study to evaluate the reliability of novel three-dimensional spinal proprioception assessments in patients with AIS. The trunk flexion-extension repositioning test may be preferable clinical test given its highest reliability.

Spinal disorders and mastication: The potential relationship between adolescent idiopathic scoliosis and alterations of the chewing patterns.

To evaluate mastication in a group of patients with adolescent idiopathic scoliosis (AIS) with a control group, by means of the prevalence of reverse chewing cycles (RCCs). This study included a group of patients (N=32; F=24; M=8; mean age ± SD=14 ± 3 years) with a confirmed diagnosis of AIS and a group of control subjects (N=32; F=24; M=8; mean age ± SD=13 ± 6 years) without spinal disorders. Mastication was recorded with both a hard and a soft bolus, following a standardized protocol, and the prevalence of RCCs was compared between the groups. The prevalence of RCCs was significantly higher in the AIS group, with both a soft and a hard bolus, compared to the control group (P < .001). The results of this study indicate that the presence of AIS influences mastication, one of the main functions of the stomatognathic system. A multidisciplinary approach to these patients may be relevant in providing the best possible treatment outcomes.

Opportunistic assessment of bone density in patients with adolescent idiopathic scoliosis using MRI-based vertebral bone quality

Patients with Adolescent Idiopathic Scoliosis (AIS) have increased prevalence of lower bone mineral density (BMD) compared to healthy adolescents. Our goal was to compare bone density in patients with AIS and a nonaffected control group using an MRI-based vertebral bone quality (VBQ) score. We reviewed 50 consecutive lumbar MRIs of patients with AIS and of 50 nonaffected controls that were matched for age and sex. The VBQ score was calculated and compared between the groups. The VBQ score for the AIS group was 2.5 (SD 0.4) and for the control group 2.1 (SD 0.3) (p < 0.001). Multiple linear regression analyses were performed for control of confounding from body weight, body height, corrected BMI, and Cobb angle. Besides the diagnosis of AIS, there was no variable that was independently associated with the VBQ score. This is the first study to evaluate bone density in pediatric patients with AIS. We found a significant difference in the VBQ-score between patients with AIS and nonaffected controls matched for sex, age, and race. MRI can be used to assess the bone quality in patients with adolescent idiopathic scoliosis.

Does Risser Casting for Adolescent Idiopathic Scoliosis Still Have a Role in the Treatment of Curves Larger Than 40°? A Case Control Study with Bracing.

Background: The most common conservative treatment for Adolescent Idiopathic Scoliosis (AIS) is bracing. However, several papers questioned the effectiveness of bracing for curves between 40° and 50° Cobb: the effectiveness in preventing curve progression could be as low as 35%. Seriate casting is considered a standard approach in early onset scoliosis; however, in the setting of AIS, cast treatment is seldom utilized, with only few studies reporting on its effectiveness. Aim of the study: The main aim of the study is to determine whether a seriate casting with Risser casts associated with bracing is more effective in preventing curve progression than bracing alone in curves larger than 40°. Furthermore, the secondary endpoints were: (1) is there a difference in effectiveness of casting between Thoracic (T) and Thoracolumbar/Lumbar (TL/L) curves? (2) Does the ‘in cast’ correction predicts the treatment outcome? (3) What is the effect on thoracic kyphosis of casting? Methods: This is a retrospective monocentric case–control study; through an Institutional Database search we identified all the patients treated at our institution between 1 January 2017 and 31 December 2020, with a diagnosis of AIS, Risser grade between 0 and 4 at the beginning of the treatment, at least one curve above 40° Cobb and treatment with either seriate Risser casting and bracing (Study Group, SG) or bracing alone (Control Group, CG). Standing full spine X-rays in AP and LL are obtained before and after the cast treatment; only AP standing full spine X-rays ‘in-cast’ are obtained for each cast made. Patients were stratified according to the curve behavior at the end of treatment (Risser 5): progression was defined as ≥6° increase in the curve magnitude or fusion needed; stabilization is defined as a change in curve by ±5°; and improvement was defined as ≥6° reduction in the curve. Results: For the final analysis, 55 compliant patients (12 M, 43 F, mean age 13.5 ± 1.6) were included in the SG and 27 (4 M, 23 F, mean age 13.6 ± 1.6) in the CG. Eight (14.5%) patients in the SG failed the conservative treatment while 14 (51.3%) failed in the CG. Consequently, the Relative Risk for progression in the Efficacy Analysis was 1.8 (95% CI 1, 3–2.6, p = 0.001), and the Number Needed to Treat was 2,4. No significant difference was found between the T and TL/L curves concerning the ‘progressive’ endpoint (z-score 0.263, p = 0.79). The mean percentage of ‘in cast’ curve reduction was 40.1 ± 15.2%; no significant correlation was found between the percentage of correction and the outcome (Spearman Correlation Coefficient 0.18). Finally, no significant differences between baseline and end of FU TK were found (32° ± 16.2 vs. 29.6 ± 15.8, p = ns). Discussion: Seriate Risser casting for AIS with larger curves (>40° Cobb) is effective in reducing curve progression when compared with full time bracing alone in treatment compliant patients. The treatment is equally effective in controlling T and TL/L curves; furthermore, a slight but non-significant decrease in TK was observed in patients treated with casting. This type of treatment should be considered for AIS patients who present with large curves to potentially reduce the percentage of surgical cases. Short : The aim of the study is to determine whether seriate Risser casting associated with bracing is more effective in preventing curve progression than bracing alone in curves larger than 40°. This is a retrospective monocentric case–control study; we identified all the patients treated at our institution with a diagnosis of AIS, Risser grade 0–4 at the beginning of the treatment, at least one curve above 40° Cobb (35° if treated with bracing alone) and treatment with either seriate Risser casting and bracing (Study Group, SG) or bracing alone (Control Group, CG). Fifty-five patients (12 M, 43 F, mean age 13.5 ± 1.6) were included in the SG and 30 (5 M, 25 F, mean age 13.9 ± 1.7) in the CG. Eight (14,5%) patients in the SG failed the conservative treatment while fifteen (50%) failed in the CG. Consequently, the Relative Risk for progression in the Efficacy Analysis was 1.8 (95% CI 1.3–2.6, p = 0.001), and the Number Needed to Treat was 2,4. Seriate Risser casting for AIS with larger curves (>40°) is effective in reducing curve progression when compared with full time bracing alone. This type of treatment should be considered for AIS patients who present with large curves.

The Relationship Between Body Mass Index and the Magnitude of Curve at Diagnosis of Adolescent Idiopathic Scoliosis: A Retrospective Chart Review.

PurposeTo evaluate the relationship between body mass index (BMI) and spinal curvature in patients presenting with idiopathic scoliosis at a major pediatric tertiary care centre.Patients and MethodsRetrospective chart review (2015–2019). Data extracted from patient’s first visit included age, sex, height, weight, spinal curvature (magnitude, location), referral source, physical activity participation (yes/no), pain (yes/no). Demographics were analyzed descriptively. The relationship between BMI and spinal curve magnitude was analyzed using Spearman correlation coefficient. Linear regression was applied to determine the relationship between BMI, curve magnitude, and curve location. Exploratory univariate analyses were conducted for BMI and referral source, pain, and skeletal maturity, and physical activity and pain.ResultsA total of 206 patient charts were included (177 females, 29 males). Patients presented with double major (41.3%), thoracic (26.7%), thoracolumbar (22.8%), and lumbar (9.2%) curves. Mean (SD) BMI percentile was 48.3 (30.5). No relationship existed between BMI percentile and curve magnitude with curve locations combined. However, a test for interaction revealed a positive relationship between BMI percentile and curve magnitude for adolescents with double major curves, and a negative relationship for adolescents with thoracic curves. Exploratory analyses suggested a relationship between BMI percentile and presence of pain, and between referral source and curve magnitude. No relationship was observed between BMI and skeletal maturity, or physical activity and pain.ConclusionThe relationship between BMI varied by curve location within this cohort, in which most patients presented with a BMI <85th percentile. Findings highlight the importance of sensitive history taking and careful physical examination for early detection of scoliosis.

'It's my back…'; developing the coming to spinal clinic resource to improve the health literacy of young people with adolescent idiopathic scoliosis and their parents.

This study focussed on identifying the key concerns and information needs of young people with Adolescent Idiopathic Scoliosis (AIS) and their parents and examined what resources might help improve young people's 'participativeness' and health literacy during clinic consultations. A qualitative participatory design underpinned the study. Workshops involving multiple methods were used to engage with young people with AIS and their parents, who were recruited through a regional children's hospital. The study design was informed by patient and public consultation with eight young people and two parents. 10 young people (aged 14-16years) and 11 of their parents participated in the study. Young people and their parents reported uncertainty and anxiety before coming to clinic and faced issues participating in the consultation, being involved in decision-making and understanding the information and language. These challenges resulted in unmet information needs. Young people's health literacy relating to an AIS diagnosis and treatment is facilitated by them being prepared and informed before coming to clinic and be actively supported to be involved during the consultation. We collaboratively developed the 'Coming to Spinal Clinic' resource to help young people with AIS and parents prepare for and get the most out of their visit.

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.

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. 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. 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. 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°.

Effect of Chêneau style braces on vertebral wedging amongst individuals with adolescent idiopathic scoliosis.

BackgroundIt is generally accepted that braces can stop curve progression but little evidence exists regarding structural improvement in the spine using spinal bracing. Our study aimed to investigate the possible structural improvements of vertebral wedging with high correction bracing.ObjectivesThe aim of our study was to assess whether spinal brace treatment may influence vertebral wedging in adolescent idiopathic scoliosis (AIS).MethodWe reviewed our database according to the following inclusion criteria: girls with a diagnosis of AIS, Risser 0–2, age 10–14 years with Cobb angles greater than 35°. Our study cohort consisted of 27 patients fulfilling the inclusion criteria with an average brace wearing time of 16.6 h per day and Cobb angles between 36° and 79°. The target value for our study was the apical vertebra wedging, measured twice before brace treatment commenced and twice after the average follow-up period of 20.5 months of treatment.ResultsThe average apex wedging noted before brace wearing started was 9.8° (median: 9) and after a period of 20.5 months of brace wearing, it had reduced to an average of 5.8° (median: 4.9), (p < 0.001). This would indicate a structural correction of 44%.ConclusionsOur study supports the hypothesis that spinal high correction braces improve the degree of vertebral wedging in skeletally immature girls with AIS.Clinical implicationsStructural corrections of the apical vertebra seem possible when high correction asymmetric braces are used in the treatment of patients with AIS.

Risk Factors, Lifestyle and Prevention among Adolescents with Idiopathic Juvenile Scoliosis: A Cross Sectional Study in Eleven First-Grade Secondary Schools of Palermo Province, Italy.

Adolescent idiopathic scoliosis (AIS) has an incidence of 2–3% in the general population and a multifactorial etiology. The present study aims to analyze modifiable risk factors and their interactions in the development of AIS in order to increase knowledge about the disease and to prevent the evolution of AIS in young students with tailored public health strategies. A cross-sectional study was conducted over two consecutive school years among students attending 11 first-grade secondary schools in the province of Palermo, Italy. A self-administered questionnaire that investigated socio-demographical, physical and anamnestic characteristics and habits, focusing on possible risk factors associated with idiopathic scoliosis, was administered. In addition, a clinical evaluation was performed with Adams’ test and Bunnel’s inclinometer. Suspected AIS cases were associated with the practice of high-risk sports (p < 0.05), weekly physical activity lasting ≥3 h (p < 0.05), lower back pain (p < 0.001), posture disorders (p < 0.01) and having had no contact with a physician (p < 0.01). Practice of high-risk sports (adj OR = 1.83; CI 95% 1.11–4.76) and suffering of posture disorders (adj OR = 1.67; CI 95% 1.12–3.60) showed a significant association with a confirmed diagnosis of AIS (Cobb angle ≥ 10° at X-ray). The risk factors associated with AIS are still unclear. Therefore, it is crucial to identify early modifiable and multiple risk factors to prevent the evolution of scoliosis in school-age children.

Diagnosis and conservative treatment of adolescent idiopathic scoliosis

Background: Adolescent idiopathic scoliosis (AIS) has a diagnosis rate of 3% to 5% per year, but the number of cases requiring surgical treatments is very small, accounting for only 0.17% to 1.75% of all AIS patients. Most patients with AIS are diagnosed, treated, and managed in outpatient clinics.Current Concepts: AIS is a disease that occurs more frequently, and progresses faster, in females than in males. Scoliosis deformity can occur due to various causes. To differentially diagnose AIS, it is necessary to perform careful physical examinations, investigate family history, and check for neurological, growth, and developmental abnormalities. Definitive diagnosis of AIS can be performed through radiographic imaging. In the case of atypical curvature and symptoms, examinations such as magnetic resonance imaging could be required in addition to radiographic imaging. Treatment of AIS patients in outpatient clinics can be performed through observation, exercise, and orthosis. The selection and application of treatment methods and the termination period of the treatments are complexly affected by the age at the time of diagnosis; pattern, location and size of the curve; and growth potential.Discussion and Conclusion: AIS is a disease in which good results can be obtained with conservative treatments such as exercise and orthosis, which is generally applied in an outpatient setting. To properly treat AIS, it is necessary to have an in-depth understanding of the characteristics of AIS, timing of treatment, and factors influencing treatment.

Assessment of reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire in adolescents with idiopathic scoliosis.

This study investigates the reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire (P-SAQ). The stages of cross-cultural adaptation were conducted according to an internationally accepted guidelines. Reliability of the P-SAQ was measured by evaluating internal consistency and test-retest reproducibility using Cronbach's α and intraclass correlation coefficient (ICC). Validity of the P-SAQ was assessed by factor analysis, and convergent and known-groups validities. Convergent validity was assessed through participant response on the P-SAQ and the revised 22-item Persian version of the Scoliosis Research Society (SRS-22r) questionnaire. Known-groups validity was assessed by comparing the P-SAQ scores according to the patients curve magnitude and treatment type. A total of 106 patients with a diagnosis of adolescent idiopathic scoliosis (AIS) were included. The P-SAQ demonstrated an acceptable internal consistency with a Cronbach's α of 0.77 (range 0.65-0.72). The test-retest reliability was excellent (range ICC 0.85-0.98). There was a correlation between the total score, average scores of the general, curve, rib prominence, kyphosis, and trunk shift subscales of the P-SAQ and subtotal and total scores of the SRS-22r, r = -0.2 to -0.4, p < 0.05. The P-SAQ discriminated between patients with differing Cobb angle magnitudes and treatment types (p < 0.01). Factor analysis supported the use of the appearance and expectations items as separate scales for the P-SAQ. The P-SAQ is a valid and reliable tool that could be utilized to evaluate the perception of appearance for Persian-speaking AIS patients with different curve magnitude and treatment strategies. Level I- diagnostic studies.

CONSERVATIVE IDIOPATHIC SCOLIOSIS TREATMENT WITH BRACE PRODUCED USING 3D TECHNOLOGY

ABSTRACT Objective To evaluate the immediate correction capacity of the Wood-Chêneau-Rigo brace (WCR), produced using digital technological resources and robotic engineering, in primary and secondary curves of adolescent idiopathic scoliosis (AIS). Methods A retrospective study was conducted of 138 patients with a diagnosis of AIS and who received a WCR brace from a laboratory that makes orthoses and orthopedic prostheses between 2019 and 2021. These individuals were submitted to an independent analysis of the radiographic parameters by a single researcher, the main outcome of which was the standardized measurement of the main and secondary curves using the Cobb method. The radiographs analyzed were performed in orthostasis before and immediately after the adaptation of the brace on the patient. The correction capacity was calculated as the ratio of the difference between the pre- and post-brace curves to the pre-brace curve. Results The mean correction with the WCR was 48.4% for the main curve and 41.0% for the secondary curve. The level of correction of the main curve was significantly higher in patients with a main curve with the apex of convexity in the thoracolumbar region (p = 0.004), especially in the left thoracolumbar region (p = 0.010); curves of magnitude between 10º and 24.9º (p &lt;0.001); and curves classified as simple (p &lt;0.001). Conclusion The use of the WCR, which is produced using modern technological resources, was effective in the immediate correction of AIS. Long-term studies on this new modality of conservative scoliosis treatment are necessary. Level of evidence III; Retrospective study.

Prevalence of Back Pain and Idiopathic Scoliosis in Adolescents From the Semiarid Region of Brazil: A Cross-sectional Study

ObjectiveThe purpose of this study was to estimate the prevalence of adolescent idiopathic scoliosis (AIS), and back pain and its risk factors, in schoolchildren from the semiarid region of Brazil. MethodsA total of 520 adolescents aged 10 to 16 years old were assessed. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument questionnaire. The screening for AIS included measuring the angle of trunk rotation using a scoliometer in the Adams forward-bend test. Participants with an angle of trunk rotation ≥ 7° were referred for radiography. The prevalence ratio was estimated by multivariable analysis using a Poisson regression model (α = 0.05). ResultsAmong the participants, 3.1% (95% confidence interval, 3.2%-6.9%) had a confirmed AIS diagnosis: 1.9% girls and 1.1% boys. There was no difference between boys and girls in AIS prevalence. The prevalence of back pain in the previous 3 months was 63.7% (95% confidence interval, 59.5%-67.7%), at a moderate level (visual analog scale = 3.83; 95% confidence interval, 3.57-4.08). Multivariable analysis showed that back pain is associated with postural variables, sex, and age. ConclusionThe prevalence of AIS in the semiarid region of Brazil was 3.1%, and that of back pain was 63.7%. Only body mass index was different between adolescents with and without AIS, with those with AIS having a lower mean body mass index. Back pain was higher in girls and increased in older adolescents. Furthermore, behavioral and postural habits and hereditary factors were associated with an increased chance of back pain.

11. Prophylactic use of local vancomycin does not decrease acute surgical site infection in adolescent idiopathic scoliosis

<h3>BACKGROUND CONTEXT</h3> Perioperative surgical site infections for adolescent idiopathic scoliosis after posterior spinal fusion range from 0.3-1.6%. Morbidities associated with infections include hospital readmissions, reoperations, and long-term antibiotic use. Prophylactic and local administration of vancomycin powder into the wound has been shown to decrease rates of surgical site infections among the adult population, and many pediatric deformity surgeons have adopted its use in an effort to decrease infections in the adolescent idiopathic scoliosis population. However, efficacy has not been established in this population. <h3>PURPOSE</h3> The purpose of this study is to investigate the efficacy of prophylactic, local application of vancomycin powder in decreasing surgical site infections in the adolescent idiopathic scoliosis population following posterior spinal fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study <h3>PATIENT SAMPLE</h3> Patients <18 years old with a diagnosis of adolescent idiopathic scoliosis, undergoing posterior spinal fusion between the years of 2008 and 2019. <h3>OUTCOME MEASURES</h3> Our primary outcome was the incidence of surgical site infection following posterior spinal fusion. Secondary outcomes included: demographics, surgical data, and infectious data. <h3>METHODS</h3> A multicenter, retrospective database query of 9 sites belonging to an organization of nonprofit medical facilities was performed for data from January 2008 to February 2019. ICD-9, ICD-10 and CPT codes were used to identify adolescent idiopathic scoliosis patients who underwent posterior spinal fusion. Identified patients were then separated into 2 groups. The vancomycin group had application of prophylactic, local vancomycin into the wound prior to closure and the nonvancomycin group had no local vancomycin added. Demographic and surgical data was compiled and SSI rates were tabulated and compared between the 2 groups. <h3>RESULTS</h3> A total of 1,917 adolescent idiopathic scoliosis patients underwent posterior spinal fusion from January 2008 to February 2019. Differences in age, body mass index, female to male ratio, and fusion levels were not statistically significant (p>0.05). The vancomycin group had 1,252 (65.3%) patients with 6 (0.48%) diagnosed with a surgical site infection, compared to 665 (34.7%) patients with 5 (0.75%) diagnosed with a surgical site infection in the nonvancomycin group (p=0.45). Of the 6 infections in the vancomycin group, 4 cultures were positive for gram-negative bacteria. Among the 5 infections in the nonvancomycin group, only 1 culture returned positive for gram-negative bacteria. <h3>CONCLUSIONS</h3> The prophylactic use of local vancomycin did not demonstrate significantly decreased rates of surgical site infections in adolescent idiopathic scoliosis patients undergoing primary posterior spinal fusion (0.48% vs 0.75%). Further studies are required to elucidate the effectiveness of the use of vancomycin in this population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P93. Does spinal deformity affect adolescents’ quality of life before we tell them it should?

<h3>BACKGROUND CONTEXT</h3> The Scoliosis Research Society 30 Questionnaire (SRS 30) scores have been shown to correlate with major curve magnitude in preoperative patients with adolescent idiopathic scoliosis (AIS). This correlation has not been consistently demonstrable in AIS patients prior to treatment or those undergoing nonoperative treatment. We hypothesize that SRS 30 scores are dependent on knowledge of scoliosis and thus scores from new patients referred for scoliosis evaluation may not correlate with curve magnitude until after counseling by a surgeon. <h3>PURPOSE</h3> Among new adolescent referrals for scoliosis, we sought to determine if SRS 30 scores would be different before and after an initial visit with a surgeon, we further sought to evaluate if this effect may be different based on presenting curve magnitude. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort analysis. <h3>PATIENT SAMPLE</h3> Patients ages 10 to 18 years old referred for their first visit with an orthopaedic surgeon for a scoliosis evaluation were prospectively enrolled from 9/30/19 to 10/22/20. Patients were excluded if they had a prior history of AIS diagnosis and/or treatment. <h3>OUTCOME MEASURES</h3> SRS 30 domain and total scores and major curve magnitude. <h3>METHODS</h3> Patients who consented were asked to complete the SRS 30 pre and post visit. Demographic and clinical data were obtained from patient charts. A Wilcoxon signed rank test was used to analyze the pre and post visit SRS 30 scores. <h3>RESULTS</h3> Fifty-three patients participated in the study at a mean age of 14.3 years (95% CI 13.8-14.8 years), the majority of whom were White (40%) or Asian (23%), and female (71%), with an average Cobb angle of 23.2 degrees (95% CI 19.5-26.9 degrees). SRS 30 scores were not correlated to major curve magnitude before or after the visit. The SRS 30 Satisfaction domain exhibited a small increase post visit (pre: 3.3, post: 3.6, p=0.010). All other SRS 30 domains and total scores did not exhibit statistically significant differences before and after the visit. When subdivided by major curve magnitude (<25, 25-40, >40 degrees) there were no significant before/after differences in SRS 30 domain or total scores. <h3>CONCLUSIONS</h3> Among new adolescent referrals for scoliosis with a wide range of presenting curve magnitudes, SRS 30 scores did not correlate to major curve magnitude. SRS 30 scores did not change before and after the visit, regardless of curve magnitude, therefore it is unlikely that counseling by a surgeon influences perceptions of quality of life in this population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Nontargeted Metabolomic Analysis of Plasma Metabolite Changes in Patients with Adolescent Idiopathic Scoliosis.

Objective Adolescent idiopathic scoliosis (AIS) is a relatively common spinal rotation deformity, and the pathogenesis of AIS is accompanied by metabolic dysfunction and changes in biochemical factors. In this study, plasma metabolite changes in AIS patients were analyzed based on nontargeted metabolomics to provide new insights for clarifying functional metabolic abnormalities in AIS patients. Methods Clinical indexes and blood samples were collected from 12 healthy subjects and 16 AIS patients. Metabolomics was used to analyze the changes in metabolites in plasma samples. The correlation between plasma metabolites and clinical indexes was analyzed by the Spearman rank correlation coefficient. Results Analysis of clinical data showed that the body weight, body mass index (BMI), and bone mineral density (BMD) index of the AIS group significantly decreased, while the blood phosphorus and Cobb angles increased significantly. Metabolomic analysis showed significant changes in 72 differential metabolites in the plasma of the AIS group, mainly including organooxygen compounds, carboxylic acids and derivatives, fatty acyls, steroids and steroid derivatives, and keto acids and derivatives. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway showed that arginine biosynthesis, D-glutamine and D-glutamate metabolism, alanine, aspartate and glutamate metabolism, and citrate cycle (TCA cycle) were significantly enriched in the AIS and healthy groups. Spearman rank correlation coefficient analysis showed that the plasma metabolites C00026 (oxoglutarate), C00062 (L-arginine, arginine), C01042 (N-acetylaspartate), and C00158 (citrate) were significantly correlated with clinical indexes in AIS patients. In the healthy group, the plasma metabolites C00122 (fumarate), C00025 (glutamate and L-glutamic acid) and C00149 (malate, L-malic acid) were significantly correlated with clinical indexes, while C00624 (N-acetylglutamate) was not significantly correlated with the clinical indexes. Conclusion The occurrence of AIS led to changes in clinical indexes and plasma metabolites. Plasma biomarkers and functional metabolic pathways were correlated with clinical indexes, which might provide new insights for the diagnosis and treatment of AIS.