Lateral Curvature Research Articles

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

Patients with adolescent idiopathic scoliosis (AIS) are either managed with non-operative strategies or surgery depending on the severity of lateral curvature and impact on quality of life. However, supportive evidence for the appropriate treatment approach is lacking in AIS patients with Cobb angles between 40 and 50 degrees. Therefore, we investigated differences in long-term patient-centered outcomes in AIS patients with Cobb angles between 40 and 50 degrees who received either operative or non-operative management. A total of 919 patients aged 10-21years old with adolescent idiopathic scoliosis and 40-50 degree Cobb angles were identified from the HARMS Study Group (HSG) registry and dichotomized based on operative or non-operative management. Baseline and 2year follow-up SRS-22 scores from these patients were analyzed for significant differences between the total score values, domain values, and the magnitude of score change over time using multiple comparisons analyses. Multivariable regressions adjusting for age, body mass index, location of spinal deformity, and management strategy were also performed. Operative versus non-operative strategy was significantly, independently associated with differences in SRS-22 total and domain scores over time (effect likelihood ratio test, p < 0.03 for all regressions). Operatively managed patients had significantly greater improvement in SRS-22 total and domain scores over the follow-up duration compared to non-operatively managed patients (p < 0.02 for all comparisons). This preliminary analysis suggests that operatively managed patients may have had better long-term outcomes than non-operatively managed patients within this AIS subpopulation. These findings support the need for further prospective investigation to determine the optimal management strategy to improve evidence-based, patient-reported outcomes for AIS patients with Cobb angles between 40 and 50 degrees. Level III.

Collagen fleece grafting for surgical treatment of patients with mild to severe peyronie's curvatures.

Collagen fleece grafting (CFG) is the recommended treatment for severe Peyronie's disease (PD) curvature (> 60°), but its efficacy in mild/moderate curvatures remains uncertain. This study evaluated CFG in patients with mild/moderate curvatures (< 60°) at risk of penile shortening or symptomatic plaque. A retrospective review was conducted on patients who underwent surgical treatment for PD using plaque incision or partial plaque excision and CFG. Clinical parameters and complications were reviewed. Subgroup analysis was performed on patients with curvatures of > 60° and curvatures ≤ 60°. 89 patients with a median age of 59years and a median curvature of 70 (20-90)° were identified. Dorsal curvature was predominant in 66% of cases, followed by lateral (16%), ventral (8%), and complex curvatures (10%). Partial plaque excision was performed in 98% of patients, with an average grafting area of 2.1cm2; 71% had a singular penile plaque, while 29% presented two or more plaques. The comparison between patients with curvatures ≤ 60° and > 60° revealed no significant differences in mean operation time (86.3 vs. 94.4min, p = 0.13) or in the incidence of postoperative complications, including glans necrosis, hypoesthesia, ecchymosis, bleeding, hematoma, infection, residual curvature, revision surgery, or pain. Early postoperative outcomes and complication rates following plaque incision or partial plaque excision and grafting with CFG were comparable in patients with mild/moderate and severe PD deformities. The technique may be a viable option with a similar risk profile for achieving penile straightening in selected PD cases, particularly when plication is not feasible.

A Comparative Study on the Consistency of Ultrasound and X-Ray in Assessing Risser Sign.

Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature, sagittal plane imbalance, and vertebral rotation. In China, AIS affects over 3 million individuals, with 300,000 new cases annually. AIS impacts physical and psychological well-being, necessitating tailored treatment plans based on growth risk factors. This study evaluates the consistency of ultrasound and X-ray assessments of the Risser sign in AIS patients and explores correlations between iliac crest distance and pelvic rotation degree. This prospective study enrolled 80 patients diagnosed with AIS from June to September 2023 at Changzhou Sports Hospital. Eligible participants were aged 10-18 with a Cobb angle >10°. Ultrasonographic examinations were conducted by 3 experienced physicians using the VINNO V10 portable ultrasound system. The primary outcome was the Risser stage determined by X-ray and ultrasound, with secondary outcomes including thoracic and thoracic-lumbar segment rotation angles. Statistical analyses included kappa statistics, correlation analyses, and multiple regression. Among the 77 valid cases, 154 iliac wings were evaluated, with a high concordance rate of 77% between ultrasound and X-ray assessments. kappa values for left and right iliac crests were 0.723 and 0.808, respectively. Grouping Risser grades (0-1, 2-3, and 4-5) into 3 categories yielded kappa values of 0.93, 0.96, and 0.93, indicating high consistency. Significant correlations were found between iliac crest distances and rotation angles (left iliac crest distance and left thoracic rotation angle, r = 0.56, P < .001; right iliac crest distance and right thoracic-lumbar rotation angle, r = 0.69, P < .001; right iliac crest distance and right thoracic rotation angle, r = 0.39, P < .01). Ultrasound is a reliable, radiation-free alternative to X-ray for assessing the Risser sign in AIS patients. Despite observed inconsistencies in intermediate Risser grades, ultrasound's ability to reduce radiation exposure and provide consistent results makes it a valuable tool in clinical practice. Further research is needed to optimize ultrasound techniques and explore its potential for early detection and intervention in scoliosis management.

The multifaceted diversification of the sagitta otolith across the fish tree of life

Abstract Otoliths of actinopterygians are calcified structures playing a key role in hearing and equilibrium functions. To understand their morphological diversification, we quantified the shape of otoliths in both lateral and dorsal view from 697 and 323 species, respectively, using geometric morphometrics. We then combined form (i.e. size and shape) information with ecological data and phylogenetically informed comparative methods to test our hypotheses. Initially, the exploration of morphospaces revealed that the main variations are related to sulcus acusticus shape, elongation and lateral curvature. We also found strong integration between otolith and sulcus shape, suggesting that they are closely mirroring each other, reinforcing a shape-dependent mechanism crucial for otolith motion relative to its epithelium and validating the functional significance of otolith morphology in auditory and vestibular processes. After revealing that otolith shape and size retained a low phylogenetic signal, we showed that the disparity of otolith size and shape is decoupled from order age and from the level of functional diversity across clades. Finally, some traits in otolith disparity are correlated with their morphological evolutionary rate and the order speciation rate. Overall, we observed that the pattern of diversification of otoliths across the fish tree of life is highly complex and likely to be multifactorial.

Effect of growth hormone to spinal growth and recombinant human growth hormone to scoliosis.

Growth hormone (GH) plays a key role in human growth and development. In addition to promoting height growth, GH affects bone metabolism, bone size, and bone mineral density (BMD) in children and adolescents by affecting bone formation and resorption. Among them, the effect of GH on spinal growth has been widely concerned. Scoliosis is a three-dimensional structural spinal deformity characterized by lateral curvature of one or more segments of the spine accompanied by vertebral rotation and sagittal imbalance. For children with growth hormone deficiency (GHD), whether GH supplementation leads to scoliosis is still controversial. In recent years, numerous scholars have conducted extensive research to investigate the correlation between recombinant human GH replacement therapy and scoliosis, yielding divergent findings with some even presenting contradictory results. This study aims to investigate the impact of GH on spinal growth and explore the association between recombinant human GH replacement therapy and scoliosis by comprehensively reviewing the effects of GH and insulin-like growth factors 1 (IGF-1) on bone metabolism, bone mass, as well as examining the consequences of GHD on bone health. Additionally, we aim to access the influence of recombinant human GH replacement therapy on adolescent idiopathic scoliosis (AIS).

Conservative treatment of adolescent idiopathic scoliosis (AIS): A narrative review of current evidence and implications for clinical practice

Introduction and purpose: Adolescent idiopathic scoliosis (AIS) is characterized by lateral curvature, vertebral rotation, and disruption of physiological curvature of the spine with the Cobb angle ≥10°. AIS affects 1-3% of children aged 10-16 years, representing the most common form of idiopathic scoliosis. Diagnosis of AIS is by exclusion and can be suspected based on Adams forward bend test and scoliometer. Untreated AIS can lead to serious consequences, such as progression of the deformity, back pain, reduced respiratory and cardiovascular function. The aim of this review is to update overview of conservative treatment options. Description of the state of knowledge: AIS treatment guidelines from the Scoliosis Research Society (SRS) and the Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) advocate for observation, bracing, or surgery depending on curve severity, with a focus on avoiding spinal fusion when possible. Additionally, SOSORT recommends scoliosis-specific physiotherapy exercises for smaller curves or as an adjunct to bracing. Conservative treatment aims to prevent curve progression, manage respiratory and spinal complications, and improve quality of life. Conclusions: AIS can significantly impair the physical and psychosocial well-being of young patients, with potential long-term consequences extending into adulthood Individualized treatment plans and patient/parent education are crucial for optimal outcomes. Schroth exercises are superior to Core Stabilization (CS) exercises in reducing Cobb angle, trunk rotation and improving spinal mobility, cosmetic trunk deformities and quality of life. CS exercises are more effective in increasing peripheral muscle strength, reducing pain and correcting vertebral rotation.

Lessons from the pandemic era: do we need new strategies to improve conservative treatment adherence in adolescent idiopathic scoliosis? A retrospective analysis.

This study aims to examine whether the COVID-19 pandemic affected the adherence to conservative AIS treatment. Adolescent Idiopathic Scoliosis (AIS) is characterized by a lateral curvature of the spine of at least 10 degrees. Compliance rates in conservative treatments are influenced by various factors. From a database of AIS patients, we selected 30 AIS patients who were assessed before, during, and after the COVID-19 pandemic. Data regarding Cobb's angle, brace prescription, prescribed brace wear time, brace wear compliance, and time dedicated to sports activities were collected over a six-year period from January 2018 to December 2023, divided into three 2-year time periods (before, during, and after COVID-19). There was an increased percentage of AIS patients prescribed with a brace during the pandemic. However, no significant differences in Cobb's angle were observed. Additionally, the prescribed wear time showed a significant decrease from the pre-COVID period to the post-COVID period (p-value = 0.03). Wear compliance exhibited a decreasing trend from pre- to during- and post-COVID-19 periods without reaching statistically significant differences, and the time dedicated to sports statistically significantly decreased. These differences were statistically significant when comparing the pre- vs. post- and pre- vs. during-COVID-19 periods (p-values 0.01, 0.04, respectively). Our study highlights changes in AIS conservative treatment during and after the COVID-19 pandemic. The increase in the number of patients prescribed with a brace during the pandemic, although not supported by an increase in Cobb's angle, may be attributed to the concerns about regular monitoring during the reduction of rehabilitation services. The observed decreases in brace compliance and involvement in sport activities, which persisted even in the post-pandemic period, emphasizes the lasting impact of the pandemic on AIS management, necessitating innovative approaches to address these ongoing concerns.

Genetics and pathogenesis of scoliosis

BackgroundScoliosis is defined as a lateral spine curvature of at least 10° with vertebral rotation, as seen on a posterior-anterior radiograph, often accompanied by reduced thoracic kyphosis. Scoliosis affects all age groups: idiopathic scoliosis is the most common spinal disorder in children and adolescents, while adult degenerative scoliosis typically affects individuals over fifty. In the United States, approximately 3 million new cases of scoliosis are diagnosed annually, with a predicted increase in part due to global aging. Despite its prevalence, the etiopathogenesis of scoliosis remains unclear. MethodsThis comprehensive review analyzes the literature on the etiopathogenetic evidence for both idiopathic and adult degenerative scoliosis. PubMed and Google Scholar databases were searched for studies on the genetic factors and etiopathogenetic mechanisms of scoliosis development and progression, with the search limited to articles in English. ResultsFor idiopathic scoliosis, genetic factors are categorized into three groups: genes associated with susceptibility, disease progression, and both. We identify gene groups related to different biological processes and explore multifaceted pathogenesis of idiopathic scoliosis, including evolutionary adaptations to bipedalism and developmental and homeostatic spinal aberrations. For adult degenerative scoliosis, we segregate genetic and pathogenic evidence into categories of angiogenesis and inflammation, extracellular matrix degradation, neural associations, and hormonal influences. Finally, we compare findings in idiopathic scoliosis and adult degenerative scoliosis, discuss current limitations in scoliosis research, propose a new model for scoliosis etiopathogenesis, and highlight promising areas for future studies. ConclusionScoliosis is a complex, multifaceted disease with largely enigmatic origins and mechanisms of progression, keeping it under continuous scientific scrutiny.

The Relationship between Incorrect Body Posture in Elementary School Children on Idiopathic Scoliosis

Idiopathic scoliosis is a condition of spinal deformity characterized by abnormal lateral curvature. The factor that is thought to play a role in the development of idiopathic scoliosis is incorrect body posture. This research is a correlation study which aims to determine the significant relationship between incorrect body posture and the incidence of idiopathic scoliosis in elementary school children. This research approach uses a quantitative approach with a descriptive quantitative research type with a correlational model. Research data was obtained through questionnaires, documentation and measurements using a scoliometer. The population in this study were all sixth grade students at SDIT Bangkinang Elementary School, totaling 35 students. Independent variable is a sitting position using the Questionnaire on Body Awareness of Postural Habits in Young People (Q BAPHYP) measurement tool. The dependent variable is scoliosis measured using the Adam's Forward bending test. Data analysis techniques are descriptive statistical analysis and inferential statistical analysis. After analyzing the research results, it shows that incorrect body posture has a significant relationship with the incidence of idiopathic scoliosis in elementary school children as proven by the results of data analysis, p= 0.000 or p&lt; 0.05. The conclusion of this study is that there is a significant relationship between incorrect body posture and the incidence of idiopathic scoliosis in elementary school children.

A light-fueled self-rolling unicycle with a liquid crystal elastomer rod engine

Active materials hold substantial potential for self-sustaining motion, however, the dependency on movable light or extensive area illumination in current structures often restricts the design and practical deployment of such active machines. In this study, we report a novel zero-energy-mode, self-rolling unicycle equipped with a liquid crystal elastomer rod engine, which fueled by a fixed, small-area light source. By employing an elaborate dynamic model for liquid crystal elastomer, we derive the lateral curvature of the liquid crystal elastomer rod and the driving moment necessary for the unicycle's self-rolling. The study results demonstrate that the self-rolling of the unicycle is driven by a moment induced by the shift in the center of gravity of the curved liquid crystal elastomer rod. Our numerical simulations indicate the presence of a supercritical Hopf bifurcation point delineating the transition between the self-rolling mode and the static mode within the unicycle system. Additionally, the rolling velocity of the unicycle relies on a handful of key system parameters, notably including light intensity, light penetration depth, length of the liquid crystal elastomer rod, rolling friction coefficient, total mass of the unicycle, and wheel radius of the unicycle. The experimental validation of a self-rolling unicycle with zero-energy-mode has been conducted. The self-rolling unicycle constructed in this paper has excellent characteristics of simple structure, zero-energy-mode, horizontal constant light source, and small area light source, providing valuable insights for the utilization of photoresponsive liquid crystal elastomer rods in soft robotics, medical devices, energy harvesting systems, and actuators.

Pisa Syndrome Secondary to Drugs: A Scope Review.

Pisa syndrome, also known as pleurothotonus, is a neurological condition characterized by more than ten degrees of constant lateral curvature of the spine when upright. In this way, the present manuscript aims to systematically review Pisa syndrome secondary to drugs. Two reviewers identified and assessed relevant reports in six databases without language restriction between January 1990 and June 2024. The prevalence of Pisa syndrome varied from 0.037 to 9.3%. We found 109 articles containing 191 cases of drug-induced Pisa syndrome reported in the literature. The mean and median ages were 59.70 (SD = 19.02) and 67 (range = 12-98 years). The most prevalent sex was female, 56.91% (107/188). The most frequent medications associated with Pisa syndrome were acetylcholinesterase inhibitors in 87 individuals. Of 112 individuals in which the onset time from the medication to the movement disorder occurrence was reported, 59 took place within a month. In this way, a return to baseline was observed in 45.50% of the cases, and partial recovery was observed in 14.28%. We proposed new diagnostic criteria for Pisa syndrome based on previous findings in the literature. Moreover, multiple mechanisms are probably involved in balance control and the development of lateral trunk flexions.

Histogenetic insights and genetic landscape of fibromatosis-like undifferentiated gastric carcinoma: a focused study

BackgroundThe aim of this study was to elucidate the histogenesis and genetic underpinnings of fibromatosis-like undifferentiated gastric carcinoma (FLUGC), a rare pathological entity.MethodThrough a detailed analysis of seven cases, including histopathological evaluation, CTNNB1 gene mutation screening, human epidermal growth factor receptor 2 (HER2) protein level quantification, and HER2 gene amplification assessment to identify the pathological and molecular characteristics of FLUGC.ResultsOf the seven patients in this study, five were male and two were female (age: 39–73 years). Four patients presented with lesions in the gastric antrum and three had lesions in the lateral curvature of the stomach. Histopathologically, over 90% of the tumor consisted of aggressive fibromatosis-like tissue, including proliferating spindle fibroblasts and myofibroblasts and varying amounts of collagenous fibrous tissues. Undifferentiated cancer cells, accounting for less than 10%, were dispersed among the aggressive fibromatosis-like tissues. These cells were characterized by their small size and were relatively sparse without glandular ducts or nested mass-like structures. Immunophenotyping results showed positive expression of CKpan, CDX2, villin, and p53 in undifferentiated cancer cells; positive expression of vimentin in aggressive fibromatosis-like tissue; positive cytoplasmic expression of β-catenin; and focal cytoplasmic positive expression of smooth muscle actin (SMA). Genetic analysis did not reveal any mutations in the CTNNB1 gene test, nor was there amplification in the HER2 gene fluorescence in situ hybridization (FISH) test. Additionally, the Epstein-Barr encoding region (EBER) of in situ hybridization was negative; and the mismatch repair (MMR) protein was positive. Programmed cell death-1 (PD-1) was < 1–5%; programmed cell death ligand 1 (PD-L1): TPS = 1–4%, CPS = 3–8.ConclusionThe study highlights the significance of CTNNB1, HER2, EBER, and MMR as pivotal genetic markers in FLUGC, underscoring their relevance for diagnosis and clinical management. The rarity and distinct pathological features of FLUGC emphasize the importance of accurate diagnosis to prevent underdiagnosis or misdiagnosis and to raise awareness within the medical community.

Fully Automated Measurement of Cobb Angles in Coronal Plane Spine Radiographs.

Background/Objectives: scoliosis is a three-dimensional structural deformity characterized by lateral and rotational curvature of the spine. The current gold-standard method to assess scoliosis is the measurement of lateral curvature of the spine using the Cobb angle in coronal plane radiographs. The interrater variability for Cobb angle measurements reaches up to 10°. The purpose of this study was to describe and assess the performance of a fully automated method for measuring Cobb angles using a commercially available artificial intelligence (AI) model trained on over 17,000 images, and investigate its interrater/intrarater agreement with a reference standard. Methods: in total, 196 AP/PA full-spine radiographs were included in this study. A reference standard was established by four radiologists, defined as the median of their Cobb angle measurements. Independently, an AI-based software, IB Lab SQUIRREL (version 1.0), also performed Cobb angle measurements on the same radiographs. Results: after comparing the readers' Cobb angle end vertebrae selection to the AI's outputs, 194 curvatures were considered valid for performance assessment, displaying an accuracy of 88.58% in end vertebrae selection. The AI's performance showed very low absolute bias, with a mean difference and standard deviation of differences from the reference standard of 0.16° ± 0.35° in the Cobb angle measurements. The ICC comparing the reference standard and the AI's measurements was 0.97. Conclusions: the AI model demonstrated good results in the determination of end vertebrae and excellent results in automated Cobb angle measurements compared to radiologists and could serve as a reliable tool in clinical practice and research.

Big river channel formation and deformation in the intermountain basin (case study of the Yana River within the Kular mountain massif)

The incised pebble-boulder channels of large mountain rivers (including the Yana in its mountainous area), their morphology and history of formation are well studied. However, local conditions within the intermountain depressions lead to the emergence of specific features of the channel development and its morphology — in this case, the formation of finger-shaped meander. The paper analyzes the historical and modern features of the formation of the Yana riverbed in the “Porogi” section located in the depression inside Kular range, and describes the negative impact of channel processes on navigation. Using this case study, we consider the characteristic features of the channel development of a large river under the influence of a complex of factors — the regional geological conditions (which caused active incision of the channel), discharge, and channel sediment composition. Characteristics of lateral migration and curvature development of meander controlled by bedrock and narrowing of the valley are presented. The discharge conditions under which the displacement of riffles is possible are calculated. The forecast of the further channel development and recommendations for sustainable navigation are given.

Comparative analysis of geometric imperfections and residual stresses on the global stability behavior of cantilever composite alveolar beams

Few studies addressed the influence of geometric and structural imperfections of steel alveolar I-sections on the stability behavior of composite beams under hogging moment. Therefore, this paper aims to study the sensitivity to geometric imperfection amplitude and residual stress distribution on their global stability. The research primarily focuses on comparing numerical results with experimental data in detail, which addresses four tests involving cantilever composite beams with castellated and cellular I-sections. It includes applying various residual stress patterns and geometric imperfection values to advanced numerical analyses as documented in the literature. Linear buckling analyses (LBA) and geometrically and materially nonlinear analyses with imperfections (GMNIA) are carried out using the ABAQUS software. Regarding the first positive eigenvalue from LBA analyses, the eigenvectors presented Web-Post Buckling (WPB) with a slight compressed flange lateral curvature, inserted as the initial geometric imperfection in the GMNIA analyses. However, when the residual stresses were implemented in the GMNIA analyses, some finite element models had different failure modes regarding the deformed configurations from LBA analyses, in which the failure modes were characterized by Lateral-Distortional Buckling (LDB), which was in agreement with the test results. As the beams reached LDB in an inelastic regime, residual stresses significantly affected their resistant capacity. This way, the distribution of compressive residual stresses in the flanges had the most critical influence on the global stability behavior of the analyzed beams, as these residual stresses favor the LDB occurrence. Finally, higher geometric imperfection amplitudes did not provide only lower ultimate loads, as when the instability phenomena are reached in an inelastic regime, the effect of global geometric imperfections becomes highly complex.

Comparative analysis of Boston and Cheneau braces in treating scoliosis: A 2-year follow-up study on curve reduction

BackgroundScoliosis, characterized by the lateral curvature of the spine, impacts the spine's alignment in three dimensions. Braces are commonly employed as a conservative treatment for individuals with scoliosis, particularly those with curves ranging from 20 to 40 degrees. This treatment approach's primary objectives include arresting the deformity's progression, enhancing clinical appearance, alleviating pain, improving overall quality of life, and circumventing the need for surgical intervention. The aim of this study was to compare the effectivences of Boston and Cheneau braces in individuals with scoliosis. MethodsIn this retrospective study, 51 subjects were included and monitored over two years. The primary parameters under evaluation encompassed the severity of both primary and secondary curves and compliance with the prescribed treatment. The subjects were classified into two groups: those utilizing the Cheneau brace and those employing the Boston brace. ResultsThe initial mean values of the primary and secondary curves during the first visit were 37.6 (±7.4) and 30.1 (±9.7) degrees, respectively. However, the in-brace curve measurements for the primary and secondary curves were 31.5 (±1.3) and 22.3 (±13.3) degrees, respectively (p-value = 0.0). The mean compliance values of subjects using Boston and Cheneau braces were 16.8 and 17.3 hours per day, respectively (p-value = 0.1). No significant difference was observed in the correction achieved with the Boston and Cheneau braces during the follow-up period. ConclusionsThe results of this study demonstrated a significant reduction in the scoliotic curve while under brace conditions. However, the degree of correction achieved did not significantly differ during the follow-up periods. Additionally, there was no notable variance in the correction obtained between the Boston and Cheneau braces. Short summaryBrace treatment can result in a significant reduction in the scoliotic curve. There was no noticeable difference in the correction achieved between the Boston and Cheneau braces. The degree of curve correction achieved by brace treatment did not vary significantly during the follow-up periods.

Impact of Computer-Aided Design and Computer-Aided Manufacturing Boston Brace on Level of Dyspnea among Patients with Adolescent Idiopathic Scoliosis

Background: Adolescent Idiopathic Scoliosis (AIS) is a prevalent spinal deformity characterized by a lateral curvature exceeding 10°. Bracing, particularly with the Boston brace, is a common conservative treatment aimed at halting the progression of spinal curvature. However, the impact of bracing on pulmonary function and the resultant dyspnea remains a concern, especially in developing countries like Pakistan where larger scoliotic curves are more common. Objective: This study aimed to evaluate the effect of the CAD/CAM Boston brace on dyspnea levels in patients with AIS and to examine the correlation between dyspnea severity, Cobb's angle, and the duration of brace wear. Methods: Necessary approvals were obtained from the institutional ethical review board, and informed consent was secured from all participants. The study included 145 participants (aged 10-19 years) diagnosed with AIS, recruited through non-probability convenient sampling. The sample size was calculated using the WHO sample size calculator, ensuring a minimum of 134 participants. Data collection involved the 6 Minute Walk Test (6MWT) followed by the Modified Borg Scale (MBS) to assess dyspnea. Participants were instructed to walk a distance of 400 to 700 meters within 6 minutes. Post-test, participants rated their dyspnea on a scale of 0 to 10. Demographic data and brace wear duration were also collected. Data were analyzed using SPSS version 25. Means and standard deviations were calculated for continuous variables, and frequency tables were used for categorical variables. Pearson correlation coefficients were computed to determine the relationships between dyspnea levels, Cobb's angle, and brace wear duration. Results: The mean age of participants was 14.71 years (SD = 2.309). The mean Cobb's angle was 52.08° (SD = 5.3729), and the mean duration of brace wear was 26.08 hours per week (SD = 7.0458). Dyspnea severity varied, with 54.5% of participants reporting "somewhat severe" dyspnea, 15.9% reporting "very, very severe" dyspnea, and 9.0% reporting "moderate" dyspnea. Pearson correlation analysis revealed a strong positive correlation between dyspnea severity and Cobb's angle (r = 0.681), and a moderate positive correlation between dyspnea severity and brace wear duration (r = 0.414). Conclusion: The study highlights the significant impact of the CAD/CAM Boston brace on dyspnea levels among AIS patients. Higher Cobb's angles and longer brace wear durations were associated with increased dyspnea severity. These findings underscore the need for careful monitoring of respiratory symptoms in AIS patients undergoing bracing and suggest exploring alternative or adjunctive treatments to minimize pulmonary compromise.

Vertebral Bone Density Variations in Scoliotic vs. Non-Scoliotic Juveniles, and Its Implications for Schmorl’s Node Development: A CT-Based Analysis Using the New Mexico Decedent Image Database

Scoliosis, characterized by an abnormal lateral curvature of the spine, is predominantly idiopathic, underscoring the need to delve into its underlying causes for effective treatment and preventive strategies. This study investigates a potential correlation between scoliosis and Schmorl’s nodes (intervertebral disc herniations) influenced by Wolff’s law, which posits that bones adapt to external pressures. We analyzed CT scans from 108 juvenile decedents, including 56 with scoliosis and 52 without. After running multiple statistical tests, there was no significance between the mean bone density when compared to having scoliosis. An independent t-test provided a t-value of 0.041, which, when compared to the original significance level of 0.05, is statistically significant, although weak. When compared to the Bonferroni correction level of 0.008, it throws out the significance to give a result of not being statistically significant. It was the same in the cases of L3 (t = 0.103), L2 (t = 0.084), and L1 (t = 0.053). If compared to the regular significance level of 0.05, T12 (t = 0.012) and T11 (t = 0.042) had weak significance, but that was then excluded when the Bonferroni correction was applied. When looking at any significance of densities in different vertebral regions, the results from a one-way ANOVA (p-value = 0.213) suggest that it is likely that the results are due to random variability or chance, and that there is no statistical significance. With a value of 0.273 from a Chi-squared (χ2)/Fisher’s exact test, it suggests that there is no statistically significant correlation or difference between the variables of scoliosis and Schmorl’s nodes. The general pattern seems to follow that as the spine ascends, the density increases, and this is true in both scoliotic and non-scoliotic individuals. As a whole, it is evident that those with scoliosis have a lower vertebral density than those without, in all of the vertebral regions. There is, however, a weak negative linear relationship between bone density and age in both scoliotic and non-scoliotic individuals. A p-value of −0.229 obtained from a Pearson correlation coefficient analysis in non-scoliotic individuals, as well as a p-value of −0.069 in scoliotic individuals, was obtained. Overall, the findings of this study are comparable to some existing studies on similar topics, but there are few results that hold statistical significance and so this would be interesting to research further, potentially using a different dataset or a larger sample size that is more representative.

S1 vertebral bone quality score independently predicts pedicle screw loosening following surgery in patients with adult degenerative scoliosis

BACKGROUND CONTEXTMRI-based vertebral bone quality (VBQ) score is an effective predictor of pedicle screw loosening after lumbar fusion surgery and has been recognized as a valuable tool for assessing preoperative bone quality. Due to the lateral curvature of lumbar spine of degenerative scoliosis, accurate measurement of VBQ score by conventional measurement methods that capture MRI signal intensity at L1–4 may be limited under certain conditions. To this end, a new simplified S1 VBQ score method has been proposed, which is comparable to the previous L1–4 VBQ score or S1 Hounsfield unit (HU) value, and has high accuracy and reliability. PURPOSETo evaluate the predictive value of MRI-based S1 VBQ score for pedicle screw loosening following surgery for adult degenerative scoliosis (ADS). STUDY DESIGN/SETTINGRetrospective single-center cohort. PATIENT SAMPLEWe reviewed 92 patients who underwent posterior lumbar interbody fusion (PLIF) with pedicle screw fixation for ADS between January 2017 and January 2020. OUTCOME MEASURESAssociation between S1 VBQ score and pedicle screw loosening following surgery for ADS. METHODSWe retrospectively reviewed the records of all patients who performed PLIF between January 2017 and January 2020. The clear zone around pedicle screws≥1 mm can be identified as screw loosening. The S1 VBQ score is calculated from the S1 central-based noncontrast T1-weighted magnetic resonance imaging (MRI). The signal intensity (SI) of the cerebrospinal fluid (CSF) was then measured using ROI placed at the L3 level to normalize the results. Multivariate logistic regression analysis was performed to identify independent risk factors for screw loosening. Then, constructed a receiver operating characteristic (ROC) curve and determined the threshold (cut-off) of VBQ score with high sensitivity and specificity based on Youden Index. RESULTSA total of 92 patients were included, including 34 males and 58 females. The mean age of the patients was 61.23±1.23 years old. At 1-year follow-up, the screw loosening rate was 56.5% (52/92). The age and levels of fixation were higher in the loosening group than in the nonloosening group (p=.036, p=.025). Patients in the loosening group had a greater VBQ score compared to patients in the nonloosening group (3.31±0.41 vs 3.01±0.28, p=.001). Multivariate logistic regression analysis showed that advanced age (OR, 1.090; 95% CI 1.005–1.183; p=.039) and higher VBQ score (OR, 5.778; 95% CI 2.889–16.177; p=.001) were independent risk factors for screw loosening. In addition, the ROC curve were created to assess the role of VBQ score as predictors of screw loosening with a diagnostic accuracy of 74.6% (95% CI 64.2%–85.1%).The most suitable threshold for the VBQ score as determined by the Youden Index was 3.175 (sensitivity: 76.0%, specificity: 83.3%). CONCLUSIONSHigher S1 VBQ score was significantly associated with pedicle screw loosening following surgery for ADS. The S1 VBQ score can be used as an effective preoperative predictor, which has the potential clinical application.

Scoliosis and Knee Osteoarthritis Classification and Detection using X-Rays

Medical imaging plays a pivotal role in the early detection and accurate classification of musculoskeletal disorders. This study focuses on the development of a robust and efficient system for the detection and classification of two prevalent musculoskeletal conditions: scoliosis and knee osteoarthritis, using X-ray images. Scoliosis is a lateral curvature of the spine, while knee osteoarthritis involves the degeneration of knee joint cartilage and underlying bone.The proposed system leverages state-of-the-art deep learning techniques to automatically detect and classify these conditions from X-ray images. The workflow involves three main stages: preprocessing, feature extraction, and classification. During preprocessing, the X-ray images are normalized, noise-reduced, and anatomical landmarks are identified for accurate alignment. Key Words: Detection and classification, knee osteoarthritis, ordinal classification, X-rays.