Scoliosis Curvature Research Articles

Muscle energy techniques versus myofascial release on scoliosis in adolescent girls: A randomized controlled trial

Background. Adolescent idiopathic scoliosis (AIS) is a complicated 3D structural spine condition occurring in children aged 10 to skeletal maturity. The study aimed to examine the impact of muscle energy technique and/or myofascial release on adolescent idiopathic scoliosis for large sample. Also, it aimed to compare the muscle energy techniques versus myofascial release on idiopathic scoliosis. Methods. A total of 50 girls with idiopathic non-bony structural scoliosis of the thoracic spine were included in this trial. They were randomly divided into two equal-sized (n = 25 for each group). For three months, group A (Muscle energy technique Group), which received Scientific Exercises Approach to Scoliosis exercises in addition to Muscle energy technique; and group B (Myofascial release Group), which received the same Scientific Exercises Approach to Scoliosis exercises conducted to group A in addition to myofascial release. The primary outcome was a standing radiological evaluation of coronal Cobb´s angle. Results. According to this study's findings, a highly significant difference was discovered in the mean values of Cobb´s angle between pre and post-treatment in muscle energy technique group. When the mean values of Cobb´s angle was compared before and after treatment for myofascial release group, it was reveals a significant change. Conclusions. After treatment for three months, both groups improved significantly, with muscle energy technique group outperforming the myofascial release group by a large margin. So, muscle energy technique was more effective than myofascial release in reducing the abnormal thoracic curvature in adolescent idiopathic scoliosis. Trial registration. The study was registered with Clinicaltrials.gov under the identifier NCT05120089.

Growing Rod versus Posterior Spinal Fusion Treatment of Juvenile Idiopathic Scoliosis: Unique Characteristics and Surgical Outcomes.

Progressive spinal curvature in juvenile idiopathic scoliosis (JIS) is challenging to treat. When conservative management fails, treatments include growing rods (GRs) or posterior spinal fusion (PSF). The purpose of this study is to compare the patient characteristics and outcomes of GR and PSF treatment of JIS. We performed a retrospective review of demographic, radiographic, and surgical data for all JIS patients requiring surgical treatment between 2012 and 2020. Patients who underwent any GR treatment were compared to PSF patients. A total of 36 patients (13 GR, 23 PSF) were reviewed. PSF patients had a larger pre-operative spinal height (p = 0.002), but similar pre-operative major curve magnitudes (p = 0.558). PSF treatment resulted in similar change in the T1-S1 length (p = 0.002), but a greater correction of the curve magnitude (p < 0.055) compared to GR patients. Eight patients initially treated with GRs later underwent definitive PSF treatment. This subset of patients had a greater spinal height before PSF (p = 0.006), but similar immediate post-PSF T1-S1 lengths (p = 0.437) and smaller changes in spinal height from PSF (p = 0.020) than primary PSF patients. At final follow-up, patients who underwent primary PSF versus PSF after GR had similar spinal heights (p = 0.842). The surgical intervention chosen to manage progressive JIS often differs based on patient characteristics. While this choice may impact immediate outcomes, the outcomes at final follow up are similar.

3D Back Contour Metrics in Predicting Idiopathic Scoliosis Progression: Retrospective Cohort Analysis, Case Series Report and Proof of Concept.

Adolescent Idiopathic Scoliosis is a 3D spinal deformity commonly characterized by serial radiographs. Patients with AIS may have increased average radiation exposure compared to unaffected patients and thus may be implicated with a modest increase in cancer risk. To minimize lifetime radiation exposure, alternative imaging modalities such as surface topography are being explored. Surface topography (ST) uses a camera to map anatomic landmarks of the spine and contours of the back to create software-generated spine models. ST has previously shown good correlation to radiographic measures. In this study, we sought to use ST in the creation of a risk stratification model. A total of 38 patients met the inclusion criteria for curve progression prediction. Scoliotic curves were classified as progressing, stabilized, or improving, and a predictive model was created using the proportional odds logistic modeling. The results showed that surface topography was able to moderately appraise scoliosis curvatures when compared to radiographs. The predictive model, using demographic and surface topography measurements, was able to account for 86.9% of the variability in the future Cobb angle. Additionally, attempts at classification of curve progression, stabilization, or improvement were accurately predicted 27/38 times, 71%. These results provide a basis for the creation of a clinical tool in the tracking and prediction of scoliosis progression in order to reduce the number of X-rays required.

Imaging study on thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis

To observe the alteration of thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis(AIS) and the difference of physiological curvature between different types of scoliosis. A retrospective analysis was conducted on 305 adolescent patients taken full spine X-ray in our hospital from January 2017 to December 2021. The patients were divided into normal group and scoliosis group. The normal group was composed of 179 patients, 79 males and 100 females, aged 10 to 18 years old with an average of (12.84±2.10) years old, with cobb agle less than 10 degrees. The scoliosis group was composed of 126 patients, 33 males and 93 females, aged 10 to 18 years old with an average of (13.92±2.20) years old. The gender, age, Risser sign, thoracic kyphosis(TK) and lumbar lordosis(LL) in 2 groups were compared, and the TK and LL were also compared between different genders, different degrees of scoliosis and different segments of scoliosis. The female ratio(P=0.001) and age (P<0.001) in scoliosis group were higher than them in normal group; the ratio of low-grade ossification was higher in normal group than in scoliosis group(P=0.038). TK was significantly smaller in scoliosis group than in normal group(P<0.001), but there was no significant difference in LL between the 2 groups(P=0.147). There were no significant difference in TK and LL between male and female. The TK was significantly bigger in mild AIS patients than in moderate AIS patients(P<0.05), but there was no significant difference in LL between mild and moderate patients(P>0.05). The TK and LL in different segments scoliosis were not found significant difference. The physiological curvature of thoracic and lumbar spine is independent of gender. The thoracic physiological curvature becomes smaller in AIS patients, but lumbar curvature remains unchanged. The thoracic physiological curvature in mild AIS patients is greater than that in moderate AIS patients, but the lumbar curvature is almost unchanged between mild and moderate scoliosis and is similar with that in normal adolescent. The alteration of thoracic and lumbar physiological curvature in AIS patients may be related to relative anterior spinal overgrowth, and the specific detailed mechanism needs to be further studied.

Prediction of Fusion Rod Curvature Angles in Posterior Scoliosis Correction Using Artificial Intelligence.

This study aimed to estimate post-operative rod angles in both concave and convex sides of scoliosis curvature in patients who had undergone posterior surgery, using neural networks and support vector machine (SVM) algorithms. Radiographs of 72 scoliotic individuals were obtained to predict post-operative rod angles at all fusion levels (all spinal joints fused by rods). Pre-operative radiographical indices and pre-operatively resolved net joint moments of the apical vertebrae were employed as inputs for neural networks and SVM with biomechanical modeling using inverse dynamics analysis. Various group combinations were considered as inputs, based on the number of pre-operative angles and moments. Rod angles on both the concave and convex sides of the Cobb angle were considered as outputs. To assess the outcomes, root mean square errors (RMSEs) were evaluated between actual and predicted rod angles. Among eight groups with various combinations of radiographical and biomechanical parameters (such as Cobb, kyphosis, and lordosis, as well as joint moments), RMSEs of groups 4 (with seven radiographical angles in each case, which is greater in quantity) and 5 (with four radiographical angles and one biomechanical moment in each case, which is the least possible number of inputs with both radiographical and biomechanical parameters) were minimum, particularly in prediction of the concave rod kyphosis angle (errors were 5.5° and 6.3° for groups 4 and 5, respectively). Rod lordosis angles had larger estimation errors than rod kyphosis ones. Neural networks and SVM can be effective techniques for the post-operative estimation of rod angles at all fusion levels to assist surgeons with rod bending procedures before actual surgery. However, since rod lordosis fusion levels vary widely across scoliosis cases, it is simpler to predict rod kyphosis angles, which is more essential for surgeons.

Comparison of morphometric measurements of lumbar muscles on the convex and concave sides of curvature in idiopathic scoliosis.

It has always been wondered how the muscle volumes of the lumbar region are affected on the convex and concave sides of the curvature in idiopathic scoliosis (IS) and their possible differences compared to healthy individuals. Muscular changes in individuals with IS have generally been tried to be determined by measurements such as muscle cross-sectional area. However, since the changes in the locomotor system in scoliosis affect the anatomical structures of the muscles such as origin and insertion, the reliability of muscle cross-sectional area measurement decreases. Our aim in this study was to compare the psoas major (PM) and quadratus lumborum (QL) muscle volumes, which undergo the most changes on the concave and convex side of the curvature in scoliosis, within themselves and with healthy individuals. 34 women with scoliosis and 29 healthy women were included in this descriptive retrospective study. PM and QL muscle volumes were measured bilaterally on computed tomography (CT) images of individuals in both groups and recorded as mm3. Statistical analysis was performed with IBM SPSS 23.0, P < .05 was considered significant. In the IS group, both PM and QL muscle volumes were greater on the convex side of the curve (P < .001). When the IS group was compared with the control group, both muscle volumes were significantly lower in the IS group bilaterally than in the control group (P < .001). It was observed that individuals with IS developed atrophy in the lumbar muscles of both sides of the curve, mostly on the concave side of the curve, compared to healthy individuals. We think that these results will be important in planning appropriate physical therapy for individuals with IS.

Comparison of Motor Evoked Potentials Neuromonitoring Following Pre- and Postoperative Transcranial Magnetic Stimulation and Intraoperative Electrical Stimulation in Patients Undergoing Surgical Correction of Idiopathic Scoliosis.

The relationships between the results of pre- and intraoperative motor evoked potential recordings during neuromonitoring and whether idiopathic scoliosis (IS) surgical correction improves the spinal efferent transmission have not been specified in detail. This study aims to compare the results of surface-recorded electromyography (EMG), electroneurography (ENG, M, and F-waves), and especially motor evoked potential (MEP) recordings from tibialis anterior muscle (TA) bilaterally in 353 girls with right idiopathic scoliosis (types 1-3 according to Lenke classification). It has not yet been documented whether the results of MEP recordings induced by transcranial single magnetic stimulus (TMS, pre- and postoperatively) and trains of electrical stimuli (TES; intraoperatively in T0-before surgery, T1-after pedicle screws implantation, and T2-after scoliosis curvature distraction and derotation following two-rod implantation) can be compared for diagnostic verification of the improvement of spinal cord neural transmission. We attempted to determine whether the constant level of optimal anesthesia during certain surgical steps of scoliosis treatment affects the parameters of MEPs recorded during neuromonitoring procedures. No neurological deficits have been observed postoperatively. The values of amplitudes but not latencies in MEP recordings evoked with TMS in IS patients compared before and after surgery indicated a slight improvement in efferent neural transmission. The results of all neurophysiological studies in IS patients were significantly asymmetrical and recorded worse on the concave side, suggesting greater neurological motor deficits at p = 0.04. The surgeries brought significant improvement (p = 0.04) in the parameters of amplitudes of sEMG recordings; however, the consequences of abnormalities in the activity of TA motor units were still reflected. ENG study results showed the symptoms of the axonal-type injury in peroneal motor fibers improving only on the concave side at p = 0.04, in parallel with F-wave parameters, which suggests that derotation and distraction might result in restoring the proper relations of the lumbar ventral roots in the spinal central canal, resembling their decompression. There were no significant differences detected in the amplitudes or latencies of MEPs induced with TMS or TES when comparing the parameters recorded preoperatively and intraoperatively in T0. The amplitudes of TES-evoked MEPs increased gradually at p = 0.04 in the subsequent periods (T1 and T2) of observation. A reduction in MEP latency at p = 0.05 was observed only at the end of the IS surgery. Studies on the possible connections between the level of anesthesia fluctuations and the required TMS stimulus strength, as well as the MEP amplitude changes measured in T0-T2, revealed a lack of relationships. These might not be the factors influencing the efferent transmission in spinal pathways beside the surgical procedures. Pre- (TMS-evoked) and intraoperative (TES-evoked) recordings are reliable for evaluating the patient's neurological status before and during surgical scoliosis correction procedures. An increase in MEP amplitude parameters recorded on both sides after scoliosis surgery proves the immediate improvement of the total efferent spinal cord transmission. Considering comparative pre- and postoperative sEMG and ENG recordings, it can be concluded that surgeries might directly result in additional lumbar ventral root decompression. We can conclude that MEP parameter changes are determined by the surgery procedures during neuromonitoring, not the anesthesia conditions if they are kept stable, which influences a decrease in the number of false-positive neuromonitoring warnings.

Treatment of Chiari Malformation and Concomitant Paediatric Scoliosis Long-Term Follow-Up in One Major Referral Centre in the UK.

Paediatric scoliosis (PS) and Chiari malformation type 1 (CM-1) have been reported to be associated with each other. Scoliosis curvature is a common finding among patients operated for CM-1, and curve development has been related to it. We report a cohort of PS and CM-1 patients managed with posterior fossa and upper cervical decompression (PFUCD) by a single surgeon, with an average of two years of follow-up. We present a retrospective cohort in a single referral centre for patients with CM-1 and PS. From 2011 to 2018, we identified fifteen patients with CM-1 and PS; eleven underwent PFUCD, ten had symptomatic CM-1, and one had asymptomatic CM-1 but showed curve progression. The remaining four CM-1 patients were asymptomatic and were hence treated conservatively. The average follow-up post-PFUCD was 26.2 months. Scoliosis surgery was performed in seven cases; six patients underwent PFUCD prior to the scoliosis correction. One scoliosis case underwent surgery in the presence of mild CM-1 treated conservatively. The remaining four cases were scheduled for scoliosis correction surgery, while three were managed conservatively, with one case lost to follow-up. The average time between PFUCD and scoliosis surgery was 11 months. None of the cases had intraoperative neuromonitoring alerts or perioperative neurological complications. CM-1 with concomitant scoliosis can be found. Symptomatic CM-1 might require surgery, but as we discovered, PFUCD had negligible effect on curve progression and the future need for scoliosis surgery.

Spinal stiffness assessment by shear wave imaging in a genetic zebrafish scoliosis model treated with anti-inflammatory medication

Background: Idiopathic scoliosis (IS) is a disease characterized by an abnormal lateral curvature of the spine that affects up to 4% of the population. Recent models in zebrafish have elucidated genetic variants which contribute to scoliotic curvature through mechanisms of neuroinflammation, and oxidative stress. Additionally, in-vivo clinical studies have demonstrated that spinal structures stiffen in patients with IS. Shear wave elastography (SWE) is novel, non-invasive imaging technique used to quantitatively estimate tissue stiffness. Objective: Here, we investigated spinal stiffness using SWE in genetically mutant zebrafish with a heterozygous scoliosis variant ( dmh4/+) treated with N-acetylcysteine ethyl ester (NACET), a potent anti-oxidant and anti-inflammatory medication which has been demonstrated to reduce scoliosis curvature formation in zebrafish by up to 70%. Hypothesis: Compared to wildtype, spinal stiffness will increase in dmh4/+ zebrafish and there will be no difference in stiffness for NACET treated zebrafish. Methods: Wildtype (WT; n=20) and mutant ( dmh4/+; n=20) zebrafish aged 10 days post fertilization (dpf) (n=10 &amp; n=10 treated with 500 μM of NACET), 16 dpf (n=10), and 21 dpf (n=10) were sacrificed and submerged in a dish containing 2% low melt agarose gel. An 18.75 MHz linear ultrasound probe was clamped to the dish apparatus dorsal to the zebra fish. Spinal stiffness was assessed by SWE, where faster shear wave velocities (SWV) represent stiffer tissue. The SWV data was processed using a well-verified, custom SWE analysis program on MATLAB by a n operator blinded to the zebrafish genotypes. Results: The spinal curvature of dmh4/+ zebrafish aged 10 dpf were morphologically indistinguishable from WT zebrafish aged 10 dpf. SWV was significantly increased in dmh4/+ zebrafish aged 10 dpf compared to WT (p&lt;0.05). There was no difference in SWV between NACET treated dmh4/+ and NACET treated WT zebrafish aged 10 dpf (p&gt;0.05). Furthermore, NACET treated dmh4/+ and WT zebrafish aged 10 dpf exhibited no difference in SWV compared to untreated WT zebrafish aged 10 dpf (p&gt;0.05). Additionally, SWV was significantly increased in dmh4/+ zebrafish aged 16 and 21 dpf compared to WT (p&lt;0.05). Conclusion: Here we demonstrate that spinal stiffness increases in zebrafish with scoliosis before the curvature pheno type is present and this increase in stiffness is sustained throughout development in later ages. Additionally, spinal stiffness in scoliosis is reduced following treatment with NACET. Our results provide evidence to support clinical trials assessing stiffness as preclinical diagnostic criteria for IS in children. Biotalent Canada - public grant This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Morphological differences in scoliosis curvatures as a cause of difficulties in its early detection based on angle of trunk inclination

IntroductionThe three dimensional deformation of the spine in scoliosis is specific for a given child with regard to the number and length of curvatures, their degree of rotation and the size of the curvature angle. Early diagnosis of scoliosis in a clinical examination according to the Adams test depends on the correlation between the angle of trunk inclination (ATI) and the Cobb angle and the adopted diagnosis criterion. The aim of the study was to demonstrate the need to adopt different diagnostic criteria for ATI depending on the age and location of scoliosis. Moreover, the observed differences in the ATI/Cobb correlation became the basis for the proposal to introduce the concept of low, medium and high-rotated of curvature to the clinical description of scoliosis.Materials and methodsThe group consisted of 229 children who were first examined, aged 6 to 17 years, with an average age of -11.57 years (SD ± 3.26), with symptoms of idiopathic scoliosis. The correlation of the criteria for the diagnosis of scoliosis in the ATI 7° clinical trial with a Cobb angle of 10° three dimensional in the X-ray image was used to distinguish three types of curvature/scoliosis, i.e., low, medium and high rotation. The frequencies of each type were compiled for three age groups and three scoliosis locations. Moreover, the degree of vertebral rotation according to the Perdriolli (AVR) of curvature was correlated with the Cobb angle and ATI. A one-way logistic regression model was used to assess the effectiveness of scoliosis detection in children based on the measurement of the ATI angle alone and the measurement of both ATI and Cobb angles.ResultsLow-rotated curves were most often found in the age groups of 6–9 and 10–12 years in 65.6% and 71.4% of patients, respectively (p < 0.05). Medium-rotated curvatures were most common in the age group of 13–17 years – 51.6%. With regard to the localization of scoliosis, the low-rotated curvatures were significantly more frequently (p < 0.05) found in the lumbar and thoracolumbar spine. Moreover, the univariate regression model for ATI showed that we could detect scoliosis best by taking the cut-off point of 5° and the mathematically determined Cobb angle was 9.5°. Patients with ATI ≥ 7° had significantly higher AVR values ​​than those with ATI < 7°, and the ATI/AVR correlation was of average strength.ConclusionThe specific morphology of the scoliotic curvature of the child’s spine may be manifested by the difference in the ATI/Cobb correlation depending on the location of the scoliosis and change with age. The curvatures of the scoliosis that form can be low, medium and high-rotated, and the low-rotated curvatures were most often found in the 6-9- and 10-12-year-old groups and in the lumbar and thoracolumbar section. To increase the rate of early diagnosis of scoliosis, the results suggest the need to adopt two ATI criteria for the diagnosis of scoliosis at screening, 5° for age of 6–12 years, and when asymmetry affects the lumbar and thoracolumbar section, and 7° for the remaining children.

Physical rehabilitation for scoliosis I-II degree

The peculiarities of physical therapy for scoliosis of the I- II degree, which are among the most serious diseases of childhood, are considered. The program of physical rehabilitation, which allows the most economical and rational approach to solving the problem of rehabilitation of patients with scoliosis I-II degree, is highlighted. The effectiveness of this program, which included physical therapy exercises; physiotherapy; massage and therapeutic swimming gave positive results and the recovery process took less time.&#x0D; The program has a pronounced positive effect on the clinical course of the disease, reduces the angle of curvature of scoliosis, stabilizes the pathological process, improves appearance and coordination of movements, improves respiratory and cardiovascular function (CCS), increases muscle strength and endurance.

PROSEDUR PEMERIKSAAN RADIOGRAFI VERTEBRA THORAKOLUMBAL PADA KLINIS SKOLIOSIS

The procedure of radiographic examination of thoracolumbar vertebrae of scoliosis according to Lampignano and Kendrick (2018), journal by Gray (1983) and journal by Levy (1996) in erect patient position further recommends the PA projections because the dose to organs that are sensitive to radiation such as breast, thyroid and gonad and the risk of getting cancer in these organs is significantly reduced compared to AP projections. While the procedure for radiographic examination of thoracolumbar vertebrae of scoliosis in the Radiology Installation RSUD Bendan Pekalongan uses AP and AP right and left bending projections in erect patient position. This study aims to determine the radiographic examination procedures of thoracolumbar vertebrae in scoliosis and the reasons for using AP and AP right and left bending projections in erect patient position. This type of research is a qualitative research with a case study approach. Data was collected in March-April 2020 in the Radiology Installation RSUD Bendan Pekalongan by observation, interview and documentation. Research subjects are patients, radiographers, radiology specialists, and sending doctors. The data obtained were processed and analyzed using open coding and then presented in the form of images, plot and quotations so that conclusions can be drawn. The results showed that the thoracolumbar vertebra radiographic examination procedure in scoliosis clinical in Radiology Installation RSUD Bendan Pekalongan used AP and right and left bending AP projections in erect position because to place the object as close as possible to IR with the hope to minimize the magnification of the object on the radiograph and has been informative to assess the cobb angle in scoliosis curvature. The suggestion from the author is that Radiology Installation should coordinate with related parties such as radiology specialists, radiographers and sending doctors in order to determine what projections are needed in the case of scoliosis because there are many projections on the scoliosis radiography examination.

Controlling the Progression of Curvature in Children and Adolescent Idiopathic Scoliosis Following the Administration of Melatonin, Calcium, and Vitamin D.

Idiopathic scoliosis affects a severe number of children. Their quality of life and development are also disturbed. Some therapeutic strategies have been developed to control illness progression and to optimize the quality of life. In this perspective, randomized, case-control, interventional study, the impact of using melatonin, calcium, and vitamin D, respectively, on idiopathic scoliosis patients was analyzed. Our preliminary results showed that these drugs positively affected the illness progression quantified by the spine curvature. Patients with idiopathic scoliosis may benefit from a novel treatment by supplementation with vitamin D, calcium, and melatonin.

Automating Scoliosis Measurements in Radiographic Studies with Machine Learning: Comparing Artificial Intelligence and Clinical Reports.

Scoliosis is a condition of abnormal lateral spinal curvature affecting an estimated 2 to 3% of the US population, or seven million people. The Cobb angle is the standard measurement of spinal curvature in scoliosis but is known to have high interobserver and intraobserver variability. Thus, the objective of this study was to build and validate a system for automatic quantitative evaluation of the Cobb angle and to compare AI generated and human reports in the clinical setting. After IRB was obtained, we retrospectively collected 2150 frontal view scoliosis radiographs at a tertiary referral center (January 1, 2019, to January 1, 2021, ≥ 16years old, no hardware). The dataset was partitioned into 1505 train (70%), 215 validation (10%), and 430 test images (20%). All thoracic and lumbar vertebral bodies were segmented with bounding boxes, generating approximately 36,550 object annotations that were used to train a Faster R-CNN Resnet-101 object detection model. A controller algorithm was written to localize vertebral centroid coordinates and derive the Cobb properties (angle and endplate) of dominant and secondary curves. AI-derived Cobb angle measurements were compared to the clinical report measurements, and the Spearman rank-order demonstrated significant correlation (0.89, p < 0.001). Mean difference between AI and clinical report angle measurements was 7.34° (95% CI: 5.90-8.78°), which is similar to published literature (up to 10°). We demonstrate the feasibility of an AI system to automate measurement of level-by-level spinal angulation with performance comparable to radiologists.

Intensive Postural and Motor Activity Program Reduces Scoliosis Progression in People with Rett Syndrome.

Background: A scoliosis prevalence of 94% was reported in the population with Rett syndrome (RTT), with an annual progression rate of 14 to 21° Cobb which may result in pain, loss of sitting balance, deterioration of motor skills, and lung disfunction. This paper describes the efficacy of an intensive conservative individualized physical and postural activity program in preventing scoliosis curvature progression in patients with RTT. Methods: Twenty subjects diagnosed with RTT and scoliosis were recruited, and an individualized intensive daily physical activity program was developed for each participant. Each program was conducted for six months by participants’ primary caregivers in their daily living environment. Fortnightly remote supervision of the program implementation was provided by an expert therapist. Pre- and post-intervention radiographs and motor functioning were analyzed. Results: An averaged progression of +1.7° ± 8.7° Cobb, over one year (12.3 ± 3.5 months) was observed in our group, together with motor function improvements. A relation between curve progression and motor skill improvement was observed. Conclusions: The intervention prevented scoliosis progression in our group. The achievement of functional motor improvements could enable better body segment control and muscle balancing, with a protective effect on scoliosis progression. The intervention was effective for individuals with RTT across various ages and severity levels. Individual characteristics of each participant and the details of their activity program are described.

Relationship between Muscle Tone of the Erector Spinae and the Concave and Convex Sides of Spinal Curvature in Low-Grade Scoliosis among Children.

The objective of the present research was to assess the relationship between muscle tone of the erector spinae and the concave and convex sides of spinal curvature in low-grade scoliosis found among children. The study included 251 children, aged 7–8. Examination of the spine and body posture was carried out using the Diers Formetric III 4D optoelectronic method. Surface electromyography (sEMG) was used to assess erector spinae muscle tone. The trial was carried out using the 14-channel Noraxon TeleMyo DTS apparatus. The highest generalised tone (sEMG amplitude) of the erector spinae occurred in the case of scoliosis. The higher the angle of curvature, the greater the erector spinae muscle tone. Regardless of the position adopted during examination of the thoracic spine, greater erector spinae tone (sEMG amplitude) was exhibited on the convex side of the spinal curvature. However, in the area of the lumbar spine, greater tone (sEMG amplitude) of the erector spinae occurred on the curvature’s concave side. The exception was the test performed in a standing position, during which greater muscle tone was noted on the side of the convex curvature. In therapeutic practice, within the thoracic section, too tense erector spinae muscles should be stretched on the convex side of the scoliosis, while in the lumbar region, this should be performed on the concave side. However, each case of scoliosis requires individually tailored treatment. The current research has applicative value and does fill a research gap with regard to erector spinae muscle tone in young children experiencing low-grade scoliosis. The development of scoliosis is associated with asymmetry and an increase in erector spinae tone. The uneven distribution of its tone, occurring on both sides of the spine and in its various segments, causes destabilisation and its abnormal progression.

Yoga Balance: Decreasing Fall Risk in Seniors

<h3>Research Objectives</h3> To investigate the effect of yoga in decreasing fall risk for activities of daily living and community mobility in the senior population thru occupational therapy. <h3>Design</h3> Basic yoga poses related to primal movement were selected/ executed with NDT techniques; 1 year. <h3>Setting</h3> Continuing Care Retirement Community(CCRC). <h3>Participants</h3> 10 clients with inclusion criteria of age 80+, live in the CCRC, can include co-morbidities, joint replacements accepted. <h3>Interventions</h3> Example of pose: horse stance was selected because as children we have a wide base of support with hips in external rotation and equine stance. Overtime this integrates to a narrower base of support, external/ internal rotation equalizes, and equine stance becomes plantar. Utilizing poses that follow typical patterns allows for neuro plasticity to engage in a way it has before enhancing the progression of decreased fall risk as it relates to ADL's. Alignment is key when addressing posture and fall risk in occupational therapy as well as in Iyengar yoga. Used handling techniques, visual work (mirror), and verbal cueing. Cues were a combination of OT and yogic cues to create proper alignment. Handling promoted neck retraction, scapular depression/ stabilization, shoulder/ pelvic girdle anterior alignment, and knee/ ankle alignment. <h3>Main Outcome Measures</h3> Tinetti: scores increased by an average of 11 points. <h3>Results</h3> When used as an individual therapeutic intervention yoga postures with NDT regressive handling techniques increases the Tinetti score by an average of 11 points; proving a marked decrease of fall risk for ADL's in seniors. Secondary outcomes that were reported by patients included scoliosis curvature decrease, bladder control improvement, and an increased ability to orgasm. <h3>Conclusions</h3> With an average number of Tinetti score improvement by 11 for the total of 10 clients with no regression this study does prove that yoga is effective in decreasing fall risk in seniors. Due to our results we believe expanded studies utilizing yoga as an individualized intervention during therapy sessions is necessary to promote decreased fall risk in elderly patients. <h3>Author(s) Disclosures</h3> N/A.

Cost-utility Analysis Comparing Bracing Versus Observation for Skeletally Immature Patients with Thoracic Scoliosis.

Cost-utility analysis. This study aimed to investigate the cost-utility of bracing versus observation in patients with thoracic scoliosis who would be indicated for bracing. There is high-quality evidence that bracing can prevent radiographic progression of spinal curvature in adolescent idiopathic scoliosis (AIS) patients with curves between 25° and 40° and Risser 0 to 2 skeletal maturity index. However, to our knowledge, the cost-utility of bracing in AIS has not been established. A decision-analysis model comparing bracing versus observation was developed for a hypothetical 10-year old girl (Risser 0, Sanders 3) with a 35° main thoracic curve. We estimated the probability, cost, and quality-adjusted life years (QALY) for each node based on comprehensive review of the literature. Costs were adjusted for inflation based on Consumer Price Index and reported in terms of 2020 real dollars. Incremental net monetary benefit (INMB) was calculated based on a probabilistic sensitivity analysis using Monte Carlo simulations of 1000 hypothetical patients. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates. Our decision-analysis model revealed that bracing was the dominant treatment choice over observation at $50,000/QALY willingness to pay threshold. In simulation analysis of a hypothetical patient cohort, bracing was associated with lower net lifetime costs ($60,377 ± $5,340 with bracing vs. $85,279 ± $4543 with observation) and higher net lifetime QALYs (24.1 ± 2.0 with bracing vs. 23.9 ± 1.8 with observation). Bracing was associated with an INMB of $36,093 (95% confidence interval $18,894-$55,963) over observation over the patient's lifetime. The model was most sensitive to the impact of bracing versus observation on altering the probability of requiring surgery, either as an adolescent or an adult. Cost-utility analysis supports scoliosis bracing as the preferred choice in management of appropriately indicated AIS patients with thoracic scoliosis.Level of Evidence: 5.

Natural History of Scoliosis in Children with NF1: An Observation Study.

(1) Background. Scoliosis is the most common musculoskeletal manifestation of Neurofibromatosis type 1 (NF1), and it might be dystrophic (D) or non-dystrophic (ND) depending on the presence of dysplastic changes of the spine. The aim of our study was to describe the characteristics and natural history of patients with NF1 and scoliosis. (2) Methods. We retrospectively reviewed records from patients with NF1 and scoliosis. Scoliosis was classified as D if at least two dystrophic changes were documented at imaging. (3) Results. Of the 438 patients reviewed, 43 fulfilled inclusion criteria; 17 were classified in D group and 26 in ND. The groups did not differ in age and localization of scoliosis curvature. Surgery was needed more often in D group, but the between-group difference was not significant. Male-to-female ratios of 3:1 and 4:1 were reported in surgically treated NF1 patients with ND and D scoliosis, respectively. (4) Conclusions. Our data suggests independently by the presence of dysplastic changes affecting the spine that males with NF1 are more often affected by scoliosis that requires surgery.

A purpose-design computational method for estimation of plane of maximum curvature in Adolescent Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional (3D) deformity, and the plane of maximum curvature (PMC) is proposed to reflect these clinical features, which refers to a vertical plane presenting the maximum projected spinal curvature and its parameters include the PMC Cobb and orientation (angle between PMC and sagittal planes). This study aimed to develop a computational method (CM) for PMC estimation. Twenty-nine patients with AIS and computed tomography (CT) images were recruited. For CT, PMC was determined by rotating a vertical plane about its vertical axis with 5°increment until the maximum Cobb angle was measured. For CM, PMC was estimated via identifying the eight points (the corner points of the superior and inferior endplates of the upper and lower end-vertebrae respectively) in the coronal and lateral CT images. Two experienced raters repeated the PMC estimation three times with one-week interval. The intra-class correlation coefficient (ICC) and Bland-Altman method were used for statistical analysis. Twenty-seven right thoracic curves (RTs) (mean Cobb: 46.1°±12.4°) and 23 left thoracolumbar/lumbar (LTLs/LLs) (mean Cobb: 30.6°±11.1°) were analysed. The intra- and inter-rater ICC values were >0.91 and 0.84 in RTs and LTLs/LLs, respectively. The PMCs obtained from the CM and CT were showed good agreement was also observed between the PMCs obtained from the two methods according to ICC (>0.90) and Bland-Altman method assessments. This purpose-design computational method could provide reliable and valid estimation of PMCs for AIS, which has potential to be used as an alternative for 3D assessment.