Scoliosis Screening Research Articles

A feasibility study of applying two-dimensional photogrammetry for screening and monitoring of patients with adolescent idiopathic scoliosis in clinical practice

Standing posteroanterior radiographs have been the golden standard to quantify the severity of scoliosis deformity. However, it exposes ionizing radiation to scoliosis patients, and cannot be used for routine screening and monitoring. This study aimed to develop a protocol of measuring postural indexes by using the noninvasive and radiation-free two-dimensional (2D) photogrammetry method and identify its clinical value in scoliosis screening and monitoring. The five postural indexes were measured from the posterior view of 110 participants. One-way ANOVA with post hoc Tukey HSD/Games–Howell analysis was used to compare the differences between the participants in the scoliosis group and the non-scoliosis group. Pearson coefficients of correlation were analyzed to identify the relationships between Cobb angles and each of the five quantitative postural indexes. Based on 2D photogrammetry, the postural indexes of C7 deviation (p = 0.02), shoulder alignment (p < 0.001), scapula alignment (p < 0.001), waist angle discrepancy (p < 0.001), and PSIS alignment (p < 0.001) could significantly differentiate scoliosis and non-scoliosis patients during screening. The waist angle discrepancy (r = 0.4, p = 0.01; r = 0.8, p = 0.03; r = 0.7, p = 0.01) and shoulder alignment (r = 0.6, p = 0.03) had moderate to strong positive correlations with the Cobb angles, which supported their clinical values in monitoring scoliotic curvature changes of adolescent idiopathic scoliosis (AIS) patients.

Developing a new tool for scoliosis screening in a tertiary specialistic setting using artificial intelligence: a retrospective study on 10,813 patients: 2023 SOSORT award winner.

The study aims to assess if the angle of trunk rotation (ATR) in combination with other readily measurable clinical parameters allows for effective non-invasive scoliosis screening. We analysed 10,813 patients (4-18years old) who underwent clinical and radiological evaluation for scoliosis in a tertiary clinic specialised in spinal deformities. We considered as predictors ATR, Prominence (mm), visible asymmetry of the waist, scapulae and shoulders, familiarity, sex, BMI, age, menarche, and localisation of the curve. We implemented a Logistic Regression model to classify the Cobb angle of the major curve according to thresholds of 15, 20, 25, 30, and 40 degrees, by randomly splitting the dataset into 80-20% for training and testing, respectively. The model showed accuracies of 74, 81, 79, 79, and 84% for 15-, 20-, 25-, 30- and 40-degrees thresholds, respectively. For all the thresholds ATR, Prominence, and visible asymmetry of the waist were the top five most important variables for the prediction. Samples that were wrongly classified as negatives had always statistically significant (p ≪ 0.01) lower values of ATR and Prominence. This confirmed that these two parameters were very important for the correct classification of the Cobb angle. The model showed better performances than using the 5 and 7 degrees ATR thresholds to prescribe a radiological examination. Machine-learning-based classification models have the potential to effectively improve the non-invasive screening for AIS. The results of the study constitute the basis for the development of easy-to-use tools enabling physicians to decide whether to prescribe radiographic imaging.

THORAX AND IDIOPATHIC SCOLIOSIS

This review is related to the role of thorax in scoliogenesis. The embryology, the prenatal and the postnatal growth of the rib cage of (RC) and the lungs are briefly described. The development of normal RC, the frontal and sagittal diameters of it, the values of mid-thoracic diameters, the thoracic index, the biomechanical contribution of the RC to thoracic stability, the increase in frontal and sagittal thoracic diameter during breathing are defined. The infancy, childhood, puberty (ICP) model of growth is used in both the segmental thoracic ratios (TR) and the Segmental Rib-vertebra angles (RVA) in order to assess the normal and deformed RC in Early Onset (EOS) and Late Onset Scoliosis (LOS). The neuromuscular mechanisms as possible factors causing age-related RVAs changes are discussed. Then the posterior truncal/thoracic asymmetries are reviewed related to school scoliosis screening (SSS) referrals. Next, the development of RC is analyzed in resolving and progressive infantile idiopathic scoliosis (IIS), and in adolescent idiopathic scoliosis (AIS). The menarche and laterality of thoracic scoliotic curves, congenitally fused ribs and pulmonary function in children with idiopathic scoliosis (IS) is also discussed. The pathogenesis of IS according to the Nottingham concept and RC, the thorax and pelvis complex during gait and rotational inertia, the Double Rib Contour Sign (DRCS) and Rib Index (RI), the effect of growth on the relationship of spinal and thoracic deformity are explained. The postoperative fate of IS hump deformity in relation to the RI and the aetiological implications for IS are then stated. The role of the rib-sternum complex is mentioned. John Sevastiks thoracospinal concept of aetiopathogenesis of AIS and his research about IS are described, namely experiments on ribs, correction of experimentally produced scoliosis, suggested surgical intervention on the ribs, experiments on nerves, vascular changes in the chest wall after unilateral resection of the intercostal nerves, and breast asymmetries in female suffering AIS. A biomechanical model using different Cobb angle and rib hump (RH) correction is mentioned. The issue of thoracic kyphosis and hypokyphosis and the impact of the lateral spinal profile (LSP), that is the sagittal plane, is discussed. Finally, IS and evolution of thoracic shape as a scar of evolution are pointed out.

A Novel Screening Method for Scoliosis Using A Bodysuit and 3-dimensional Imaging.

A single-center prospective observational study. To clarify the usefulness of a novel scoliosis screening method using a 3-dimensional (3D) human fitting application and a specific bodysuit. Several scoliosis screening methods, such as scoliometer and Moiré topography, are available for detecting scoliosis. In the present study, a novel screening method for scoliosis using a 3D human fitting application and a specific bodysuit was developed. Patients with scoliosis or suspected scoliosis, non-scoliosis patients, and healthy volunteers were enrolled. They were divided into Non-Scoliosis and Scoliosis groups. The Scoliosis group was further subdivided into Mild-, Moderate-, and Severe-Scoliosis. Patients' characteristics and Z values, which were calculated by a 3D virtual human body model created by a 3D human fitting application and a specific bodysuit to evaluate trunk asymmetry caused by scoliosis, were compared between the Non-Scoliosis and Scoliosis groups or among the Non-, Mild-, Moderate- and Severe-Scoliosis groups. Finally, the optimal cutoff of the Z value was determined to detect moderate to severe scoliosis using receiver operating characteristics (ROC) curve analysis. A total of 101 patients were included. The Non-Scoliosis group consisted of 47 patients, and the Scoliosis group included 54 patients, with 11, 31, and 12 patients in the Mild-, Moderate-, and Severe-Scoliosis groups, respectively. The Scoliosis group showed a significantly higher Z value than the Non-Scoliosis group. The Moderate- or Severe-Scoliosis group had a significantly higher Z value than the Non- or Mild-Scoliosis group. The ROC curve analysis revealed that the optimal cutoff of the Z value was 19.9mm (sensitivity, 95.3%; specificity, 58.6%). A novel scoliosis screening method consisting of a 3D human fitting application and a specific bodysuit may be useful for detecting moderate to severe scoliosis.

Clinical and radiological assessment of scoliosis in Koolen-de Vries syndrome.

The Koolen-de Vries syndrome (KdVS) is a multisystem disorder characterized by developmental delay, intellectual disability, characteristic facial features, epilepsy, cardiovascular and urogenital malformations, and various musculoskeletal disorders. Scoliosis is a common feature. The aim of this study is to fill the gap in the current knowledge about scoliosis in individuals with KdVS and to provide recommendations for management and follow-up. In total, 54 individuals with KdVS were included in the study, with a mean age of 13.6 years (range 1.9-38.8 years). Spine radiographs, MR scans, and corresponding radiology reports were analyzed retrospectively for scoliosis and additional anomalies. The presence of scoliosis-related clinical conditions was assessed in participants' medical records and by use of a parent survey. Scoliosis was present in 56% of the participants (30/54) with a mean age of onset of 10.6 years and curve progression during the growth spurt. Prevalence at age 6, 10, and 18 years was, respectively, 9%, 41%, and 65%. Most participants were diagnosed with a single curve (13/24, 54%), of which five participants had a long C-curve type scoliosis. No significant risk factors for development of scoliosis could be identified. Severity was mostly classified as mild, although 29% (7/24) of the curves were larger than 30° at last follow-up. Bracing therapy was received in 13% (7/54), and surgical spinal fusion was warranted in 6% (3/54). Remarkably, participants with scoliosis received less often physical therapy compared to participants without scoliosis (P = 0.002). Scoliosis in individuals with KdVS should be closely monitored and radiologic screening for scoliosis and vertebrae abnormalities is recommended at diagnosis of KdVS, and the age of 10 and 18 years.

Prevalence of anisometropia and influencing factors among school-age children in Nantong, China: a cross-sectional study.

To investigate the prevalence of anisometropia and associated parameters among school-aged children in Nantong, China. This school-based, cross-sectional study examined students from primary schools, junior high schools, and senior high schools in an urban area of Nantong, China. Univariate and multivariate logistic regression analyses were used to investigate the specific correlations between anisometropia and related parameters. Non-cycloplegic autorefraction was assessed for each student. Anisometropia was defined as the spherical equivalent refraction (SE) difference ≥ 1.0 D between eyes. A total of 9,501 participants were validated for analyses, of which 53.2% (n = 5,054) were male, and 46.8% (n = 4,447) were female. The mean of age was 13.32 ± 3.49 years, ranging from 7-19 years. The overall prevalence of anisometropia was 25.6%. Factors such as myopia, scoliosis screening positive, hyperopia, female sex, older age, and higher weight had a significantly higher risk of anisometropia (p < 0.05). There was a high prevalence of anisometropia in school-age children. Some physical examination parameters are closely related to children's anisometropia, especially myopia and scoliosis. Preventing myopia and controlling its progression may be the most important ways to reduce the prevalence of anisometropia. Correcting scoliosis may be an important factor in controlling the prevalence of anisometropia, and maintaining good reading and writing posture may be helpful in controlling the prevalence of anisometropia.

A New Clinical Tool for Scoliosis Risk Analysis: Scoliosis Tele-Screening Test.

Methodological, observational clinical study. This study aimed to develop a virtual screening test to detect scoliosis risk initially by parents without the need for medical visit during the coronavirus disease 2019 pandemic. The scoliosis screening program has been implemented to early detect scoliosis. Unfortunately, access to health professionals was limited during the pandemic. However, during this time, interest in telemedicine has increased remarkably. Recently, mobile applications related to postural analysis were developed, but none permits evaluation by parents. Researchers developed the Scoliosis Tele-Screening Test (STS-Test), which included drawing-based images of body asymmetries, to assess the scoliosis-associated risk factors. The STS-Test was shared on social networks, allowing the parents to evaluate their children. After test completion, the risk score was generated automatically, and children with medium and high risks were then advised for medical consultation for further evaluation. The test accuracy and consistency between the clinician and parents were also analyzed. Of the 865 tested children, 358 (41.4%) consulted clinicians to confirm their STS-Test results. Scoliosis was then confirmed in 91 children (25.4%). The parents were able to detect asymmetry in 50% of the lumbar/thoracolumbar curvatures and 82% of the thoracic curvatures. In addition, the forward bend test revealed favorable agreement between parents and clinicians (r =0.809, p<0.0005). Internal consistency of the esthetic deformities domain in the STS-Test was also excellent (α=0.901). This tool was 94.97% accurate, 83.51% sensitive, and 98.87% specific. The STS-Test is a new parent-friendly, virtual, cost-effective, result-oriented, and reliable tool for scoliosis screening. It allows parents to actively participate in the early detection of scoliosis by screening their children for the risk of scoliosis periodically without the need to visit the health institution.

Screening of adolescent idiopathic scoliosis using generative adversarial network (GAN) inversion method in chest radiographs.

Conventional computer-aided diagnosis using convolutional neural networks (CNN) has limitations in detecting sensitive changes and determining accurate decision boundaries in spectral and structural diseases such as scoliosis. We devised a new method to detect and diagnose adolescent idiopathic scoliosis in chest X-rays (CXRs) employing the latent space's discriminative ability in the generative adversarial network (GAN) and a simple multi-layer perceptron (MLP) to screen adolescent idiopathic scoliosis CXRs. Our model was trained and validated in a two-step manner. First, we trained a GAN using CXRs with various scoliosis severities and utilized the trained network as a feature extractor using the GAN inversion method. Second, we classified each vector from the latent space using a simple MLP. The 2-layer MLP exhibited the best classification in the ablation study. With this model, the area under the receiver operating characteristic (AUROC) curves were 0.850 in the internal and 0.847 in the external datasets. Furthermore, when the sensitivity was fixed at 0.9, the model's specificity was 0.697 in the internal and 0.646 in the external datasets. We developed a classifier for Adolescent idiopathic scoliosis (AIS) through generative representation learning. Our model shows good AUROC under screening chest radiographs in both the internal and external datasets. Our model has learned the spectral severity of AIS, enabling it to generate normal images even when trained solely on scoliosis radiographs.

Comparison of scoliosis diagnostic capabilities in screening of schoolchildren by computer optical topography and video rasterstereography using TODP and Formetric topographs

Objective. To analyze the results of scoliosis diagnostics during the examination of the same group of schoolchildren by TODP and Formetriс topographs.Material and Methods. A total of 364 schoolchildren (197 girls and 167 boys, mean age 8.92 ± 1.9 years) were examined, divided into 3 age groups: 6–8 years old (n = 135, mean age 7.22 ± 0.7 years), 8–10 years old (n = 134 children, mean age 8.95 ± 0.56 years), 10–12 years old (n = 95 children, mean age 11.35 ± 1.59 years). Schoolchildren were examined in turn by computer optical topography (TODP, released in 2021, WTOPO 5.4-2021 software) and video raster stereography (Formetric 4D released in 2015, DICAM2.6.4 software). Three standard screening poses were used for TODP, and one pose with averaging 12 frames – for Formetric.Results. The obtained statistics on the distribution of topographic analogs of the Cobb angle (the angle of lateral asymmetry for TODP and the angle of scoliosis for Formetric) showed a significant discrepancy in the percentage of detected scoliosis cases: 0–5° – 50,0 % (TODP) and 4.1 % (Formetric); 5–7° – 33.8 % and 9.3 %; 7–9° – 12.4 % and 17.9 %; 9–15° – 3.8 % and 51.6 %; 15–25° – 0,0 % and 16.2 %; 25–50° – 0,0 % and 0.8 %, respectively. Clinically significant cases of scoliosis (9° or more) in the age groups was 3.7 %, 2.2 %, 6.6 % (mean – 3.8 %) for TODP and 71.1 %, 70.1 %, 63.2 % (average – 68.7 %) for Formetric. At the same time, only 14 cases of clinically significant scoliosis (from 9° to 15°), including 9 structural and 5 compensatory scoliosis, were detected by TODP, and 250 scoliosis cases (188 – from 9° to 15°, 59 – from 15° to 25°, 3 – from 25° to 37°) – by Formetric. For 9 structural scoliosis cases (according to TODP), the Formetric diagnosis coincided completely only in 2 cases and partially in 3 (55 %), and in 5 cases of compensatory scoliosis (according to TODP) it coincided completely in 3 cases and partially in 1 (80 %).Conclusion. According to the results of topographic screening of 364 schoolchildren using the TODP topograph, 3.8 % of scoliosis cases of 9° or more was detected, which corresponds to the average screening data in a number of countries around the world. Examination of the same schoolchildren using the Formetric topograph revealed 68.7 % of cases of scoliosis of 9° or more, which allows us to judge about overdiagnosis and conclude that Formetric is poorly suited for topographic screening of scoliosis in schoolchildren.

RASopathies and spinal deformities for screening of scoliosis.

The RASopathies (Noonan syndrome [NS] and Costello syndrome [CS]) are rare disorders. Although these have been characterized, precise delineation of the differences in the spinal deformities associated with RASopathy has not been described. This study characterized the spinal deformities found in NS and CS and describes a strategy for the screening of scoliosis. The clinical records and spinal X-rays of 35 consecutive NS and CS patients were reviewed. Spinal X-rays were assessed to define the presence and progression of scoliosis. Clinical records were examined to identify the risk factors associated with scoliosis. In addition, we investigated the association between clinical records and scoliosis using logistic regression analysis. Twenty-four patients with NS and 11 with CS were included. Nine patients with NS and five with CS showed scoliosis. The mean ± SD age at diagnosis was 12.6 ± 2.4 years in NS and 11.4 ± 2.5 years in CS (p = 0.55), and mean follow-up period was 4.8 ± 2.6 years and 6.3 ± 2.4 years (p = 0.42), respectively. The coronal angular deformity at final follow-up was 27.3 ± 8.5° in NS and 19.4 ± 6.9° in CS (p = 0.030) with a mean annual progression of 2.8 ± 1.1° in NS 1.0 ± 1.0° in CS (p = 0.030). Cardiac disease was present in eight out of nine patients with NS with concomitant scoliosis in NS, and significantly more than in CS (p = 0.007). PTPN11 significantly correlated with scoliosis (odds ratio 12.4 0.035, 95% confidence interval: 1.20-128.00). Spinal deformity in NS is more severe than in CS. This study identified a relationship between PTPN11 and scoliosis. Therefore, PTPN11 can be used for the screening of scoliosis.

Associations of physical activity and screen time with adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is the most common type of idiopathic scoliosis, affecting approximately 0.61%-6.15% adolescents worldwide. To date, the results on the relationship between moderate-to-vigorous physical activity (MVPA) and AIS were inconsistent, and the association between screen time (ST) and AIS remained unclear. This study aimed to describe MVPA and ST among adolescents, and to explore the independent and joint associations between PA, ST, and AIS. A frequency-matched case-control study based on the 2021 Chinese School-based Scoliosis Screening Program in Shenzhen city, south China, was conducted. The research involved 494 AIS patients (aged 9-17 years) and 994 sex- and age-matched healthy controls. MVPA and ST were measured using a self-administered questionnaire. Logistic regression models estimated associations between PA, ST, and AIS. Compared to subjects meeting the recommended 60-min daily of MVPA, adolescents reporting daily MVPA time less than 60 min had 1.76 times higher odds of experiencing AIS (95% CI: 1.32-2.35) and adolescents reporting daily MVPA in inactive status had 2.14 times higher odds of experiencing AIS (95% CI: 1.51-3.03). Moreover, participants reporting ST for 2 hours or more had 3.40 times higher odds of AIS compared with those reporting ST less than 2 hours (95% CI: 2.35-4.93). When compared with the adolescents reporting both ST and MVPA meeting the guidelines recommended times (ST < 2 h and MVPA ≥ 60 min/day), those reporting both ST ≥ 2 h and MVPA in inactive status are 8.84 times more likely to develop AIS (95% CI: 3.99-19.61). This study reported that the insufficient MVPA, especially MVPA in inactive status, and excessive ST were risk factors for AIS. Additionally, the joint effects of insufficient MVPA and excessive ST probably increase the risk of AIS.

3D Spine Model Reconstruction Based on RGBD Images of Unclothed Back Surface.

Most 3D spine reconstruction methods require X-ray images as input, which usually leads to high cost and radiation damage. Therefore, these methods are hardly ever applied to large scale scoliosis screening or spine pose monitoring during treatment. We propose a novel, low-cost, easy-to-operate and none-radioactive 3D spine model reconstruction method, which is based on human back surface information without requiring X-ray images as input. Our method fits a pre-built Spine Priors Model (SPrM) to human back surface information and reconstructs the main part of spine with 17 vertebrae: lumbar vertebrae L1-L5 and thoracic vertebrae T1-T12. The Spine Priors Model is constructed according to human spine priors, including Statistical Spine Shape Model (SSSM), Spine Pose Model (SPM) and Spine Biomechanical Simplified Model (SBSM). The spine-related information on back surface, including back surface spinous curve and local symmetry nearby spinous curve is extracted from the RGBD images of human back surface. We formulate the spine optimization constraints from spine-related feature on back surface and spine priors, then optimize the spine model by gradient descent to get the optimal personalized shape parameters and pose parameters of the Spine Priors Model (SPrM). We assess our reconstruction by scoliosis Cobb angle error, and the result is comparable to current X-ray based methods.

Regional disparity in epidemiological characteristics of adolescent scoliosis in China: Data from a screening program.

We investigated regional disparities in rates of scoliosis among adolescents in western and eastern China and the dominant factors underlying these disparities. This cross-sectional study used data from a school scoliosis screening program conducted in two typical areas: Yangpu District of Shanghai (eastern China) and Tianzhu Tibetan Autonomous County of Gansu Province (western China), during October 2020 to February 2021. Participants included adolescents aged 12-16 years (4,240 in Shanghai and 2,510 in Gansu Province). School scoliosis screening data were obtained on age, sex, height, weight and BMI, and region as well. We screened angles of trunk rotation in level of proximal thoracic (T1-T4), main thoracic (T5-T12), and lumbar (T12-L4) by the forward bend test with scoliometer. An angle of trunk rotation ≥5° was used as the criterion to identify suspected scoliosis. The proportion of suspected scoliosis was lower in Shanghai (6.9%) than in Gansu (8.6%). Angle of trunk rotation tended to increase with age in Shanghai, peaking at 15 years, but decreased with age in Gansu, and bottomed at 15 years. The angle of trunk rotation in the proximal thoracic, main thoracic, and lumbar part of the spine appeared to be larger in Gansu adolescents and in Shanghai female adolescents. Age was a relevant factor in angle trunk rotation in regression models and interacted with region as well. We found regional and age- and sex-related disparities in rates of suspected scoliosis.

Postural habits and lifestyle factors associated with adolescent idiopathic scoliosis (AIS) in China: results from a big case–control study

BackgroundAdolescent idiopathic scoliosis (AIS) is the most prevalent type of scoliosis affecting children between the ages of 10–16 years. However, risk factors for AIS, particularly the modifiable ones, are still largely unknown. This study aims to investigate the associations of lifestyle and social environment factors with AIS in Chinese schoolchildren.MethodsThis is a matched case–control study based on survey data collected from school-based scoliosis screening program. We used conditional logistic regression models to describe the relative risk of AIS incidence for each variable in the analyses. To examine the independent effect of each factor on developing AIS, a multivariate conditional logistic regression was conducted and odds ratios (ORs) were adjusted for age and other significant variables.ResultsOverall, 2538 participants from 49 schools were included in this study, comprising 1269 AIS cases and 1269 controls. Mean age of the study population was 13.4 years ± 1.06 (range 10–18). One thousand five hundred and fifty (61.1%) of the study subjects were girls. After adjusting for other significant factors, inappropriate desk heights, either too low (OR = 1.40, 95% CI 1.04–1.90) or too high (OR = 1.61, 95% CI 1.09–2.38), standing with anterior pelvic tilt (OR = 2.73, 95% CI 1.41–5.28), and sleeping on the right side (OR = 1.38, 95% CI 1.00–1.91), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.69 (95% CI 0.50–0.96) for sitting normally, and 0.72 (95% CI 0.53–0.98) for sitting positions change.ConclusionsThis is the first study to address the associations between desk heights and AIS and showed inappropriate desk heights were related to increased AIS risks. To protect school children from developing AIS, stakeholders are advised to consider introducing height-adjustable desks in the class, changing students’ sitting positions in the classroom on a regular basis, and implementing educational programs to help students maintain correct sitting postures.

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.

Screening for adolecent idiopathic scoliosis: A literature review

BACKGROUND: Despite more than 60 years of screening for adolescent idiopathic scoliosis, it is still a controversial issue in the scientific literature. There are both opponents and supporters of the intervention, represented by government agencies, medical organizations, and individual researchers. Several countries have rejected national scoliosis screening, although some medical associations in these countries believe that screening based on the Medical Home model is feasible. By contrast, school-based scoliosis screening has been implemented nationally in a few countries. Given the lack of consensus on this issue, it is useful to systematize conflicting views on screening for adolescent idiopathic scoliosis.&#x0D; AIM: This study aimed to review publications presenting information on the status of screening for juvenile idiopathic scoliosis to identify unresolved organizational issues.&#x0D; MATERIALS AND METHODS: Data were searched in the open electronic scientific literature databases (eLIBRARY, PubMed, and Cochrane Library) using the following keywords and phrases: scoliosis screening; screening for adolescent idiopathic scoliosis (AIS); school screening for scoliosis; school scoliosis screening program. The depth of the search was 30 years.&#x0D; RESULTS: Arguments for focus on the need for the early detection of AIS through screening in terms of the effectiveness of timely treatment, proven efficacy of conservative treatment of scoliosis, and reduction of surgical interventions among screened adolescents. The arguments against are related to the lack of a unified methodology for screening, high rate of false-positive and false-negative results, unproven effectiveness of screening in reducing the frequency of surgical interventions, economic efficiency, and psychological effect on adolescents and violation of their rights during the event.&#x0D; CONCLUSIONS: Several organizational issues should be addressed with regard to screening. These include the training of staff who conducts the screening and development of a referral and follow-up system. The screening scheme and methods should be unified through the introduction of noninvasive screening methods to standardize the results and their subsequent uniform interpretation. The referral process for further examination should be standardized according to a defined protocol. The development of a special computer program to assist medical decision-making is relevant.

Is Shoulder Imbalance a Useful Parameter in the Screening of Idiopathic Scoliosis? A Preliminary Study.

Objective The present study aims to analyze the use of shoulder imbalance as a parameter for scoliosis screening as well as its relationship with other parameters of physical examination. Methods This study assesses a smartphone application that analyzes several parameters of the physical examination in adolescent idiopathic scoliosis. Medical and non-medical examiners applied the screening tool in students in a public school and in a private sports club. After data collection, interobserver correlation was done to verify shoulder imbalance and to compare shoulder imbalance with Adam's bending test and with trunk rotation. Results Eighty-nine participants were examined, 18 of whom were women and 71 of whom were men. Two subjects were excluded from the analysis. The mean age of subjects from the public school was 11.30 years and, for those from the sports club, it was 11.92 years. The examiners had poor-to-slight interobserver concordance on shoulder asymmetry in the anterior and posterior view. No significant statistical correlation was found between shoulder asymmetry and positive Adam's forward bending test. Conclusion Our preliminary study shows that the shoulder asymmetry has a poor correlation with the Adam's forward bending test and measuring trunk rotation using a scoliometer. Therefore, the use of shoulder imbalance might not be useful for idiopathic scoliosis screening. Level of Evidence III; Diagnostic Study.

Scoliosis among children in Qinghai-Tibetan Plateau of China: A cross-sectional epidemiological study.

BackgroundThe average altitude of Qinghai-Tibetan Plateau is 4,500 m and most of the residents are Tibetan ethnicity. The purpose of this study was to investigate the prevalence of scoliosis and associated factors among children in this region through a scoliosis screening program.MethodsA cross-sectional study was preformed between May 2020 and December 2020 in Qinghai-Tibetan Plateau. A total of 9,856 children aged 6–17 years from schools and nearby villages were screened using visual inspection, the Adams forward-bending test, the angle of trunk rotation, and radiography. A self-designed questionnaire was used to collect demographic data. The prevalence of scoliosis and associated factors were analyzed.ResultsThe overall prevalence of scoliosis among children in Qinghai-Tibetan Plateau was 3.69%, with 5.38% for females and 2.11% for males. The prevalence of scoliosis was 3.50% in children resided below 4,500 m while 5.63% in those resided above 4,500 m (P = 0.001). The prevalence of congenital scoliosis (2.14 vs. 0.42%, P < 0.001) and neuromuscular scoliosis (0.34 vs. 0.07%, P = 0.041) were significantly higher in the altitude above 4,500 m. 50.00% of patients resided above 4,500 m were recommended for surgery while 16.24% in those resided below 4,500 m (P < 0.001). Independent associated factors were detected as female (OR = 2.217, 95 CI% 1.746–2.814, P < 0.001), BMI < 18.5 (OR = 1.767, 95 CI% 1.441–2.430, P = 0.005), altitude of residence ≥ 4,500 m (OR = 1.808, 95 CI% 1.325–2.483, P = 0.002), and sleep time < 8 h (OR = 2.264, 95 CI% 1.723–2.846, P = 0.001).ConclusionThe prevalence of scoliosis among children in Qinghai-Tibetan Plateau was 3.69%. With increasing altitudes, the prevalence of scoliosis and its major type were different from that at lower altitudes. Female, BMI < 18.5, altitude of residence ≥ 4,500 m, and sleep time < 8 h were independently associated with the prevalence of this disease. Early screening should be carried out before the age of 7 years, especially in the high-altitude, underdeveloped, and rural areas.

Parents can reliably and accurately detect trunk asymmetry using an inclinometer smartphone app

PurposeAn inclinometer smartphone application has been developed to enable the measurement of the angle of trunk inclination (ATI) to detect trunk surface asymmetry. The objective was to determine the reliability and validity of the smartphone app in the hands of non-professionals.MethodsThree non-professional observers and one expert surgeon measured maximum ATI twice in a study involving 69 patients seen in the spine clinics to rule out scoliosis or for regular follow-up (10-18 y.o., Cobb [0°-58°]). Observers were parents not familiar with scoliosis screening nor use of an inclinometer. They received training from a 4-minute video. Intra and inter-observer reliability was determined using the generalizability theory and validity was assessed from intraclass correlation coefficients (ICC), agreement with the expert on ATI measurements using Bland-Altman analysis, and correct identification of the threshold for consultation (set to ≥6° ATI).ResultsIntra-observer and inter-observer reliability coefficients were excellent ϕ = 0.92. The standard error of measurement was 1.5° (intra-observer, 2 measurements) meaning that a parent may detect a change of 4° between examinations 95% of the time. Comparison of measurements between non-professionals and the expert resulted in ICC varying from 0.82 [0.71-0.88] to 0.84 [0.74-0.90] and agreement on the decision to consult occurred in 83 to 90% of cases.ConclusionThe use of a smartphone app resulted in excellent reliability, sufficiently low standard error of measurement (SEM) and good validity in the hands of non-professionals. The device and the instructional video are adequate means to allow detection and regular examination of trunk asymmetries by non-professionals.

The Prevalence of Scoliosis Screening Positive and Its Influencing Factors: A School-Based Cross-Sectional Study in Zhejiang Province, China.

ObjectiveEarly detection of scoliosis is of great significance to patients with scoliosis and the whole society. This paper aims to learn the prevalence of scoliosis screening positive among students in primary and secondary schools and to explore the influencing factors.MethodsIn 2019, a stratified cluster sampling technique was employed in this school-based cross-sectional study. The sampling covers all prefecture-level cities in Zhejiang Province. Based on the whole class, at least 80 students in each grade of primary school, junior high school, and senior high school were selected. Physical examination and scoliosis screening were performed in the school-based investigation. The distribution of demographic characteristics and nutritional status of children and adolescents with scoliosis screening positive were explored.ResultsA total of 45,547 students were screened. The overall prevalence of children and adolescents with scoliosis screening positive were 3.9%. Higher prevalence of scoliosis screening positive was found in students living in urban area (4.1%), women students (4.1%), students with low weight (5.3%) (p < 0.05), and the prevalence increased with age (p < 0.05). In logistic analysis, we found age (OR = 1.145; 95% Cis: 1.128, 1.162), gender (OR = 1.118; 95% Cis: 1.016, 1.230) and low weight (OR = 1.48; 95% Cis: 1.25, 1.751) were the influencing factors for prevalence of scoliosis screening positive (p < 0.05).ConclusionsThere were no disparities between living areas, but there was a significant difference between genders, among different ages, and among different nutritional statuses of children and adolescents with or without scoliosis screening positive. In multi-analysis, age, gender, and low weight were the influencing factors for the prevalence of scoliosis screening positive. Age and gender-specific scoliosis screening strategies and nutritional public health policies for children and adolescents are needed.