Scoliosis Screening Research Articles

MGScoliosis: Multi-grained scoliosis detection with joint ordinal regression from natural image

Scoliosis is among the most prevalent diseases affecting teenagers. However, traditional scoliosis screening methods often resort to physical examination or radiographic imaging. The two ways both rely on experts with high costs, which are not suitable for wide-range screening. Besides, estimating Cobb angle level only using natural images are challenging. To tackle these issues, we propose a multi-grained scoliosis detection framework by jointly estimating severity level and Cobb angle level of scoliosis from a natural image instead of a radiographic image, which has not been explored before. Specifically, we regard scoliosis estimation as an ordinal regression problem, and transform it into a series of binary classification sub-problems. Besides, we adopt the visual attention network with large kernel attention as the backbone for feature learning, which can model local and global correlations with efficient computations. The feature learning and the ordinal regression is put into an end-to-end framework, in which the two tasks of scoliosis severity level estimation and scoliosis angle level estimation are jointly learned and can contribute to each other. Extensive experiments demonstrate that our approach outperforms state-of-the-art methods as well as human performance, which provides a promising and economical solution to wide-range scoliosis screening. Particularly, our approach achieves accuracies of 94.90% and 79.62% in estimating severity level and Cobb angle level, improving large margins of 4.90% and 12.15% over existing natural image based scoliosis detection performance, respectively. The code is available at https://github.com/RuiChen-stack/MGScoliosis.

Association between Changes in Menarcheal Age and Adolescent Idiopathic Scoliosis: An Analysis of 38,879 Patients over 20 Years.

Menarche has a significant impact on the progression of adolescent idiopathic scoliosis (AIS); however, studies in this area are insufficient. This study used large-scale school screening data to investigate the relationship between menarcheal age and AIS, especially the severity of scoliosis. Of 2,326,577 students who participated in school screening for scoliosis (SSS) in South Korea from 2001 to 2021, 38,879 girls with AIS, who experienced menarche, were included. Data including the patient's demographics, such as menarcheal age, Cobb angle, Risser stage, and the interval between menarche and the time of screening were retrieved from the SSS database. Pearson correlation coefficient was used to identify the changes in menarcheal age according to the birth year and to investigate the relationship between menarcheal age and each variable of interest. Based on the birth year, the mean menarcheal ages in girls with AIS from 1988 to 2008 demonstrated a steadily decreasing trend over time (r = -0.857, p < 0.001). Girls with AIS and late menarche demonstrated a higher Cobb angle at the time of screening (r = 0.095, p < 0.001). Other variables did not significantly correlate with menarcheal age. Based on the SSS, a large-scale school screening dataset, menarcheal age in girls with AIS demonstrated an ongoing downward trend in the recent 20 years in South Korea. Notably, girls with AIS and late menarche had a higher Cobb angle at screening. Our findings indicate the need for earlier screening of AIS in girls who have not undergone menarche.

A New Method for Scoliosis Screening Incorporating Deep Learning With Back Images.

Retrospective observational study. Scoliosis is commonly observed in adolescents, with a world0wide prevalence of 0.5%. It is prone to be overlooked by parents during its early stages, as it often lacks overt characteristics. As a result, many individuals are not aware that they may have scoliosis until the symptoms become quite severe, significantly affecting the physical and mental well-being of patients. Traditional screening methods for scoliosis demand significant physician effort and require unnecessary radiography exposure; thus, implementing large-scale screening is challenging. The application of deep learning algorithms has the potential to reduce unnecessary radiation risks as well as the costs of scoliosis screening. The data of 247 scoliosis patients observed between 2008 and 2021 were used for training. The dataset included frontal, lateral, and back upright images as well as X-ray images obtained during the same period. We proposed and validated deep learning algorithms for automated scoliosis screening using upright back images. The overall process involved the localization of the back region of interest (ROI), spinal region segmentation, and Cobb angle measurements. The results indicated that the accuracy of the Cobb angle measurement was superior to that of the traditional human visual recognition method, providing a concise and convenient scoliosis screening capability without causing any harm to the human body. The method was automated, accurate, concise, and convenient. It is potentially applicable to a wide range of screening methods for the detection of early scoliosis.

The back body temperatures of patients with idiopathic scoliosis measured through exercise.

Aerobic exercise is closely associated with the vital functions of patients with scoliosis. Infrared thermography (IRT) has been increasingly applied in physiological measurements in recent years. This observational study aimed to use IRT to examine the back body surface temperatures of patients with idiopathic scoliosis during aerobic exercise. Forty-two participants who completed a pre-test were divided into a scoliotic group and a non-scoliotic group. Both groups completed a 30-minute cycling exercise, during which their back body temperature was measured using IRT, and the root-mean-square of the back electromyography value after 30minutes of aerobic exercise was analyzed. The back body temperature decreased significantly after 30minutes of exercise in the non-scoliotic group. In contrast, the back body temperature (at the trapezius and quadratus lumborum muscles) was asymmetric or increased after exercise in the scoliotic group. These findings suggest that when patients with scoliosis exercise, their back body temperature should be assessed thoroughly to prevent adverse physiological reactions potentially caused by back body temperature imbalances as well as the potential health problems caused by poor heat dissipation. In addition, such observations can be useful in the early screening of scoliosis.

Poorer clinical outcomes after THA in patients with a spinal scoliotic deformity: a case-control study of 268 patients assessed with PROMS

IntroductionSpinal deformities can lead to specific complications after total hip arthroplasty (THA), such as functional leg length discrepancy due to a fixed pelvic obliquity, as well as an increased risk of prosthetic instability due to a lack of adaptive pelvic mobility, but these issues were not investigated in large comparative series. Therefore a retrospective case-control study was done aiming: 1) to analyze the impact of a preoperative scoliotic deformity on the functional outcomes of patients who underwent THA with a minimum 1-year follow-up, 2) to measure the prevalence of scoliosis in both the case and control groups 3) to screen other factors that may be correlated with poorer clinical outcomes in patients who underwent THA, including age, gender, Body Mass index (BMI), American Society of Anesthesiologists (ASA) score, primary THA etiology and postoperative complication occurrence. HypothesisThe presence of scoliosis would have a negative impact on THA outcomes as assessed by PROMs. Materials and methodsA case-control study was conducted using prospectively collected data including 268 patients who underwent THA between January 2009 and December 2021 through a direct anterior approach by the same senior surgeon. Cases were identified based on a 1-year follow-up modified Harris Hip score (mHHS) lower than 81 while controls were defined as patients with an excellent 1-year follow-up mHHS score (equal to or higher than 81). Three controls were randomly matched with each case based on the surgery period. To assess the impact of a concurrent scoliosis on clinical outcomes, a mathematical univariate and multivariate logistic model was used, including other confounding factors (age, gender, ASA score, BMI, Complication occurrence, etiology), to calculate the adjusted odds-ratio. ResultsIn the multivariate analysis, scoliosis was found to be a significant risk factor, with a three-fold higher adjusted odds-ratio of lower mHHS score (adjOR = 3.1; 95 CI:1.4–7, [p < 0.01]). The mean mHHS score was significantly lower in the scoliosis group compared to the non-scoliosis group (77 vs. 84 [p = 0.01]) as well as the mean Oxford Hip Score (36 vs. 43 [p < 0.001]). Among the other assessed risk factors, only the occurence of a postoperative complication was associated with an increased odds ratio of poorer mHHS scores (adjOR = 7.1; 95 CI: 2.78–18.24, [p < 0.001]). The prevalence of scoliosis in our practice was 19%. Discussion: Given the prevalence of 19% found in our study, we recommend screening for scoliosis in all patients scheduled for THA. Our results indicate that patients who had scoliosis experienced lower PROMs scores compared to those who had not. Surgeons should consider delivering this information to patients who have scoliosis undergoing THA to mitigate patient dissatisfaction. Level of evidenceIII; retrospective case-control study.

Early-onset scoliosis in children aged 4-7 years in Nanjing, China: A cross-sectional study.

This study aimed to investigate the potential variance in the prevalence of early-onset scoliosis among children aged 4-7 years and analyze the influencing factors. The goal was to establish a crucial reference point for monitoring and evaluating spinal curvature development in preschoolers, ultimately to reduce the occurrence of adverse health outcomes. Children aged 4-7 years within the main urban area of Nanjing were selected using a stratified random sampling method. A team of four senior therapists conducted screenings for spinal curvature among children using visual inspection, the Adams forward bending test, and an electronic scoliometer to measure the angle of trunk rotation (ATR) and identify children displaying signs of scoliosis. Children with suspected scoliosis in the initial screening underwent X-ray Cobb angle assessment for confirmation. The prevalence of early-onset scoliosis was then determined from the screening results. R version 4.2.0 software was used to analyze the factors associated with scoliosis among children using partial least squares structural equation modeling. A total of 2281 children were included in this study, consisting of 1211 boys and 1070 girls, with a mean age of 5.44 ± 0.81 years (ranging from 4 to 7 years). Among them, 7.58% exhibited positive signs of scoliosis, 5.87% had early-onset scoliosis, and the positive predictive value was 77.5%. Significant differences in ATR were observed among children in different age groups (Kruskal-Wallis = 15, p = 0.0104) and by sex (t = 3.17, p = 0.00153). Significant variations in ATR were noted in children with scoliosis (t = -22.7, p < 0.001), with a cutoff at ATR = 4.5°, and auxiliary values of 0.947 and 0.990. Children diagnosed with early-onset scoliosis generally exhibited lower body mass index values, with a statistically significant difference (t = 2.99, p = 0.003). Using visual inspection, the Adams test, and an electronic scoliometer to measure the ATR, the present triad method is more sensitive for early scoliosis screening in children with abnormal posture aged 4-7 years. A full spine X-ray is advised in children with an ATR over 4.5° and poor posture.

Association between incorrect postures and curve magnitude of adolescent idiopathic scoliosis in china

BackgroundDespite advancements in school scoliosis screening (SSS), there are still no effective indicators to estimate the severity of spinal curvature. We aim to investigate the association between incorrect postures and curve magnitude of adolescent idiopathic scoliosis (AIS) among Chinese adolescents.MethodsIn this SSS program, we examined the incorrect posture, Adam’s forward bending test (FBT) results, and angle of trunk rotation (ATR) in adolescents. Those with suspected scoliosis were referred for a standing anteroposterior whole-spine radiography as outpatients. The radiographic data of 426 students with lateral Cobb angles were collected from 2016 to 2022 and the associations were studied using logistic regression (LR) models and receiver operating characteristic (ROC) curves.ResultsUnivariate LR revealed that female gender [odds ratio (OR) = 2.92, 95% confidence interval (CI) 1.67–5.09, P < 0.001], age 16–19y (OR = 2.83, 95%CI 1.10–7.28, P = 0.031), right shoulder height (OR = 2.15, 95%CI 1.23–3.75, P = 0.007), right scapula tilt (OR = 2.03, 95%CI 1.18–3.50, P = 0.010), right rib hump (OR = 1.88, 95%CI 1.23–2.85, P = 0.003), right thoracic rotation ≥ 5° (OR = 2.14, 95%CI 1.43–3.20, P < 0.001), and left thoracolumbar kyphosis (OR = 3.79, 95%CI 1.06–13.56, P = 0.041) were all significantly associated with the severity of the curve magnitude. Multivariate LR showed that female gender [adjusted OR (AOR) = 3.23, 95%CI 1.81–5.73, P < 0.001], those aged 16–19y (AOR = 5.08, 95%CI 1.86–13.91, P = 0.002), and with a right rib hump (AOR = 1.72, 95%CI 1.11–2.64, P = 0.015) presented with a higher risk of severe curve magnitude than men, those aged 7–12y, and without a rib hump, respectively. ROC curves further proved that sex, age, shoulder-height difference, scapula tilt, flat back, rib hump, angle of thoracic rotation were the risk predictors for curve magnitude.ConclusionIncorrect posture and ATR, especially the right rib hump, were significantly associated with the curve magnitude of AIS. Early screening for incorrect postures and ATR could be an effective and economical strategy to predict the severity of AIS through SSS in Chinese adolescents.

Prevalence and plasma exosome-derive microRNA diagnostic biomarker screening of adolescent idiopathic scoliosis in Yunnan Province, China.

Idiopathic scoliosis significantly affects the physical and mental health of children and adolescents, with varying prevalence rates in different regions. The occurrence of idiopathic scoliosis is associated with genetic regulation and biochemical factors, but the changes in exosome-derived miRNA profiles among idiopathic scoliosis patients remain unclear. This study aimed to determine the prevalence of idiopathic scoliosis in Yunnan Province, China, and identify key exosome-derived miRNAs in idiopathic scoliosis through a cohort study. From January 2018 to December 2020, a cross-sectional study on idiopathic scoliosis in children and adolescents was conducted in Yunnan Province. A total of 84,460 students from 13 cities and counties in Yunnan Province participated in a scoliosis screening program, with ages ranging from 7 to 19 years. After confirmation through screening and imaging results, patients with severe idiopathic scoliosis and normal control individuals were selected using propensity matching. Subsequently, plasma exosome-derived miRNA sequencing and RT-qPCR validation were performed separately. Based on the validation results, diagnostic performance analysis and target gene prediction were conducted for differential plasma exosome-derived miRNAs. The overall prevalence of idiopathic scoliosis in children and adolescents in Yunnan Province was 1.10%, with a prevalence of 0.87% in males and 1.32% in females. The peak prevalence was observed at age 13. Among patients diagnosed with idiopathic scoliosis, approximately 12.8% had severe cases, and there were more cases of double curvature than of single curvature, with thoracolumbar curvature being the most common in the single-curvature group. Sequencing of plasma exosome-derived miRNAs associated with idiopathic scoliosis revealed 56 upregulated and 153 downregulated miRNAs. Further validation analysis confirmed that hsa-miR-27a-5p, hsa-miR-539-5p, and hsa-miR-1246 have potential diagnostic value. We gained insights into the epidemiological characteristics of idiopathic scoliosis in Yunnan Province and conducted further analysis of plasma exosome-derived miRNA changes in patients with severe idiopathic scoliosis. This study has provided new insights for the prevention and diagnosis of idiopathic scoliosis, paving the way for exploring clinical biomarkers and molecular regulatory mechanisms. However, further validation and elucidation of the detailed biological mechanisms underlying these findings will be required in the future.

The Prevalence of Scoliosis after Fontan Circulation Surgery Followed-Up to Adolescence.

The advancement of surgical techniques and perioperative management for congenital heart disease (CHD) has increased life expectancy. The surgical creation of the Fontan circulation maintains pulmonary blood flow without relying on an effective pump from the abnormal heart, relying on peripheral vascular resistance to maintain effective flow through the lungs. Unfortunately, this delicate mechanism is compromised when scoliosis restricts ventilation, leading to Fontan failure and a poor prognosis for life. This report describes the prevalence of scoliosis with Fontan completion surgery and the role of screening and surgical correction. Ninety-six consecutive Japanese patients undergoing Fontan completion surgery for CHD between 2000 and 2017 were identified in our institutional records. The inclusion criterion was at least 7 years of follow-up after Fontan completion surgery, while the exclusion criteria were congenital, syndromic, and neuromuscular scoliosis. Radiographic and clinical parameters, including cardio-thoracic ratio (CTR) for cardiomegaly and cyanosis saturation, were compared between with and without scoliosis. There were 23 and 40 patients in the scoliosis and no scoliosis groups, respectively. The mean age at the final follow-up was 18.5 and 16.7 years in the scoliosis and no scoliosis groups, respectively (p=0.02). Mean CTR was 43.7% and 39.4% in the scoliosis and no scoliosis groups (p=0.016), and the mean saturation in room air at the final follow-up was 88.8% and 93.2%, respectively (p=0.036). There were no significant differences to clarify the risk factors with multivariate logistic regression analysis. The prevalence of scoliosis with Fontan completion surgery was 36.5%. Screening for scoliosis is important for children with Fontan circulation surgery as part of their routine follow-up at least until they reach adolescence.

School Screening for Idiopathic Scoliosis

School Screening for Idiopathic Scoliosis

Automatic Assessment of Ultrasound Curvature Angle for Scoliosis Detection Using 3-D Ultrasound Volume Projection Imaging

Scoliosis is a spinal deformation in which the spine takes a lateral curvature, generating an angle in the coronal plane. The conventional method for detecting scoliosis is measurement of the Cobb angle in spine images obtained by anterior X-ray scanning. Ultrasound imaging of the spine is found to be less ionising than traditional radiographic modalities. For posterior ultrasound scanning, alternate indices of the spinous process angle (SPA) and ultrasound curve angle (UCA) were developed and have proven comparable to those of the traditional Cobb angle. In SPA, the measurements are made using the spinous processes as an anatomical reference, leading to an underestimation of the traditionally used Cobb angles. Alternatively, in UCA, more lateral features of the spine are employed for measurement of the main thoracic and thoracolumbar angles; however, clear identification of bony features is required. The current practice of UCA angle measurement is manual. This research attempts to automate the process so that the errors related to human intervention can be avoided and the scalability of ultrasound scoliosis diagnosis can be improved. The key objective is to develop an automatic scoliosis diagnosis system using 3-D ultrasound imaging. The novel diagnosis system is a three-step process: (i) finding the ultrasound spine image with the most visible lateral features using the convolutional RankNet algorithm; (ii) segmenting the bony features from the noisy ultrasound images using joint spine segmentation and noise removal; and (iii) calculating the UCA automatically using a newly developed centroid pairing and inscribed rectangle slope method. The proposed method was evaluated on 109 patients with scoliosis of different severity. The results obtained had a good correlation with manually measured UCAs (R2=0.9784 for the main thoracic angle andR2=0.9671 for the thoracolumbar angle) and a clinically acceptable mean absolute difference of the main thoracic angle (2.82 ± 2.67°) and thoracolumbar angle (3.34 ± 2.83°). The proposed method establishes a very promising approach for enabling the applications of economic 3-D ultrasound volume projection imaging for mass screening of scoliosis.

School Scoliosis Screening: The Influence of Dominant Limbs and Gender

This study aimed to examine whether (a) there is an association of the dominant hand (DH) and leg (DL) with the side of the primary angle of trunk rotation (ATR A) and (b) there are any differences between boys and girls in the degree of the angle of trunk rotation (ATR) and the dominant hand and leg. One thousand sixty-five (age: 14 ± 3 years; height: 162 ± 13 cm; weight: 56 ± 18.7 kg; BMI: 21.18 ± 5.07) secondary school children participated in this study. Of the participants, 52.5% (n = 559) were male students (age: 14 ± 2 years; height: 166 ± 16 cm; weight: 58.7 ± 22.6 kg; BMI: 21.41 ± 5.61), and 47.5% (n = 506) were female students (age: 14 ± 3 years; height: 159.5 ± 8.5 cm; weight: 53.9 ± 14.8 kg; BMI: 21.03 ± 4.38). The ATR was measured with a scoliometer. Boys were taller and heavier (p = 0.001) and had more left DLs (p = 0.039) than girls. Girls were biologically more mature (p = 0.002), also having higher measurements for the ATR A (p = 0.004) and secondary angle of trunk rotation (ATR B) (p = 0.023) degrees compared to boys. In the general sample, only in boys, there was a significant association between the DH (p = 0.012) and DL (p = 0.001) with the ATR A side. Also, within the scoliotic group, only in boys, there was a significant association between the DH (p = 0.048) and DL (p = 0.024) with the ATR A. In conclusion, girls had higher measurements for the ATR than boys, but cross laterality was found only in boys. The results suggest different progression patterns of ATR between genders during their growth. Future research should focus on examining other possible progression mechanisms.

Advanced Camera-Based Scoliosis Screening via Deep Learning Detection and Fusion of Trunk, Limb, and Skeleton Features.

Scoliosis significantly impacts quality of life, highlighting the need for effective early scoliosis screening (SS) and intervention. However, current SS methods often involve physical contact, undressing, or radiation exposure. This study introduces an innovative, non-invasive SS approach utilizing a monocular RGB camera that eliminates the need for undressing, sensor attachment, and radiation exposure. We introduce a novel approach that employs Parameterized Human 3D Reconstruction (PH3DR) to reconstruct 3D human models, thereby effectively eliminating clothing obstructions, seamlessly integrated with an ISANet segmentation network, which has been enhanced by Multi-Scale Fusion Attention (MSFA) module we proposed for facilitating the segmentation of distinct human trunk and limb features (HTLF), capturing body surface asymmetries related to scoliosis. Additionally, we propose a Swin Transformer-enhanced CMU-Pose to extract human skeleton features (HSF), identifying skeletal asymmetries crucial for SS. Finally, we develop a fusion model that integrates the HTLF and HSF, combining surface morphology and skeletal features to improve the precision of SS. The experiments demonstrated that PH3DR and MSFA significantly improved the segmentation and extraction of HTLF, whereas ST-based CMU-Pose substantially enhanced the extraction of HSF. Our final model achieved a comparable F1 (0.895 ±0.014) to the best-performing baseline model, with only 0.79% of the parameters and 1.64% of the FLOPs, achieving 36 FPS-significantly higher than the best-performing baseline model (10 FPS). Moreover, our model outperformed two spine surgeons, one less experienced and the other moderately experienced. With its patient-friendly, privacy-preserving, and easily deployable solution, this approach is particularly well-suited for early SS and routine monitoring.

Scoliosis as a clinical and social problem: case study

This is a case study of a 7-year-old boy with thoracolumbar scoliosis. An examination revealed trunk, shoulder and scapular asymmetry, pelvic obliquity, head and shoulder protraction, and reduced flexibility of the paraspinal and pelvic muscles. The child underwent a 1-year rehabilitation programme according to the Functional Individual Therapy of Scoliosis (FITS) method and three-plane manual therapy of foot defects as well as scoliotic curve correction with asymmetric exercises and the use of Thera-Band. After one year of rehabilitation, a physical and radiographic examination showed a considerable reduction in the Cobb angle as well as the angle of trunk rotation. Regular scoliosis screening should be offered to children and adolescents in kindergartens and schools.

Deep learning prediction of curve severity from rasterstereographic back images in adolescent idiopathic scoliosis.

Radiation-free systems based on dorsal surface topography can potentially represent an alternative to radiographic examination for early screening of scoliosis, based on the ability of recognizing the presence of deformity or classifying its severity. This study aims to assess the effectiveness of a deep learning model based on convolutional neural networks in directly predicting the Cobb angle from rasterstereographic images of the back surface in subjects with adolescent idiopathic scoliosis. Two datasets, comprising a total of 900 individuals, were utilized for model training (720 samples) and testing (180). Rasterstereographic scans were performed using the Formetric4D device. The true Cobb angle was obtained from radiographic examination. The best model configuration was identified by comparing different network architectures and hyperparameters through cross-validation in the training set. The performance of the developed model in predicting the Cobb angle was assessed on the test set. The accuracy in classifying scoliosis severity (non-scoliotic, mild, and moderate category) based on Cobb angle was evaluated as well. The mean absolute error in predicting the Cobb angle was 6.1° ± 5.0°. Moderate correlation (r = 0.68) and a root-mean-square error of 8° between the predicted and true values was reported. The overall accuracy in classifying scoliosis severity was 59%. Despite some improvement over previous approaches that relied on spine shape reconstruction, the performance of the present fully automatic application is below that of radiographic evaluation performed by human operators. The study confirms that rasterstereography cannot be considered a valid non-invasive alternative to radiographic examination for clinical purposes.

Assessment of idiopathic scoliosis among adolescents and associated factors in Palestine

PurposeThis study aimed to investigate adolescent idiopathic scoliosis (AIS) and its related risk factors, including body mass index (BMI), physical activity (PA), gender, time of the first menstrual cycle, transportation, backpack weight and the way of carrying a backpack. Design and methoda cross-sectional quantitative design was utilized. A convenient sample of adolescent students in grades seven through ten was included in the study. A self-reported questionnaire with three sections: demographic data; physical data including height, weight and PA; and Adam's forward bend test to determine each student's spine's Cobb angle by measuring the angle of trunk rotation using a scoliometer. The data were analyzed using SPSS version 25, with confidence intervals of 95%. ResultsA total of 820 schoolchildren participated in the study; 53.7% were female and 46.3% were male. Only 22% of these students engaged in vigorous exercise, compared to 36.7% who engaged in low PA; additionally, 10% of the adolescents had a low BMI. After the analysis, it was found that 5.4% of participants had AIS. Low PA (p = 0.001), being underweight (p = 0.038), and time of first menstrual period (p = 0.033) were significantly associated with AIS, while gender, backpack weight, and way of carrying were not statistically related to AIS. Binary logistic regression identified low PA as an independent predictor of AIS (OR = 7.22, 95%CI [1.64, 31.79]). ConclusionsThe frequency of AIS in Palestine was significant, which highlighted the importance of this issue at a national and global level. There was an association between AIS and BMI, PA, and the time of the first menstrual cycle, which signifies the importance of early detection of the problem to limit its burden later in life. Practice implicationsTeachers, teenagers, and their parents should be provided with programs that educate and clarify AIS, and a specific protocol should be established for scoliosis screening in schools.

Prevalence angle of trunk rotation in adolescents: a study from an idiopathic scoliosis school screening in Surabaya

Link of Video Abstract: https://youtu.be/GtRgpMD7tsM Background: Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis. The condition begins in early puberty, affects 1-3% of adolescents, and randomly affects young women. Scoliosis screening is still a hot topic discussed by various researchers, especially in the school child population, and it is still an important preventive program to reduce the progression of spinal deformity. This study aims to determine the prevalence rate angle of trunk rotation in idiopathic scoliosis school screening in Surabaya. Methods: This research is a cross-sectional study with a descriptive observational type using surveys and examinations. In this study, the sample used was 405 junior high school students in Surabaya. The sampling method is cluster random sampling, where each member of the population is divided into subclasses with the school as the cluster. Samples were randomly selected from each area of Surabaya. Data were analyzed using SPSS version 25.0 for Windows. Results: These data found that the age distribution of the scoliosis screening study was an average of 13.87 years and a median of 14 years. The gender distribution of the scoliosis screening study sample was more female, 211 samples (52.1%) compared to men, 194 samples (47.9%). The distribution was obtained from 405 total samples; 2 positive samples were obtained during the Adam's Forward Bend Test, both 14 years old and female. On examination with a scoliometer, both showed 9 and 11 degrees, respectively. The prevalence angle of trunk rotation in idiopathic scoliosis school screening in Surabaya was 0.49%. Conclusion: This figure is lower than several studies conducted in several other countries. This may be obtained due to differences in the number of research samples undertaken in each country.

Scoliosis school screening of 139,922 multi-ethnic children in Dali, southwestern China: A large epidemiological study

Idiopathic scoliosis (IS) primarily impacts adolescents and requires early intervention to prevent deformity. Early diagnosis and prediction of spine curvature in children could be aided by school scoliosis screening (SSS). In the Dali Bai Autonomous Prefecture, SSS, including 139,922 children from 18 ethnic groups in 8 counties ranging in age from 6 to 18, was carried out. A medical team conducted the screening with inspection, Adam's test, and angles of trunk rotation (ATR). The overall prevalence of suspected scoliosis was 2.37%, with girls (2.5%) more affected than boys (2.0%). Using penalized regression analysis of LASSO, the variable-selection process was conducted to determine the final regression model. The results showed that age, gender, height, BMI, altitude, latitude, ethnicity, and county were all influencing variables for suspected scoliosis, according to the adjusted final model of multi-factor regression analysis. These results provide substantial information and suggestions for preventative and person-centered healthcare interventions for IS.

Pathogenesis and Intervention Study of Idiopathic Scoliosis in Elementary and Middle School Students

Scoliosis, also known as lateral curvature of the spine or spinal lateral deviation, is a three-dimensional spinal deformity characterized by the bending of one or multiple segments of the spine to the side accompanied by vertebral rotation. It appears in the shape of an "S" or "C" and can cause pain during standing, walking, or lifting heavy objects, leading to a reduction in physical activity. Scoliosis is the most common spinal disorder among children and adolescents. Adolescent Idiopathic Scoliosis (AIS) refers to scoliosis that occurs during the teenage years and its etiology remains unclear. AIS is a spinal condition characterized by a three-dimensional deformity in the coronal, sagittal, and axial planes, with a Cobb angle of 10 degrees or more. The global prevalence of AIS ranges from 0.47% to 5.2% (Erwin et al., 2020; Konieczny et al., 2013). According to a study by Qiu Guixing et al., the prevalence of scoliosis in China is estimated to be approximately 0.6% to 2.0%, with 90% of cases being AIS. Jia Juanjuan et al., conducted a scoliosis screening of 8,026 students in Jiaxing City in 2019, with initial screening identifying 218 positive cases. Among them, 132 cases were confirmed through X-ray examination, estimating a scoliosis prevalence rate of 5.46% among primary and secondary school students in Jiaxing City. Chen Xiaosheng, Ru Shouhang et al., conducted a scoliosis survey among students from the fourth grade of primary school to the second grade of high school in various districts of Shenzhen City from January to December 2020, with the results showing a scoliosis prevalence rate of 5.01% among primary and secondary school students in Shenzhen City. The prevalence rate was higher in females than males and increased with age. If scoliosis in adolescents is not promptly and effectively treated during their growth process, the spinal deformity can rapidly progress and lead to various complications. For example, scoliosis can cause changes in the shape of the ribs, resulting in unequal thoracic cavity volume and breathing difficulties. Prolonged restricted breathing can lead to complications such as chest tightness and shortness of breath. Additionally, scoliosis can affect the functioning of abdominal organs, leading to pulmonary dysfunction and hypoxia, and in severe cases, it can cause cardiorespiratory failure. Furthermore, scoliosis not only affects the physical health of patients but also their mental well-being. The physical appearance changes caused by scoliosis deformity can potentially lead to psychological disorders.

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.