Screening For Adolescent Idiopathic Scoliosis Research Articles

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.

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.

Non-Invasive Assessment of Back Surface Topography: Technologies, Techniques and Clinical Utility.

(1) Background: Frequent exposure to ionising radiation is often used to determine the diagnosis of adolescent idiopathic scoliosis (AIS), a lateral curvature of the spine in those aged between 10 and 18 years, and a treatment plan according to Cobb angle. This narrative review outlines the clinical utility of surface topography (ST), a radiation-free imaging modality. (2) Methods: Publicly available databases were searched to yield literature related to ST. Identified articles were classified based on the equipment used and in order of how it was developed, i.e., historical, recent developments, and state-of-the-art developments. (3) Conclusions: ST is a reliable cost-effective non-invasive technique that provides an alternative to radiation-based imaging to aid with the diagnosis and potential screening of AIS. Several scanning methods are available, which allows ST to be used in several clinical environments. Limitations of inter-reliability and differences of apparatus resulting in variations of data have been noted through this narrative review.

A targeted antibody-based array reveals a serum protein signature as biomarker for adolescent idiopathic scoliosis patients

BackgroundEvident adolescent idiopathic scoliosis (AIS) incurs high treatment costs, low quality of life, and many complications. Early screening of AIS is essential to avoid progressing to an evident stage. However, there is no valid serum biomarker for AIS for early screening.MethodsAntibody-based array is a large-scale study of proteins, which is expected to reveal a serum protein signature as biomarker for AIS. There are two segments of the research, including biomarkers screening and validation. In the biomarkers screening group, a total of 16 volunteers participated in this study, and we carried out differentially expressed proteins screening via protein array assay between No-AIS group and the AIS group, through which GeneSet enrichment analysis was performed. In the validation group with a total of 62 volunteers, the differentially expressed proteins from screening group were verified by Enzyme-Linked immunosorbent assay (ELISA), and then multiple regression analysis.ResultsIn our study, there were twenty-nine differentially expressed proteins in AIS, through Protein array assay and GeneSet enrichment analysis in the biomarkers screening group. Then the expression of FAP, CD23 and B2M decreased as the degree of AIS increased via ELISA in validation group (FAP, p < 0.0001; CD23, p = 0.0002; B2M, p < 0.0001). Further, the results of multiple regression analysis showed that FAP, CD23 are linked to Cobb angle, whereas B2M were excluded because of multicollinearity.ConclusionsAltogether, we found that serum protein FAP and CD23 are intimately related to AIS, suggesting FAP and CD23 are expected to serve as the serum biomarkers, which significantly facilitate frequent longitudinal monitoring as to keep track of disease progression and tailor treatment accordingly.

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.

Idiopathic adolescent scoliosis and obesity: prevalence study.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that affects 5% of the population. This pathology has multiple known etiological factors such as family predisposition, female gender, low body mass index, decrease in lean and fat masses. However, recent studies suggest that ciliary dysfunction could be the origin of certain types of obesity and AIS. This study aims to verify the existence of a link between these two pathologies. A retrospective, cross-sectional, descriptive and monocentric study, based on a cohort of adolescents with obesity treated in a paediatric rehabilitation centre for specific care between 1 January 2010 and 1 January 2019. The prevalence of AIS was calculated by radiographic measurements. The diagnosis of AIS was established if the Cobb angle was ≥ 10°, associated with intervertebral rotation. 196 adolescents with obesity were included in the study (mean age 13.2years, mean BMI 36kg/cm2, gender ratio 2.1 of female to male.) The prevalence of AIS in adolescents with obesity was 12.2%, twice the prevalence of AIS in the general population. The characteristics of AIS in adolescents with obesity are predominantly female, 58.3% left thoracolumbar or lumbar principal curvatures, mean Cobb angle 26° and progressive in 29% of cases. Our study established a correlation between AIS and obesity with a higher prevalence than in the general population. The morphology of these adolescents makes screening for AIS more difficult.

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.

Incidence of radiographic scoliosis in asymptomatic young Pakistani adults.

Background: Adolescent idiopathic scoliosis (AIS) is the most common scoliotic deformity of young adults. Screening of AIS is performed as part of the routine preemployment examination for physically demanding positions. We attempted to establish the incidence of clinically overt scoliosis in an adolescent (16 years old) and young adult (21 years old) population.Methods: We clinically and radiographically (X-rays) evaluated 85 applicants for physically demanding jobs in two age groups: those 16 versus those 21 years of age. Cobb’s angles and kyphosis angles were measured for each group. These data were then categorized into three grades based on radiographically documented scoliotic curvatures.Results: Most 16 years old demonstrated normal Cobb’s angles (90.56%), but kyphosis angles of 20–30° (40.27%). For the 21 years old, most participants had normal Cobb’s angles (93.75%), but exhibited higher than normal kyphosis angles (50%).Conclusion: Most young adults ages 16–21 years applying for physically demanding work were “fit.” However, the incidence of kyphosis was higher among the 21 years old population. Such screening for idiopathic scoliosis should be more stringently performed in younger patients applying for physically demanding work.

Screening for adolescent idiopathic scoliosis is more accurate when performed by healthcare professionals compared to untrained parents: a diagnostic accuracy study.

Many countries ended their professional scoliosis screening due to ongoing controversies. Discontinuation resulted in a shift of screening responsibility from trained healthcare professionals to untrained parents. To compare the diagnostic accuracy of picture-based scoliosis screening between parents and healthcare professionals. In this cross-sectional diagnostic accuracy study, parents and healthcare professionals assessed pictures of 28 children (20 AIS & 8 non-scoliosis). Each child had two photographs (standing position & full-flexion during forward-bending test) that were presented simultaneously. Lumbar and thoracic curves were represented with a range in severity (10 to >40°). The assessors had to answer whether they detected an abnormality that ought to be referred to a specialist. Measures of accuracy were calculated for both groups and various curve severities. All pictures were assessed by 101 parents and 122 healthcare professionals. The sensitivity for detecting scoliosis was significantly lower in untrained parents (63.8%, [95% CI: 61.7-65.9%]) compared to healthcare professionals (73.4%, [95% CI: 71.6-75.2%]; p <0.001), while the specificity was not significantly different (63.6%, [95% CI: 60.2-66.9%] vs. 65.3%, [95% CI: 62.2-68.3%]; p = 0.49). Healthcare professionals consistently recognized the gibbus as a warning sign when referring patients, while untrained parents highlighted various regions, including the spine, gibbus and scapula regions. The sensitivity of screening for scoliosis was significantly lower when it was performed by parents, while the false-positive rate was similar to healthcare professionals. The window of opportunity for conservative treatment may be missed when parents rather than professionals are responsible for screening.

School Scoliosis Screening for Adolescent Idiopathic Scoliosis Comparing Preoperative Patients Referring from Areas with Visual Examination Only Versus Visual Examination and Moiré Testing

School Scoliosis Screening for Adolescent Idiopathic Scoliosis Comparing Preoperative Patients Referring from Areas with Visual Examination Only Versus Visual Examination and Moiré Testing

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

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

Screening for Adolescent Idiopathic Scoliosis is More Accurate When Performed by Healthcare Professionals Compared to Untrained Parents: A Diagnostic Accuracy Study

Background: Many countries ended their professional scoliosis screening due to ongoing controversies. Discontinuation of a screening program results in a shift of screening responsibility from trained healthcare professionals to untrained parents. It is unclear if parents are able to detect scoliosis. Therefore, this study aims to evaluate the diagnostic accuracy of screening when it was performed by untrained parents and compare this with healthcare professionals. Methods: In this cross-sectional study, parents and healthcare professionals were asked to complete a survey with pictures of 28 children (20 AIS & 8 non-scoliosis). Each slide contained two photographs of one child (standing position & full-flexion during forward-bending test). Lumbar and thoracic curves were represented with a range in severity (10 to >40°). Respondents had to answer whether they detected an abnormality that ought to be referred to a specialist. Diagnostic accuracy measures of the screening were calculated for both groups and for various curve severities. Differences were statically tested with the McNemar test. Findings: Digital surveys were completed by 100 untrained parents and 122 healthcare professionals. The sensitivity for recognizing scoliosis was significantly lower in untrained parents (63.8%, [95% CI 61.7-65.9%]) compared to healthcare professionals (73.4%, [95% CI 71.6-75.2%]; p 40°) lumbar curves (Δ18.0%), followed by curves between 30-40° (lumbar curves Δ12.7%; thoracic curves Δ10.5%). Interpretation: The sensitivity of screening was significantly lower when it was performed by parents, while the false positive rate was similar between both groups. This suggests that scoliosis is less frequently detected when parents have the responsibility of screening and that the window of opportunity for conservative treatment may be missed. Trial Registration: The protocol was registered in the Dutch register for clinical trials (NL5777, https://www.trialregister.nl/). Funding Statement: The authors received no specific funding for this work. Declaration of Interests: All authors declare they have no commercial associations that might pose a conflict of interest in relation to the submitted manuscript. Ethics Approval Statement: Approved by the local Medical Ethics Committee (WO 16.017) before initiation. All individuals provided informed consent before participation in the study; both for using the pictures in the survey and for participating in this survey.

Low Body Mass Index for Early Screening of Adolescent Idiopathic Scoliosis: A Comparison Based on Standardized Body Mass Index Classifications

PurposeScoliosis is a common musculoskeletal problem in adolescents. This study aimed to identify the prevalence of adolescent idiopathic scoliosis (AIS) and its associated factors among Korean adolescents. The prevalence of thin individuals among students with AIS was compared based on body mass index (BMI) classifications. MethodsThis study was a secondary data analysis and used the 2016 Korean National Health Examination for School Students data. Data from 16,412 students were analyzed using descriptive statistics, Chi-square tests, and logistic regression analysis. ResultsThe prevalence of AIS was higher in women (3.8%) than in men (1.6%), and a higher school year was a risk factor for AIS in both sexes. In woman adolescents, scoliosis was associated with thinness; however, the risk of AIS was inversely associated with overweight/obesity in both sexes. The prevalence of thin woman students with scoliosis differed based on the criteria used: 3.3% by the World Health Organization criteria and 14.3% by the International Obesity Task Force criteria. ConclusionThe prevalence of thin students with scoliosis could increase by up to four times depending on the BMI criteria. For early screening of thin people at risk of AIS among female students, the criterion of International Obesity Task Force should be used as it is more permissive of thinness. This is also because of the underestimation of AIS prevalence when using the BMI Z score of the World Health Organization cutoff.

Adolescent idiopathic scoliosis screening: Could a school-based assessment protocol be useful for an early diagnosis?

Adolescent idiopathic scoliosis screening still needs a considerable implementation, particularly throughout a school-based assessment protocol. This study aims to evaluate the effectiveness of clinical examinations currently in use for the diagnosis of adolescent idiopathic scoliosis, through a survey carried out in secondary schools to standardize a screening protocol that could be generalized. In their classrooms, the adolescents underwent an idiopathic scoliosis screening through three examinations: Adam's test, axial trunk rotation (ATR) and plumb line. In case of single positivity to one of the three examinations, a column X-ray examination was recommended. The sensitivity and diagnostic specificity of Adam's test or ATR were 56.3% and 92.7%, respectively. The positivity to at least one between ATR or plumb line showed that sensitivity was higher than specificity: 91.3% versus 80.8%; the positivity to at least one between Adams's test or plumb line showed a sensitivity of 95.2% and a specificity of 81.5%. Finally, the positivity to all three examinations showed an increase in specificity (99.7%). Taken together, our findings show that this school-based screening protocol had a very high specificity in early diagnosis of adolescent idiopathic scoliosis.

Relationship Between Intervertebral Disc Morphology and Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is an abnormal 3-dimensional curvature of the spine that appears in youth. In progressive cases, a small curve may be augmented rapidly and leads the victim to a high-risk surgical operation. Recognition of the AIS in the early stage can help in treating it with noninvasive methods. The goal of the study was to examine the relationship between intervertebral disc morphology and AIS as an applicable index and useful method for developing the screening and recognition of AIS before the start of disease. Based on a biomechanical model, we examined the relationship between AIS and intervertebral disc morphology in the thoracic and lumbar region separately and comparatively. For this purpose, the mean disc height (MDH) in the thoracic (MDHT) and lumbar (MDHL) regions and mean ratio of disc height per vertebral radius (MDHPVR) in the thoracic (MDHPVRT) and lumbar (MDHPVRL) regions were compared between 20 girls with AIS and 20 normal girls as the control group by using magnetic resonance imaging. Although there was a significant difference between the AIS and control group in MDHT (P = .004) and MDHPVRT (P = .006), this difference was more significant in the lumbar region (MDHL, P &lt; .0001, and MDHPVRL, P &lt; .0001). According to obtained results, the relation of MDHPVR and scoliosis can be established and used to develop as a screening method for diagnosis and treatment of adolescents who are exposed to scoliosis disorder at an early stage.

Evaluation of Adam's Forward Bend Test and Smartphone Application in Screening of Adolescent Idiopathic Scoliosis

Evaluation of Adam's Forward Bend Test and Smartphone Application in Screening of Adolescent Idiopathic Scoliosis

The end of being a straight child: an autoethnography of coping with adolescent idiopathic scoliosis

Purpose In the field of research on adolescent idiopathic scoliosis, the personal dimension is undervalued. Even the most comprehensive and current recommendations focus on biomedical issues and are entirely based on quantitative studies. Reports and narratives presenting people’s preferences, values, views, and opinions, especially of those affected by this health condition, are not considered in those reports. This article’s aim is to present personal experiences of scoliosis screening, diagnosis, and treatment, to contribute to the discussion. Methods This is an evocative narrative autoethnography study, which allows focusing on the personal story of the author’s experiences of adolescent idiopathic scoliosis management, connecting it to the rehabilitation context. Results Experiences of non-person-centred rehabilitation resulted in stigmatisation, distress, and emotional upset, including anxiety and fear. In contrast, person-centred therapeutic relationship involved more positive outcomes of care, such as becoming an engaged co-responsible and active partner in rehabilitation. Conclusions It is strongly suggested to promote biographical research into the personal experiences of all aspects of adolescent idiopathic scoliosis, to identify patients’ preferences and values more clearly. Furthermore, screening, diagnosis and treatment processes should be reviewed in terms of person-centredness, to ensure they are responsive to young people’s needs in the vulnerable time of puberty. IMPLICATIONS FOR REHABILITATION Adolescent idiopathic scoliosis, including the treatment, and even the diagnosis, may be stigmatising and may lead to emotional and psychosocial harms Adolescent idiopathic scoliosis screening, diagnosis and treatment processes need to be person-centred, recognising young people’s needs for privacy and support in the vulnerable time of puberty Emotional support from therapists ought to be part of the professional relationship based upon being with another person An explication of experiences of living with adolescent idiopathic scoliosis should be considered as a legitimate contribution to the practical and scientific understanding of this health condition

Provider-Focused Intervention to Promote Comprehensive Screening for Adolescent Idiopathic Scoliosis by Primary Care Pediatricians.

Screening can detect adolescent idiopathic scoliosis (AIS). The objective was to determine if computer-based simulation (CBS) and computerized clinical decision-support systems (CCDSS) would improve primary care providers' AIS screening exams as noted in their documentation. All participants received AIS screening CBS training. Participants were then randomized to receive either CCDSS when an eligible patient was seen (intervention arm) or no further intervention (comparison arm). Eligible patients' documentation was analyzed looking for a complete AIS screening exam. Over the span of 17 weeks, 1051 eligible patients were seen; 468 by providers in the intervention arm, 583 in the comparison arm. In all, 292/468 (62%) of eligible patients seen in the intervention arm and 0/583 (0%) in the comparison arm had a complete AIS screening exam documented. Compared with single CBS training alone, repeated exposure to CCDSS after CBS training resulted in improved documentation of the screening exam for AIS.

Measurement of Vertebral Rotation from Moire Image for Screening of Adolescent Idiopathic Scoliosis

Measurement of Vertebral Rotation from Moire Image for Screening of Adolescent Idiopathic Scoliosis

0075 - Snapshot of First Presentation Adolescent Idiopathic Scoliosis in the UK and the Growing Evidence for School Prevention Programme Introduction

INTRODUCTION: Currently the UK national screening committee does not recommend screening for adolescent idiopathic scoliosis (AIS).