Scoliosis Screening Research Articles

Is rasterstereography a valid noninvasive method for the screening of juvenile and adolescent idiopathic scoliosis?

Aim of the study was to verify the accuracy of rasterstereography (RST), as radiation-free alternative to plain radiography (RAD) in the monitoring of spine deformity and scoliosis progression in juvenile and adolescent subjects with idiopathic scoliosis. 192 subjects underwent RST (by Formetric 4D device) and low-dose RAD (EOS Imaging, France) in the same session. A sub-group of 30 subjects, selected for conservative treatment with corrective bracing, was assessed at 6-months follow-up. The Cobb angles (CA) obtained by the 3D spine reconstruction from RAD were compared with those provided by RST. Thoracic kyphosis (TK) and lumbar lordosis (LL) were compared as well. RST provided lower CA compared to RAD (15° vs. 33°, mean values). The average difference in measuring CA was 18°, and the correlation coefficient was 0.55. Comparable TK was observed, whereas LL resulted underestimated by RST compared to RAD (34° vs. 43°, average values). The within-subjects correlation, measuring the accuracy of RST in monitoring the scoliosis progression, was 0.3. Accuracy of RST in identifying increased or decreased CA was 67%. Sensitivity and specificity were 64% and 69%. RST demonstrated moderate accuracy in measuring the scoliosis degree and low accuracy in monitoring the curve progression. Accordingly, it cannot be considered as a valid alternative to radiographic evaluation. However, since demonstrated capable of revealing the presence of spine deformity, it could be in principle considered for the early screening in large adolescent populations, but after accounting for a cost-benefit analysis with respect to other traditional approaches. These slides can be retrieved under Electronic Supplementary Material.

Two cases of Arnold Chiari malformation detected by chance in scoliosis screening

Two cases of Arnold Chiari malformation detected by chance in scoliosis screening

Prevalence of Adolescent Idiopathic Scoliosis in the State of São Paulo, Brazil.

A cross-sectional study. To estimate the prevalence of adolescent idiopathic scoliosis (AIS) in cities in the state of São Paulo, Brazil, as well as to identify demographic, clinical, and lifestyle factors associated with AIS. AIS is a common three-dimensional spinal deformity. Epidemiological data about the condition in the southern hemisphere are scarce, and Brazil has no public health policies to implement school-based scoliosis screening programs. We assessed 2562 adolescents between 10 and 14 years of age. The screening procedure included measurement of the angle of trunk rotation using a scoliometer in the Adams forward bend test and the radiographic examination. The overall prevalence of AIS was 1.5% (95% confidence interval [CI]: 1%-1.9%). The AIS prevalence was higher among the females than among the males-2.2% (95% CI: 1.4%-2.9%) and 0.5% (95% CI: 0.1%-0.9%), respectively. The following factors were associated with the development of AIS: being female (OR = 4.7, 95% CI: 1.8-12.2; P = 0.001) and being in the 13- to 14-year age group (OR = 2.2; 95% CI: 1.0-4.8; P = 0.035). Double curves and right laterality were more common (59.4% and 56.8%, respectively), although the curves were of low magnitude (75% of the curves having a Cobb angle ≤22°), as was the progression factor (≤1.2 in 75% of the cases). The prevalence of AIS in cities within the state of São Paulo was similar to that reported in the literature, was higher among females, and was higher during puberty (13-14 years of age). Because puberty occurs later for males than for females, the recommendation to screen both sexes at 10 to 14 years of age should be reconsidered. 3.

Scoliosis Screening through a Machine Learning Based Gait Analysis Test

This study discussed application of a machine learning approach (Support vector machine, SVM) for the automatic cognition of gait changes due to scoliosis using gait measures: kinematic based on gait phase segmentation. The gaits of 18 controls and 24 scoliosis patients were recorded and analyzed using inertial measurement unit (IMU)-based systems during normal walking. Altogether, 72 gait features were extracted for developing gait recognition models. Cross-validation test results indicated that the performance of SVM was 90.5% to recognize scoliosis patients and controls gait patterns. When features were optimally selected, a feature selection algorithm could effectively distinguish the age groups with 95.2% accuracy. Applying the method that the previous test used, the severity of scoliosis was classified after clinician labeled the severity based on the Cobb angle. Test results indicated an accuracy of 81.0% by the SVM to recognize scoliosis severity gait patterns. Optimal selected features could effectively distinguish the scoliosis severity with 85.7% accuracy. When the measured features are ranked in order of high contribution, the abduction and adduction of left hip joint in the single support phase is most important in gait of patients with scoliosis. These results demonstrate considerable potential in applying SVMs in gait classification for medical applications.

Screening of scoliosis in school children in Tehran: The prevalence rate of idiopathic scoliosis.

Scoliosis is the abnormal sideways curve of the spine. Screening for scoliosis is controversial, and there has been significant heterogeneity between studies. In Iran, there is still no suitable device to screen sideways curves in spine. To investigate the simple scolioscreen software for screening the students of elementary schools for detecting schoolchildren scoliosis. This students has been examined by trained medical student and data entered in scolioscreen application of an iPhone. One hundred forty-four 7-12 years old students from primary schools in the 17th district of Tehran were randomly invited to participate. Initial screening of the students was done in schools by health care provider or medical student who has been trained by a pediatrician to undergo a vertebral examination. Scoliometer for iPhone's smartphone has been used for measuring the angle of deviation. 1.4% of students had overt scoliosis and 10.4% were suspected to have a kind of mild abnormality in spine curve. These individuals were referred to clinic for radiologic evaluation and it was confirmed that relative frequency of this abnormality was defined as 4.86% in our population study. There was no significant correlation between sex and degree of spinal curve. Regarding the high rate of scoliosis in our population and approval of this screening test in different studies, routine use of this screening method is highly recommended in schoolchildren. It is cost beneficial and can be effective in prevention and early treatment of scoliosis.

Treatment of adolescent idiopathic scoliosis and evaluation of the adolescent patient

Adolescent idiopathic scoliosis (AIS) is a three-dimensional, multi-faceted deformity of the vertebral column. Although screening is mandated by several states, debate exists surrounding the efficacy or utility of in-school scoliosis screenings. Detailed history and physical examination are crucial to this diagnosis of exclusion. Assessment of curves has long been limited to static radiography; however, use of MRI may permit detection of associated spinal anomalies, while three-dimensional gait analysis may permit improved understanding of functional improvement in AIS patients before and after treatment. Nonoperative management includes bracing, which is a complex, yet important, component to treatment of AIS. The Bracing in Adolescents with Idiopathic Scoliosis Trial (BrAIST) and other studies have revealed the potential for halting curve progression and a positive dose-response relationship of bracing. Surgical management has focused on the mainstay of posterior spinal fusion with pedicle screw fixation and rod instrumentation, with new techniques under development that modify fusion and fixation or focus on different approaches altogether (i.e. vertebral body tethering). This article details evaluation and treatment of AIS, supplemented by a review of the historical progression of management, to equip readers with an appreciation for the complex nature of this pathology and its treatment.

School Screening For Scoliosis in the Eastern Part of Nepal

Background: Scoliosis is common in children of school going age particularly in the adolescents. This condition is asymptomatic and often children present in the advanced stage of this condition with large deformity. Therefore, early detection avoids the problems associated with large curves. Material and Methods: Retrospective analysis of data obtained from screening of eight schools in the eastern part of Nepal between April 2016 and May 2017 was done; Morang district (5 schools) and Sunsari district (3 schools). A consultant Orthopaedic Surgeon, a trained Physiotherapist and an Orthopaedic nurse conducted school screening for scoliosis using the Adam’s forward bend test in the Morang district while the latter two were involved in screening in the Sunsari district. The data collected included demographics, number of positive cases and treatment prescribed. Results: 5505 children {2840 boys (51.6%) and 2665 girls (48.4%)} were screened for scoliosis in this period. Majority of patients were from the Morang district (86.2%). All six children (five girls and one boy) who were found to have positive Adam’s forward test had adolescent idiopathic scoliosis. One child had a curve of 35 degrees and bracing was started. Rest of the children had curves less than 25 degrees and were kept on regular follow up. The referral rate was 1.1 per 1000 children screened for scoliosis. Conclusion: Though the overall prevalence of scoliosis appears to be less in our population, school screening is still important for two main reasons. This may be the only way to detect cases early so that treatment can be instituted before deformity becomes large. Secondly, this activity would also spread awareness about this little known condition in the community. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 37-40

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.

Scoliosis in School- Aged Children

Context: Scoliosis is a frequent pathology in school aged children that may become a concern for parents and can challenge for practitioners and family doctors. The aim of the study is to make a comprehensive overview concerning scoliosis in school-aged children as well as elucidate red flags and related referral criteria for general practitioners that have to deal with school-aged children in their daily practice. Evidence Acquisition: This article does not aim to be a systematic review as we have not applied a strict methodology. We conducted a bibliography search limited to MEDLINE and expanded with a search of the publications cited in the selected articles. Results: The scoliosis research society (SRS) advise on annual examination of all children between the prepubertal period and 14 years of age. American academy of pediatrics (AAP), recommend a screening school children program between 10 to 16 years of age. These societies reported that school scans were necessary and useful for scoliosis, they emphasize on the benefits of receiving an early diagnosis and treatment of spinal deformities; thus, avoiding future surgical interventions. Conclusions: Early diagnosis of scoliosis and assessment of the risk of curve progression is critical in school aged children. There is still a need for a large cohort study to ensure reliable consequences of school scoliosis screening programs.

Hemidystrophic Thorax Mimicking Scoliosis.

Background:We regularly use Angle of Trunk Rotation (ATR) measurements for scoliosis screening and also for clinical follow-up of our scoliosis patients under treatment. In some patients, when ATR measurements exceed the screening threshold but without a significant degree of curvature on the X-ray (Cobb angle), a Hemidystrophic Thorax (HDT) is diagnosed. The purpose of this paper was to present a case series of patients with this kind of thoracic deformity because this may be mimicking scoliosis to a significant degree.Materials and Methods:This case series is a consecutive series of patients where the first author detected a hemidystrophic thorax instead of or in combination with scoliosis. A 3D scan of the trunk was made and adjusted to the coordinates in order to achieve an upright orientation of the upper trunk. The scan was scaled in order to determine certain anatomic landmarks, as performed in preparation for bracing. The scan was cut horizontally at the xiphoid level and the plane at this level was analysed visually in order to detect deformations that were different to the typical scoliotic deformations in the horizontal plane.Results:Seven cases were analysed and described in more detail.Conclusion:The condition of HDT may lead to significant rib humps that mimic scoliosis. According to our case series, mild scoliosis can also be associated with HDT. HDT, according to the cases presented in this study, seems to be a relatively benign deformity. Long-term observations are necessary before a final conclusion can be drawn with respect to prognosis.

Evidence supporting the need to reintroduce school screening for scoliosis in the UK

Evidence supporting the need to reintroduce school screening for scoliosis in the UK

Association between idiopathic scoliosis and bone quality

It is reported that adolescent idiopathic scoliosis patients have abnormal bone quality. However, the study of bone quality in idiopathic scoliosis (IS) patients is still sparse. The objective of this study was to determine whether an association exists between IS and bone quality in a school scoliosis screening program. In total, 391 IS patients (263 girls/128 boys) and 282 healthy controls (185 girls/97 boys) from 6 to 19 years of age in a school scoliosis screening program were included. Quantitative ultrasound measurements were performed at the left distal 1/3 of the radius, and the standard method to estimate speed of sound was recorded. Z-score was then calculated. The Z-score is defined as the difference between the raw score to be standardized and the mean difference divided by the standard deviation (a Z-score less than or equal to −2.0 indicates low bone quality and a Z-score greater than −2 indicates normal bone quality). The mean age of IS patients and healthy controls were (12.1 ± 3.2) and (10.7 ± 3.0) years old respectively. The mean Cobb angle of IS patients was 14.7° ± 4.9°. Of 391 IS patients, 101 (25.8%) had low bone quality. Of 282 healthy controls, 51 (18.1%) had low bone quality. There was significant association between IS and low bone quality (OR: 1.58; 95% CI: 1.08–2.30). After adjustment for age, gender and body mass index, a positive association was seen between IS and low bone quality (OR: 1.60; 95% CI: 1.08–2.37). IS patients have a higher risk of low bone quality. It is recommended that bone quality should be monitored in IS patients.

경력에 따른 성장기 야구선수들의 척추 측만도와 기능적 움직임 평가 비교

경력에 따른 성장기 야구선수들의 척추 측만도와 기능적 움직임 평가 비교

School scoliosis screening by Moiré topography – Overview for 33 years in Miyazaki Japan

BackgroundSince 1981, we have performed school scoliosis screening (SSS) using Moiré topography in Miyazaki, Japan and attained a certain result in detecting scoliosis. However, this screening system was discontinued due to cessation of repair and production of Moiré topographic equipment. The purpose of this study was to make clear both the results and the problems of SSS by Moiré topography on the basis of our past 33 years' experiences. MethodsThe subjects were 689,293 students (5th grade boys in 200,329, 5th grade girls in 191,919, 8th grade boys in 151,351, and 8th grade girls in 145,694) who were screened by Moiré topography between 1981 and 2013. The number of students received SSS, the positive rate of Moiré topography, the discovery rate of scoliosis greater than 20°, the reference rate to the second screening, and the positive predictive value of Moiré topography to detect scoliosis greater than 20° were investigated. ResultsThe number of students received SSS achieved a peak in 1992. The positive rate of Moiré topography and the discovery rate of scoliosis were highest in 8th grade girls. The reference rates to the second screening were 49.8% in 5th grade students and 41.4% in 8th grade students. The positive predictive values were 2.1% in 5th grade students and 7.6% in 8th grade students. ConclusionSSS by Moiré topography seemed to be effective in detecting scoliosis although both the positive predictive value and the reference rate to the second screening were low.

SCOLIOSIS SCREENING AND MONITORING USING SELF CONTAINED ULTRASOUND AND NEURAL NETWORKS.

We aim to diagnose scoliosis using a self contained ultrasound device that does not require significant training to operate. The device knows its angle relative to vertical using an embedded inertial measurement unit, and it estimates its angle relative to a vertebrae using a neural network analysis of its ultrasound images. The composition of those angles defines the angle of a vertebrae from vertical. The maximum difference between vertebrae angles collected from a scan of a spine yields the Cobb angle measure that is used to quantify scoliosis severity.

US Task Force Shifts Major Decisions on Scoliosis Screening to Healthcare Providers and Patients

US Task Force Shifts Major Decisions on Scoliosis Screening to Healthcare Providers and Patients

Torsion bottle, a very simple, reliable, and cheap tool for a basic scoliosis screening

BackgroundOne of the reasons that make scoliosis a disease that scares so much the parents is its specific characteristic of being difficult to detect on its onset.The aim of this paper is to check the possible usefulness of a simple tool (the torsion bottle) that has been developed with the aim to offer an instrument for home use by parents but also for screening purposes in the low-income countries.MethodsStudy design: retrospective analysis to evaluate intra-operator reliability of the tools and inter-operator repeatability using the torsion bottle.For the first and the second part of the study, 35 subjects were measured.The goal of the first experiment was to evaluate the reliability of the torsion bottle to identify all individuals who experienced a thoracic or lumbar prominence equal or greater than 7°.The secondary aim was to verify the reliability of blinded inter-operator assessments, performed with the torsion bottle by two physiotherapists on the same patients.ResultsThe reliability of the assessments of the torsion bottle has been performed with the Kappa statistic to evaluate the measurement agreement.The results have shown that the intra-operator reliability of the tool is very high between the measurements collected with the scoliometer® and those collected with the torsion bottle (kappa = 0.9278; standard error = 0.7094).The data of the second part of the study show that the inter-operator reliability is good (kappa = 0.7988; standard error 0.1368).ConclusionThe collected data showed that the torsion bottle revealed itself as an efficient tool to execute a basic screening to identify the presence of a prominence in a significant group of adolescents.

Referral patterns and patient characteristics at the first visit to a scoliosis center: a 2-year experience in South Korea without a school scoliosis-screening program.

OBJECTIVE The need for scoliosis screening remains controversial. Nationwide school screening for scoliosis has not been performed in South Korea, and there are few studies on the referral patterns of patients suspected of having scoliosis. This study aimed to examine the referral patterns to the largest scoliosis center in South Korea in the absence of a school screening program and to analyze the factors that influence the appropriateness of referral. METHODS The medical records of patients who visited a single scoliosis center for a spinal deformity evaluation were reviewed. Among 1895 new patients who visited this scoliosis center between April 2014 and March 2016, 1211 with presumed adolescent idiopathic scoliosis were included in the study. Patients were classified into 4 groups according to the referral method: non-health care provider, primary physician, hospital specialist, or school screening program. The appropriateness of referral was labeled as inappropriate, late, or appropriate. In total, 213 of 1211 patients were excluded because they had received treatment at another medical facility; 998 patients were evaluated to determine the appropriateness of referral. RESULTS Of the 998 referrals of new patients with presumed adolescent idiopathic scoliosis, 162 (16.2%) were classified as an inappropriate referral, 272 (27.3%) were classified as a late referral, and 564 (56.5%) were classified as an appropriate referral. Age, sex, Cobb angle of the major curve, and skeletal maturity were identified as statistically significant factors that correlated with the appropriateness of referral. The referral method did not correlate with the appropriateness of referral. CONCLUSIONS Under the current health care system in South Korea, a substantial number of patients with presumed adolescent idiopathic scoliosis are referred either late or inappropriately to a tertiary medical center. Although patients referred by school screening programs had a significantly lower late referral rate and higher appropriate referral rate than the other 3 groups, the referral method was not a significant factor in terms of the appropriateness of referral.

Trunk rotation alters postural sway but not gait in female children and early adolescents: Results from a school-based screening for scoliosis

ObjectiveThe purpose of this study was to assess the influence of trunk rotation (TR) on postural sway and spatial-temporal parameters of gait in children and early adolescents screened at school for the presence of scoliosis. MethodsTwo hundred and fifty-five individuals aged 9–14 (141 boys, 114 girls) underwent trunk rotation (TR) assessment by means of angle of trunk rotation (ATR) measurements performed with Bunnell’s scoliometer. Participants with ATR ≥ 5° formed the TR group whose data were compared with those of a control group (CON) composed of individuals with ATR < 5° matched for age and anthropometric features. Postural sway was calculated on the basis of center of pressure (COP) time series acquired using a pressure plate. Spatial-temporal parameters of gait were derived from trunk accelerations collected by a single inertial sensor located in the low-back region. ResultsSway area, sway path, COP velocities in medio-lateral (ML) and antero-posterior (AP) directions and COP displacements in ML direction were found significantly higher in girls with TR, while no differences between the TR and CON groups were detected in boys. Both boys and girls with TR exhibited gait patterns similar to those of their CON schoolmates. ConclusionsThese findings suggest that even mild levels of TR may influence balance of female children and early adolescents screened for scoliosis, and thus early interventions including selective and task-oriented exercises appear advisable. In contrast, TR does not appear to influence gait, but further investigations are required to clarify whether different ATR cut-offs may reveal alterations of spatial-temporal parameters.

Evolving Recommendations for Scoliosis Screening

Evolving Recommendations for Scoliosis Screening