Adolescent Idiopathic Scoliosis and Mental Health Disorders: A Narrative Review of the Literature

Effectiveness of dynamic neuromuscular stabilization approach in lumbopelvic stability and gait parameters in individuals with idiopathic scoliosis: A randomized controlled trial

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that leads to impaired lumbopelvic stability, gait dysfunction, and associated pain and psychological distress. This study evaluates the effectiveness of dynamic neuromuscular stabilization (DNS) in improving lumbopelvic stability and gait in AIS patients, comparing it to core stability exercises (CSE). This study evaluates the effectiveness of DNS in improving lumbopelvic stability and gait in AIS patients, comparing it to CSE.

METHODS

This randomized controlled trial involved participants aged 18 to 25 years with mild to moderate idiopathic scoliosis, who were randomly assigned to either the control or experimental group. Both groups received 12 sessions of supervised exercises over 6 weeks, with the experimental group also incorporating DNS exercises alongside CSE. Lumbopelvic stability was assessed using the single leg squat, while core stability was evaluated with the stabilizer pressure Biofeedback in combination with the Sahrmann core stability test. Additionally, gait spatiotemporal parameters and pelvic dynamics were analyzed using the BTS-G-WALK system.

RESULTS

Of 30 participants, 28 completed the study, comprising 12 males and 16 females, with 26 having mild right-sided thoracic scoliosis. Both groups showed improvement in the left single leg squat, with the control group reaching 93.3% "Good" performance and the experimental group achieving 69.2%. Gait analysis showed a significant reduction in duration for both groups, with the control group improving from 112.98 to 71.41 seconds (P = .005) and the experimental group improving from 112.33 to 67.68 seconds (P = .021).

CONCLUSION

This ongoing 12-week study shows that the combined DNS and CSE approach significantly improves lumbopelvic stability in individuals with idiopathic scoliosis. However, the impact on gait parameters was minimal, possibly due to the short duration of the intervention and the similar walking strategies of those with single-curve scoliosis and healthy individuals. These findings highlight the potential of integrating DNS into scoliosis rehabilitation and underscore the need for further research to optimize treatment duration and assess long-term functional outcomes.

Sex and age differences in depression and anxiety networks among adolescents with idiopathic scoliosis: A network analysis

BACKGROUND

Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis (AIS), affecting individuals across both sex and age groups.

AIM

To explore the network structure of depression and anxiety symptoms, with a focus on identifying differences at the symptom level between sex and age subgroups.

METHODS

A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale (PHO-9) and the Generalized Anxiety Disorder Scale (GAD-7), and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized to construct and compare the depression-anxiety symptoms networks among sex and age subgroups.

RESULTS

The results revealed GAD3 "Excessive worry" and PHQ2 "Sad mood" were the most significant central symptoms in all subgroups, while "Sad mood" had higher strength than "Excessive worry" in the lower age group. In the network comparisons, the female network exhibited tighter connectivity, especially on GAD6 "Irritability" and GAD2 "Uncontrollable worry", while only PHQ3 "Sleep" and PHQ9 "Suicidal ideation" had differences at the local level in the lower age group.

CONCLUSION

Several interventions targeting excessive worry and sad mood could reduce the risk of depression and anxiety symptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbances and suicidal ideation in the lower age group, should be addressed at an early stage to prevent significant disruptions in mental health trajectories.

Is the information provided by large language models valid in educating patients about adolescent idiopathic scoliosis? An evaluation of content, clarity, and empathy : The perspective of the European Spine Study Group

PURPOSE

Large language models (LLM) have the potential to bridge knowledge gaps in patient education and enrich patient-surgeon interactions. This study evaluated three chatbots for delivering empathetic and precise adolescent idiopathic scoliosis (AIS) related information and management advice. Specifically, we assessed the accuracy, clarity, and relevance of the information provided, aiming to determine the effectiveness of LLMs in addressing common patient queries and enhancing their understanding of AIS.

METHODS

We sourced 20 webpages for the top frequently asked questions (FAQs) about AIS and formulated 10 critical questions based on them. Three advanced LLMs-ChatGPT 3.5, ChatGPT 4.0, and Google Bard-were selected to answer these questions, with responses limited to 200 words. The LLMs' responses were evaluated by a blinded group of experienced deformity surgeons (members of the European Spine Study Group) from seven European spine centers. A pre-established 4-level rating system from excellent to unsatisfactory was used with a further rating for clarity, comprehensiveness, and empathy on the 5-point Likert scale. If not rated 'excellent', the raters were asked to report the reasons for their decision for each question. Lastly, raters were asked for their opinion towards AI in healthcare in general in six questions.

RESULTS

The responses among all LLMs were 'excellent' in 26% of responses, with ChatGPT-4.0 leading (39%), followed by Bard (17%). ChatGPT-4.0 was rated superior to Bard and ChatGPT 3.5 (p = 0.003). Discrepancies among raters were significant (p < 0.0001), questioning inter-rater reliability. No substantial differences were noted in answer distribution by question (p = 0.43). The answers on diagnosis (Q2) and causes (Q4) of AIS were top-rated. The most dissatisfaction was seen in the answers regarding definitions (Q1) and long-term results (Q7). Exhaustiveness, clarity, empathy, and length of the answers were positively rated (> 3.0 on 5.0) and did not demonstrate any differences among LLMs. However, GPT-3.5 struggled with language suitability and empathy, while Bard's responses were overly detailed and less empathetic. Overall, raters found that 9% of answers were off-topic and 22% contained clear mistakes.

CONCLUSION

Our study offers crucial insights into the strengths and weaknesses of current LLMs in AIS patient and parent education, highlighting the promise of advancements like ChatGPT-4.o and Gemini alongside the need for continuous improvement in empathy, contextual understanding, and language appropriateness.

MRI in early stages of adolescent idiopathic scoliosis indicates a neuro-osseous growth mismatch associated with curve progression

PURPOSE

To investigate the relationship between spinal cord anatomy and the risk of curve progression in mild to moderate adolescent idiopathic scoliosis (AIS).

METHODS

We prospectively included patients presenting with mild or moderate AIS (< 40 degrees). Irrespective of curve severity, patients underwent 3-dimensional MRI and were followed until skeletal maturity or surgery. Retrospectively, we measured the true lateral cord space (LCS) ratio on transverse cuts of the curve apex. This is a measure of the lateral displacement of the medulla in the spinal canal. The primary outcome measure was curve progression defined as a Cobb angle increase ≥ 10 degrees at follow-up.

RESULTS

Of the 64 included patients, 18 (28%) progressed more than 10 degrees during follow-up. At baseline, mean age in the progression and non-progression group was 13.1 ± 1.6 vs. 15.8 ± 1.5 years (p < 0.001), and mean Cobb angle was 32 ± 7 vs. 26 ± 9 degrees (p < 0.001). The time from baseline x-ray to MRI was 1.3 ± 3 months vs. 1.7 ± 3.6 months (p = 0.738). LCS ratio was 1.5 (IQR: 1.1-1.7) in the progression group and 1.0 (IQR:0.8-1.3) in the non-progression group (p < 0.001). When matched according to baseline Cobb angle and age, median LCS ratio was 1.5 [1.1, 1.7] and 0.9 [0.7-1.2] in the progression and non-progression group, respectively (p < 0.001).

CONCLUSIONS

We found significant displacement of the medulla towards the concavity of the curve in progressive AIS. This finding supports the theory of a neuro-osseous growth mismatch as a part of the etiopathophysiology of AIS and may play a predictive role in prognosis of milder cases of AIS.

The silent struggle: how chronic hip pain shapes adolescent lives

Adolescence is a critical stage of development marked by physical growth, social exploration, and academic pursuits. Chronic hip pain, which is often overlooked due to its physical effects, can significantly impact the psychosocial well-being of affected adolescents. This vulnerable group faces various challenges, including disruptions in their education, feelings of social isolation, and emotional distress, highlighting an urgent need for comprehensive interdisciplinary interventions. By addressing both the psychosocial factors and the physical treatment of chronic hip pain, we can help adolescents navigate their developmental years with resilience and hope.

Advances in 3D correction of adolescent scoliosis: The superiority of scoliocorrector fatma-UI in rotational realignment

This letter compares the clinical efficacy and economic feasibility of the scoliocorrector fatma-UI (SCFUI) with direct vertebral rotation (DVR) in treating adolescent idiopathic scoliosis (AIS). SCFUI has shown promising results in three-dimensional spinal correction, providing superior rotational alignment compared to DVR and achieving significant improvements in coronal and sagittal planes. Additionally, SCFUI's advanced design reduces risks associated with AIS surgeries and enhances overall patient outcomes. Economic analysis reveals SCFUI as a cost-effective option, potentially lowering long-term healthcare costs by minimizing complications and revisions. Our findings suggest that SCFUI is a viable, innovative approach in AIS treatment, meeting clinical and economic demands in orthopedic care.

Development of a model for measuring sagittal plane parameters in 10-18-year old adolescents with idiopathic scoliosis based on RTMpose deep learning technology

PURPOSE

The study aimed to develop a deep learning model for rapid, automated measurement of full-spine X-rays in adolescents with Adolescent Idiopathic Scoliosis (AIS). A significant challenge in this field is the time-consuming nature of manual measurements and the inter-individual variability in these measurements. To address these challenges, we utilized RTMpose deep learning technology to automate the process.

METHODS

We conducted a retrospective multicenter diagnostic study using 560 full-spine sagittal plane X-ray images from five hospitals in Inner Mongolia. The model was trained and validated using 500 images, with an additional 60 images for independent external validation. We evaluated the consistency of keypoint annotations among different physicians, the accuracy of model-predicted keypoints, and the accuracy of model measurement results compared to manual measurements.

RESULTS

The consistency percentages of keypoint annotations among different physicians and the model were 90-97% within the 4-mm range. The model's prediction accuracies for key points were 91-100% within the 4-mm range compared to the reference standards. The model's predictions for 15 anatomical parameters showed high consistency with experienced physicians, with intraclass correlation coefficients ranging from 0.892 to 0.991. The mean absolute error for SVA was 1.16 mm, and for other parameters, it ranged from 0.22° to 3.32°. A significant challenge we faced was the variability in data formats and specifications across different hospitals, which we addressed through data augmentation techniques. The model took an average of 9.27 s to automatically measure the 15 anatomical parameters per X-ray image.

CONCLUSION

The deep learning model based on RTMpose can effectively enhance clinical efficiency by automatically measuring the sagittal plane parameters of the spine in X-rays of patients with AIS. The model's performance was found to be highly consistent with manual measurements by experienced physicians, offering a valuable tool for clinical diagnostics.

Stigma assessment scale for adolescent idiopathic scoliosis: A new tool for spine deformity stigma evaluation

PURPOSE

Stigma is the negative attitudes towards an illness or difference. The literature lacks detailed scales specifically addressing stigmatization in AIS. This study aimed to develop Adolescent Idiopathic Scoliosis Stigma Assessment Scale (AIS-SAS) to measure stigmatization in AIS patients.

METHODS

In creating the AIS-SAS, we developed items via literature review and expert input, confirmed content validity, and conducted a field test for construct validity and reliability. Our experts designed 38 items in three subscales: Scoliosis, Brace, and Surgery-related stigma. Exploratory factor analysis (EFA) and convergent validity were examined for construct validity. The convergent validity of AIS-SAS was assessed through its correlations with the Rosenberg Self-Esteem Scale (RSES), SRS-22, and Spinal Appearance Questionnaire (SAQ). Reliability was gauged via internal consistency and test-retest methods.

RESULTS

Sixty-seven adolescents with AIS were included in the study. EFA results confirmed one-dimensionality for each subscale, with factor loadings from 0.51 to 0.96, leading to the removal of 8 items with loadings below 0.3 from the AIS-SAS. The final AIS-SAS has three subscales: scoliosis (18 items), brace (5 items), and surgery-related stigma (7 items). Regarding convergent validity, the scoliosis-related stigma scores significantly correlated with SRS-22 self-image (r= -0.413 p = 0.001) and SAQ-Appearance (r = 0.441 p = 0.002). The RSES-Total score shows a negative correlation with Scoliosis, Brace, and Surgery-related stigma scores: -0.500 (p < 0.001), -0.435 (p = 0.049), and  -0.498 (p = 0.042), respectively. AIS-SAS subscales showed good reliability (Cronbach-α > 0.8 ICC > 0.8).

CONCLUSION

AIS-SAS is the first valid and reliable high-quality scale assessing stigmatization from AIS, measuring scoliosis, brace, and surgery-related stigma via three subscales.

The efficacy of combined physiotherapeutic scoliosis-specific exercises and manual therapy in adolescent idiopathic scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is a pathological condition characterized by vertebral curvature and associated trunk deformities in adolescents. The clinical efficacy of conservative treatment in alleviating spinal curvature of AIS remains a topic of ongoing debate. The objective of this study was to investigate the impact of combined physiotherapeutic scoliosis-specific exercises (PSSE) and manual therapy (MT) on trunk deformity, spinal function, mobility, and mental health in patients with AIS.

METHODS

Thirty-one participants who were diagnosed with AIS whose Cobb angle was between 10-45°were enrolled in the study. Participants in the intervention group received 50 min of PSSE combined with 10 min of MT, while the control group performed 50 min of PSSE as their home exercise program. Both treatments were implemented three times a week for four weeks. Cobb angle, spinal mobility, trunk morphology (vertebral rotation angle, apical deviation, pelvic obliquity distance and angle), movement capability, and quality of life (QOL) were assessed at baseline and post intervention. The treatment effects between the intervention and control groups were analyzed using a two-way repeated measures ANOVA.

RESULTS

Following a 4-week treatment period, Cobb angle was significantly reduced from 21.58° to 18.58° in intervention group and increased from 18.00° at baseline and 19.14° post intervention in the control group. Significant improvements were also observed in spinal mobility, movement capability, quality of life, and some of the trunk morphology indices in the intervention group compared to baseline (p < 0.05). Improvements were significantly higher in the intervention group than the control group.

CONCLUSION

Combining PSSE and MT shows potential benefits in alleviating AIS symptoms and improving QOL. Further studies to substantiate these findings are warranted.

TRIAL REGISTRATION

The trial was retrospectively registered in the Chinese Clinical Trial Registry ( https://www.chictr.org.cn ) with the registration number: ChiCTR2300071357, (Date: 12/05/2023).

Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in paediatric idiopathic scoliosis patients undergoing posterior spine fusion surgery: a randomized controlled trial

PURPOSE

Major spinal surgery causes severe pain. We examined the ability of erector spinae plane block (ESPB) to alleviate pain after posterior spinal fusion (PSF) in paediatric scoliosis patients.

METHODS

Seventy-two patients who underwent PSF were randomized into a preoperative ultrasound-guided ESPB group or a no-block control group. The composite primary outcome was the area under the curve (AUC) of the numerical rating scale (NRS) score in the first 24 h after surgery and the number of parent-controlled intravenous analgesia (PCIA) boluses administered 24 h after surgery. The secondary outcomes included the NRS score, opioid consumption, rescue analgesia, adverse events, and quality of recovery.

RESULTS

The AUC-NRS at rest was 62 (13) in the ESPB group and 89 (13) in the control group (P < 0.001). There were 15 (5) 24-h PCIA boluses administered in the ESPB group and 30 (7) in the control group (P < 0.001). Compared with those in the control group, the NRS scores at rest were lower in the ESPB group at 0, 3, 6, and 9 h postoperatively, and the NRS scores during movement were lower in the ESPB group at 0, 3, 6, 9 and 12 h postoperatively. The ESPB group showed a lower need for PCIA than did the control group at 0-6, 6-12, 12-18 and 1-24 h postoperatively. In the ESPB group, fewer patients required rescue analgesics, and patients exhibited a higher quality of recovery.

CONCLUSION

Preoperative ESPB improves postoperative analgesia in paediatric scoliosis patients who underwent PSF.

TRIAL REGISTRATION NUMBER

ChiCTR2300074505.

DATE OF REGISTRATION

August 8, 2023.

Discontinuation of brace treatment in adolescent idiopathic scoliosis (AIS): a scoping review

PURPOSE

Brace treatment for adolescent idiopathic scoliosis (AIS) is usually prescribed for 20-40° curves in patients with growth potential. The aim is to reduce the risk of curve progression during growth and to avoid the curve reaching a surgical threshold. Having as small a curve as possible at skeletal maturity will reduce the risk of curve progression during adult life. While evidence exists for brace treatment in AIS, there is disagreement on how and when to discontinue bracing. The purpose of this review was to investigate what criteria have been reported for initiating brace cessation and published weaning protocols and to look at estimates of the number of patients that may progress > 5 degrees after the end of growth.

METHODS

This scoping review summarizes existing knowledge on the best time to stop bracing in AIS patients, how to "wean," and what happens to spinal curves after bracing. Searches were carried out through MEDLINE, EMBASE, and PsycINFO in April 2022. A total of 1936 articles were reduced to 43 by 3 reviewers. Full papers were obtained, and data were extracted.

RESULTS

Weaning was most commonly determined by Risser 4 (girls) and 5 (boys). Other requirements included 2 years post-menarche and no growth in standing/sitting height for 6 months. Skeletal maturity assessed from hand and wrist radiographs, e.g., Sanders' stage; distal radius and ulnar physes, could determine the optimal weaning time to minimize curve progression. Complete discontinuation was the most common option at skeletal maturity; variations on weaning protocols involved gradual reduction of bracing over 6-12 months. Curve progression after weaning is common. The 12 studies reporting early curve progression after brace weaning found a mean Cobb angle progression of 3.8° (n = 1655). From the seven studies reporting early curve progression by > 5 degrees, there were 236/700 (34%) patients. There is limited information on risk factors to predict early curve progression after finishing brace treatment with larger curves, especially those over 40 degrees possibly having more chance of progression.

CONCLUSION

Curve progression after bracing cessation is a negative outcome for patients who have tolerated bracing for several years, especially if surgery is required. The literature shows that when to start brace cessation and weaning protocols vary. Approximately 34% of patients progressed by more than 5 degrees at 2-4 years after brace cessation or weaning. Larger curves seem more likely to progress. More research is needed to evaluate the risk factors for curve progression after brace treatment, defining the best time to stop bracing based on the lowest risk of curve progression and whether there is any benefit to weaning.

Evaluation of the prevalence of adolescent scoliosis and its associated factors in Gansu Province, China: a cross-sectional study

Introduction

Gansu Province is situated in the northwest region of China, characterized by diverse and complex topography and a rich diversity of ethnic groups. This study aims to explore the prevalence and risk factors of adolescent suspected scoliosis in Gansu Province through a cross-sectional population study.

Methods

From April 2022 to July 2022, a prospective cross-sectional study was conducted in Baiyin City, Jinchang City, Lanzhou City, Linxia Hui Autonomous Prefecture, and Gannan Tibetan Autonomous Prefecture in Gansu Province. The screening covered 3,118 middle and high school students across 24 institutions, including middle and high schools. Diagnosis of suspected scoliosis was established through visual inspection, the Adams forward bend test, and measurement of trunk rotation angle. Employing a custom-designed questionnaire, demographic data were collected, and the prevalence of suspected scoliosis was calculated. Univariate and multivariate logistic regression analyses were employed to assess factors associated with suspected scoliosis.

Results

A total of 3,044 participants were ultimately included in the analysis. The overall prevalence of suspected scoliosis was 5.68% in Gansu Province. The peak prevalence for boy is at 14 years (6.70%), while for girl, it is at 15 years (8.75%). Lanzhou City exhibits the highest prevalence rates (boy, 9.82%; girl, 10.16). The results of univariate logistic regression analysis presented that BMI (OR = 0.92, 95% CI: 0.88-0.96), altitude of habitation (1,600 m-2000 m) (OR = 0.50, 95% CI: 0.34-0.73), altitude of habitation (2000 m-3321 m) (OR = 0.58, 95% CI: 0.40-0.83), family medical history (OR = 1.56, 95% CI: 1.02-2.31), and shoulders of unequal height (OR = 1.49, 95% CI: 1.09-2.03) were significantly correlated with suspected scoliosis. The multivariate logistic regression analysis indicated that BMI (OR = 0.91, 95% CI: 0.86-0.95), altitude of habitation (1,600 m-2000 m) (OR = 0.35, 95% CI: 0.23-0.54), altitude of habitation (2000 m-3321 m) (OR = 0.39, 95% CI: 0.24-0.60), family medical history (OR = 1.66, 95% CI:1.08-2.49), and shoulders of unequal height (OR = 1.45, 95% CI:1.06-1.99) were independently associated with suspected scoliosis.

Conclusion

Low BMI, residence at an altitude of 1,600 m-3321 m, family medical history, and shoulders of unequal height were independently associated with an increased prevalence of suspected scoliosis. It is recommended to promptly screen high-risk adolescents for suspected scoliosis, provide effective preventive and intervention measures.

The effect of bilateral ultrasound-guided erector spinae plane block on postoperative pain control in idiopathic scoliosis patients undergoing posterior spine fusion surgery: study protocol of a randomized controlled trial

BACKGROUND

Posterior spinal fusion (PSF) for the correction of idiopathic scoliosis is associated with severe postoperative pain. Erector spinae plane block (ESPB) has been proposed to provide analgesia and reduce opioid consumption. We aimed to investigate the effect of bilateral ultrasound-guided single-shot ESPB on postoperative analgesia in pediatric patients undergoing PSF.

METHODS

This double-blinded, randomized controlled trial will enroll 74 AIS patients undergoing elective PSF. Participants will be assigned to the ESPB group or control group at a 1:1 ratio. Patients in the ESPB group will receive ultrasound-guided bilateral ESPB preoperatively, and patients in the control group received sham ESPB using normal saline. The primary joint endpoints are the area under the curve (AUC) of numerical rating scale (NRS) score and opioid consumption in postoperative 24 h. The secondary endpoints are numerical rating scale (NRS) score and opioid consumption at postoperative 0.5, 3, 6, 9, 12, 24, 36, and 48 h, rescue analgesia, recovery outcomes, and adverse events.

DISCUSSION

At present, studies investigating the effect of ESPB on pediatric patients are still needed. This study focuses on the effect of ESPB on pediatric patients undergoing PSF on postoperative pain control and intends to provide a new strategy of multimodal analgesia management for major spine surgery.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300074505. Registered on August 8, 2023.

Three-Level Concavity Apical Pediculectomy During Intraoperative Neuromonitoring Loss: Following the Checklist Resulted in an Ambulatory Patient

Adolescent idiopathic scoliosis is the most common form of scoliosis, with severe cases leading to a decline in patients with worsening angulation of deformity. Technical nuances of spinal flexibility and cord type based on the extent of the deformity may impact operating safety and outcome, with risks including neurological loss during and after surgical intervention. Here we present a case of posterior osteotomy and correction of a patient with adolescent idiopathic scoliosis with a T2 - L3 fusion in which transcranial motor evoked potentials (TcMEPs) and somatosensory evoked potentials (SSEPs) were lost intraoperatively, thus requiring application of operative consensus guidelines for the loss of neuromonitoring data. Particularly, the discussion focuses on the decision-making process that resulted in the complete recovery of TcMEPs and SSEPs post-operatively.

Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spine and trunk deformity. Bracing is an effective treatment for medium-degree curves. Thermal sensors help monitor patients' adherence (compliance), a critical issue in bracing treatment. Some studies investigated adherence determinants but rarely through sensors or in highly adherent cohorts. We aimed to verify the influence of personal and clinical variables routinely registered by physicians on adherence to brace treatment in a large cohort of consecutive AIS patients from a highly adherent cohort. We performed a cross-sectional study of patients consecutively recruited in the last three years at a tertiary referral institute and treated with braces for one year. To ensure high adherence, for years, we have provided specific support to brace treatment through a series of cognitive-behavioural interventions for patients and parents. We used iButton thermal sensor systematic data collection to precisely analyse the real brace-wearing time. We included 514 adolescents, age 13.8 ± 1.6, with the worst scoliosis curve of 34.5 ± 10.3° Cobb. We found a 95% (95CI 60-101%) adherence to the brace prescription of 21.9 ± 1.7 h per day. Determinants included gender (91% vs. 84%; females vs. males) and age < 14 years (92% vs. 88%). Brace hours prescription, BMI, and all clinical variables (worst curve Cobb degrees, angle of trunk rotation, and TRACE index for aesthetics) did not influence adherence.

The effects of physiotherapeutic scoliosis-specific exercise on idiopathic scoliosis in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physiotherapeutic scoliosis-specific exercise (PSSE) is recommended by SOSORT as the first step in the treatment of adolescent idiopathic scoliosis (AIS). However, a thorough summary and meta-analysis of the evidence for the effectiveness of PSSE is lacking.

OBJECTIVE

To summarise the up-to-date evidence on the efficacy of PSSE in AIS compared with the other non-surgical therapies.

DATA SOURCES

The PubMed, Web of Science, Cochrane, Scopus, Embase and CNKI databases were systematically searched from 1 January 2012 to 1 November 2022.

STUDY SELECTION

Controlled trials comparing the effects of PSSE and other non-surgical therapies on improving Cobb angle and quality of life in young people aged 6-18 years were included.

DATA SYNTHESIS

Three researchers independently extracted data and evaluated methodological quality. Meta-analysis was performed where possible; otherwise, descriptive syntheses were reported.

RESULTS

Seventeen studies with a total of 930 participants (76% female) were included. Among them, ten studies were RCTs. Six studies were of excellent quality. Thirteen studies were included in the meta-analysis. PSSE corrected the Cobb angle in patients better than other non-surgical therapies (I2 = 82%, MD = -2.82, 95%CI = -4.17 to -1.48, P < 0.01). PSSE was more effective than brace in improving patients' pain, self-image and mental health. Patients with a Risser grade of 0-3 or who had never received brace therapy had better outcomes.

CONCLUSION

Evidence from higher quality studies suggests that PSSE was superior to general exercise and conventional therapy for correcting the Cobb angle in AIS.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO ID CRD42022345157 CONTRIBUTION OF THE PAPER.

Impact of mental health components on the development of back pain in young adults with adolescent idiopathic scoliosis

BACKGROUND

Back pain occurs commonly in adults and is multifactorial in nature. This study aimed to assess the prevalence and intensity of back pain during young adulthood in subjects with adolescent idiopathic scoliosis (AIS), as well as factors that may be associated with its prognosis.

METHODS

Subjects with AIS aged 20-39 treated conservatively were included in this study. Patient-reported outcome measures in adulthood involved episodes of back pain, and scales of self-image, depression, anxiety, and stress. Additionally, pain, self-image, and mental health scores were retrieved at the first clinic consultation. Occurrence of back pain was defined as a numeric pain rating scale ≥ 6.

RESULTS

101 participants were enrolled. The prevalence of back pain in the lifetime, past 12 months, past 6 months, past 1 month, past 7 days, and past 24 h were 37%, 35%, 31%, 27%, 23%, and 20%, respectively. Male, self-image, and depression were significant associated factors for the development of back pain at all time points. Furthermore, the analyses of the initial presentation of participants have shown that participants with back pain in adulthood were characterised by poor self-image and mental health during their adolescence.

CONCLUSION

The present study addressed the natural history of back pain in young adults with conservatively treated AIS. Psychological makeup has been shown to constitute the development of back pain and is strongly hinted as an early sign of having back pain in adulthood among subjects with AIS.

Psychosocial interventions for teenagers with adolescent idiopathic scoliosis: A systematic literature review

OBJECTIVES

Psychosocial interventions can improve teenagers' self-esteem, mental health and bracing compliance. There is a need to compile available evidence of psychosocial care in adolescent idiopathic scoliosis. This systematic review aimed to identify and evaluate the effects of existing interventional studies of psychosocial care for the adolescent idiopathic scoliosis population.

METHODS

A comprehensive search of relevant literature published from the inception to March 2023 was conducted using nine databases. A google scholar search was performed on 1 July 2023, to update the searching results. Two reviewers independently assessed the methodological quality and extracted details of the included studies. Given the heterogeneity of the selected articles, the findings were synthesized narratively without conducting a meta-analysis.

RESULTS

Four randomized controlled trials reported in six articles involving 385 teenagers were included. The interventions appeared acceptable with high recruitment rates and low dropout rates reported. Psychosocial interventions had shown significant positive effects on postoperative pain, engagement in daily and social activities as well as brace use, coping abilities and anxiety.

CONCLUSION

Psychosocial interventions are generally feasible and acceptable among the adolescent idiopathic scoliosis population and have produced positive effects on a variety of physical and psychosocial outcomes. Study findings need to be interpreted with caution due to the limited number of available articles and the methodological concerns of the reviewed articles.

PRACTICAL IMPLICATIONS

Well-designed clinical trials are warranted in people from cultural backgrounds to develop and implement effective psychosocial interventions for teenagers with adolescent idiopathic scoliosis, not only for those at the post-surgery stage but also for those receiving conservative treatment.

Infrared Thermography for Real-Time Assessment of the Effectiveness of Scoliosis Braces

This work proposes an innovative method, based on the use of low-cost infrared thermography (IRT) instrumentation, to assess in real time the effectiveness of scoliosis braces. Establishing the effectiveness of scoliosis braces means deciding whether the pressure exerted by the brace on the patient's back is adequate for the intended therapeutic purpose. Traditionally, the evaluation of brace effectiveness relies on empirical, qualitative assessments carried out by orthopedists during routine follow-up examinations. Hence, it heavily depends on the expertise of the orthopedists involved. In the state of the art, the only objective methods used to confirm orthopedists' opinions are based on the evaluation of how scoliosis progresses over time, often exposing people to ionizing radiation. To address these limitations, the method proposed in this work aims to provide a real-time, objective assessment of the effectiveness of scoliosis braces in a non-harmful way. This is achieved by exploiting the thermoelastic effect and correlating temperature changes on the patient's back with the mechanical pressure exerted by the braces. A system based on this method is implemented and then validated through an experimental study on 21 patients conducted at an accredited orthopedic center. The experimental results demonstrate a classification accuracy slightly below 70% in discriminating between adequate and inadequate pressure, which is an encouraging result for further advancement in view of the clinical use of such systems in orthopedic centers.

Efficacy of spinal manipulations and Schroth exercises on psychological parameters in patients with functional scoliosis: a randomised controlled trial

Functional scoliosis is defined as the reversible and temporary lateral spinal curvature that mainly occurs due to abnormal postural habits that leads to non-structural and compensatory changes in spine. Functional scoliosis can lead to the development of mental health issues, such as stress, anxiety and depression. The purpose of the present study was to evaluate the effects of spinal manipulation techniques and Schroth exercises on psychological parameters in patients with functional scoliosis. The subjects were randomly allocated into experimental (n=31) and control group (n=31). Spinal manipulation techniques and Schroth exercises were given to the patients of experimental group, while only Schroth exercises were given to the patients of control group. Outcome measures were Depression, Anxiety & Stress Score that was examined by using ‘DASS-21 questionnaire’. Treatment was given for four weeks, thrice weekly. After the completion of four weeks, DASS scores were obtained from the participants. Patients were followed up after 2 months and data was collected again. Repeated measures ANOVA were used to compare the mean changes within-group. Independent t-test was used to analyse the mean improvement between-group. Results suggested that there was a statistically significant difference between pre-/post and pre-/follow-up scores of the DASS, but there was statistical non-significant difference between post-/follow-up scores of the DASS. Results also suggested that experimental group showed better improvement compared to the control group. This study concluded that the combine use of spinal manipulation techniques and Schroth exercise protocol can significantly reduce the psychosomatic symptoms in functional scoliosis.

Clinical Trial Registry of India: CTRI/2020/02/023221

The Influence of Family Crisis Coping Strategies on Family Quality of Life in the Assessment of Patients with Idiopathic Scoliosis

The aim of the study was to assess the impact of the strategies of coping with the family crisis in children and adolescents with idiopathic scoliosis on the level of their family's quality of life (FQOL). The study group consisted of 100 adolescents (girls 83%, boys 17% of the entire main group) with an average age of 14 (13.83 ± 1.92). The control group consisted of the same number of people as the study group (girls 78%, boys 22% of the entire control group) with an average age of 14 (14.09 ± 2.16). The FQOL scale was used to assess the family's quality of life, and the F-COPES scale was used to assess the problem-solving strategies used by the family (individual members) in a difficult life situation. Statistical analysis showed significant differences between the two compared groups. While dealing with a crisis situation in their families, adolescents treated for idiopathic scoliosis were using the spiritual support strategy (M ± SD 5.12 ± 2.07) significantly more often, while their healthy peers much more willingly and more often benefited from other possible strategies (F-COPES). Additionally, statistically significant differences were observed in the assessment of children and adolescents from both groups that the usage of different strategies available on the F-COPES scale correlated and affected the areas of the FQOL level of their families. Gaining spiritual support had a negative impact on the area of physical and financial well-being of FQOL, as assessed by juveniles with SI (R = -0.254, p = 0.011). However, in the opinion of healthy peers, the strategy of gaining social support (F-COPES) resulted in a higher level of FQOL in the area of disability problems (p = 0.005). A long process of SI treatment can cause crisis situations for patients and their families and affect both the physical and mental health of patients by changing the FQOL level of their families.

Correlational analysis of three-dimensional spinopelvic parameters with standing balance and gait characteristics in adolescent idiopathic scoliosis: A preliminary research on Lenke V

Background: Adolescent idiopathic scoliosis (AIS), the most common spinal deformity, possibly develops due to imbalanced spinal loading following asymmetric development. Since altered loading patterns may affect standing balance and gait, we investigated whether a correlation exists between balance ability, gait pattern, and the three-dimensional radiographic spinopelvic parameters in AIS patients. Methods: A cross-sectional observational study was conducted with 34 AIS patients (aged 10-18 years) and an equal number of healthy age and sex-matched teenagers (normal group). We obtained the spinopelvic three-dimensional parameters and balance parameters simultaneously through the EOS imaging system and gait and center of pressure (CoP) characteristics using a plantar pressure measurement mat. Besides determining the intergroup differences in balance and gait parameters, multiple linear regression analyses were performed to identify any correlation between the static plantar pressure and radiographic parameters. Results: Compared to the normal group, the CoPx is lower, the CoP path length and 90% confidence ellipse area were significantly higher in AIS patients (AIS: -13.7 ± 5.7 mm, 147.4 ± 58.1 mm, 150.5 ± 62.8 mm2; normal: -7.0 ± 5.4 mm, 78.8 ± 32.0 mm, 92.1 ± 41.7 mm2, respectively), correlated with apical vertebra translation, sagittal pelvic tilt, and pelvis axial rotation, respectively. Moreover, AIS patients had a shorter stance phase (61.35 ± 0.97 s vs. 62.39 ± 1.09 s), a longer swing phase (38.66 ± 0.97 s vs. 37.62 ± 1.08 s), and smaller maximum pressure peaks in the gait cycle, especially on the left foot, as compared to healthy subjects. Moreover, the CoP trajectory in AIS patients was different from the latter, and changes in the bipedal trend were not consistent. Conclusion: The standing balance and gait characteristics of AIS patients are different from those of healthy subjects, as reflected in their three-dimensional spinopelvic radiographic parameters. Trial registration: The study protocol was registered with the Chinese Clinical Trial Registry (Number ChCTR1800018310) and the Human Subject Committee of Guangzhou Sport University (Number: 2018LCLL003).