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Diagnosis and Treatment of Adolescent Idiopathic Scoliosis

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (28 February 2026) | Viewed by 9994

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Dr. Laura Scaramuzzo

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Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
Interests: adult and pediatric deformities; degenerative diseases of the spine; spine trauma; biomechanics
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Dr. Calogero Velluto

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Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
Interests: spine; spine surgery; spinal surgery; spinal cord injury; fracture; lumbar spine; intervertebral disk degeneration
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Dear Colleagues,

Adolescent idiopathic scoliosis (AIS) remains one of the most prevalent spinal deformities during adolescence, with significant implications for physical and psychological health. Advances in imaging, diagnostic criteria, and treatment modalities have continuously evolved to address the complex challenges posed by this condition. Understanding the etiology, progression patterns, and effective interventions for AIS is crucial for clinicians, surgeons, and researchers striving to improve patient outcomes.

This Special Issue aims to provide a comprehensive platform for exploring novel diagnostic tools, cutting-edge surgical techniques, and interdisciplinary treatment approaches for AIS. By highlighting recent advances and identifying future directions, this collection will contribute to bridging the gap between research and clinical practice. We welcome original research articles, systematic reviews, and innovative case studies that address various aspects of AIS, including biomechanical insights, minimally invasive techniques, long-term outcomes, and patient-centered care strategies.

We look forward to your valuable contributions to this important endeavor, which aligns with Medicina's mission to disseminate impactful research across medical disciplines.

We look forward to receiving your contributions.

Dr. Laura Scaramuzzo
Guest Editor

Dr. Calogero Velluto
Guest Editor Assistant

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Keywords

adolescent idiopathic scoliosis
spinal deformities
diagnosis
surgical treatment
minimally invasive techniques
biomechanics
clinical outcomes
patient-centered care
multidisciplinary approaches

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Published Papers (5 papers)

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Research

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14 pages, 1362 KB

Open AccessArticle

Enhanced Recovery After Surgery Incorporating Erector Spinae Plane Block Versus Standard Care in Adolescent Idiopathic Scoliosis: A Comparative Cohort Analysis of Early Postoperative Recovery

by Sergio De Salvatore, Gianmichele Di Cosimo, Paolo Brigato, Michele Inverso, Leonardo Oggiano, Sergio Sessa, Davide Palombi, Francesca Palmieri, Stefano Guida, Antonio Contursi, Caterina Fumo, Cloe Curri, Sebastian Miccio, Maria D’Alessandro and Pier Francesco Costici

Medicina 2026, 62(4), 775; https://doi.org/10.3390/medicina62040775 - 16 Apr 2026

Viewed by 435

Abstract

Background and Objectives: Enhanced Recovery After Surgery (ERAS) pathways are increasingly used in spine surgery, but uptake in adolescent idiopathic scoliosis (AIS) remains heterogeneous across institutions. Evidence in pediatric deformity surgery supports shorter recovery with protocolized care, yet real-world comparative data combining ERAS and the erector spinae plane block (ESPB) remain limited. This study aimed to compare early postoperative outcomes between a historical standard-care pathway and a structured ERAS+ESPB pathway in adolescents undergoing posterior spinal fusion for AIS. Materials and Methods: A single-center retrospective time-based comparative cohort study design included consecutive AIS patients (<18 years) treated between 1 January 2024 and 31 December 2025. The standard-care pathway was applied to patients operated on before 1 June 2025 (n = 34), whereas the ERAS+ESPB pathway was applied to those operated on from 1 June 2025 onward (n = 35), following formal institutional implementation. Outcomes included postoperative pain assessed using the visual analog scale under two functional conditions—at rest in the supine position and during standing/mobilization—at POD0, POD1, POD2, POD3, discharge, and 2-week follow-up; postoperative nausea at POD0–POD3; and length of stay (LOS). Between-group pain comparisons used Welch’s t-test; nausea used Fisher’s exact test; LOS used the Wilcoxon rank-sum test. Results: At POD0, supine pain was lower in ERAS+ESPB (1.50 ± 0.55) than in standard care (3.20 ± 1.50; p < 0.001). From POD1 onward, supine pain did not differ significantly between groups. Among assessable patients, standing pain was lower in ERAS+ESPB at POD2 (3.05 ± 1.53 vs. 4.50 ± 1.05; p = 0.020), POD3 (2.82 ± 1.62 vs. 4.17 ± 1.03; p = 0.006), and 2-week follow-up (1.45 ± 0.80 vs. 2.26 ± 0.93; p = 0.006). Nausea was lower in ERAS+ESPB at POD0 (11.4% vs. 35.3%; p = 0.024) and POD2 (8.6% vs. 32.4%; p = 0.018), with no significant differences at POD1 or POD3. LOS was shorter in ERAS+ESPB (5.41 ± 1.10 vs. 8.32 ± 2.06 nights; p < 0.001). Conclusions: In adolescents undergoing posterior spinal fusion for AIS, an ERAS-based perioperative pathway incorporating ESPB was associated with improved early postoperative recovery, particularly in terms of immediate postoperative pain, pain during mobilization, early postoperative nausea at selected time points, and length of hospital stay. Prospective multicenter studies are needed to confirm these findings and clarify the independent contribution of individual pathway components. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Adolescent Idiopathic Scoliosis)

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13 pages, 783 KB

Open AccessArticle

Comparison of Objective and Subjective Indicators in Patients with Idiopathic Scoliosis Undergoing PSSE Therapy—Retrospective Observational

by Marianna Białek, Sylwia Piorun, Ewelina Białek-Kucharska, Paulina Poświata, Małgorzata Poczynek and Justyna Pękala

Medicina 2026, 62(4), 652; https://doi.org/10.3390/medicina62040652 - 29 Mar 2026

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Abstract

Background and Objectives: Physiotherapeutic Scoliosis-Specific Exercises (PSSE) are recognized treatment methods for idiopathic scoliosis, focused on correcting three-dimensional postural abnormalities. Objective indices such as Angle of Trunk Rotation (ATR), Anterior Trunk Symmetry Index (ATSI), and Posterior Trunk Symmetry Index (POTSI) enable precise assessment of clinical changes, while the Trunk Appearance Perception Scale (TAPS) reflects the patient’s subjective perception of their posture. Combining these data allows for a comprehensive assessment of the effects of therapy after intensive 5-day inpatient rehabilitation. We aimed to assess the improvement in the patients’ clinical appearance and compare objective and subjective trunk assessment indicators after intensive 5-day inpatient rehabilitation, treated by PSSE, according to the Functional Individual Therapy of Scoliosis (FITS) Method. Materials and Methods: This retrospective study included 75 patients with idiopathic scoliosis who participated in a 5-day inpatient rehabilitation, treated by FITS Method. The average age was 13.5 years, and 63% of the girls were after menarche. The mean Cobb angle was 27.41° in single-curve scoliosis and 31.03° in double-curve scoliosis (31.24° in the thoracic spine, 30.82° in the lumbar spine), Risser test 2, and ATR was 7.1° in the thoracic spine and 4.6° in the lumbar spine. Forty-nine patients wore a brace. At the beginning and end of inpatient care, objective assessments were performed, including ATR at the peak of the scoliosis using the Adams test and photoregistration of the trunk in the front and back standing positions—ATSI and POTSI. A subjective assessment was also performed using the TAPS. Results: A statistically significant difference was demonstrated after therapy in the ATSI (p < 0.001) and POTSI (p = 0.008) values. A reduction in the ATR in the thoracic spine was observed (p < 0.001). The TAPS questionnaire demonstrated a statistically significant difference in the values of all indicators measured before and after therapy: in the frontal plane SET 1 (p = 0.002), in the transverse plane SET 2 (p = 0.042), and in the frontal plane SET 3 (p = 0.028). A statistically significant negative correlation was demonstrated between objective and subjective indicators after therapy: ATR Th vs. TAPS-SET 2 (−0.45) (p < 0.001) and ATSI vs. SET 3 (−0.29) (p = 0.011). Conclusions: The subjective assessment of trunk appearance correlates with the objective assessment, except for SET 1 vs. POTSI. Patients who noticed a change in their posture can expect confirmation in objective clinical tests. FITS Method positively influences the improvement of subjective and objective assessments of idiopathic scoliosis patients during the short term of intensive care. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Adolescent Idiopathic Scoliosis)

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28 pages, 4702 KB

Open AccessArticle

Clinical Failure of General-Purpose AI in Photographic Scoliosis Assessment: A Diagnostic Accuracy Study

by Cemre Aydin, Ozden Bedre Duygu, Asli Beril Karakas, Eda Er, Gokhan Gokmen, Anil Murat Ozturk and Figen Govsa

Medicina 2025, 61(8), 1342; https://doi.org/10.3390/medicina61081342 - 25 Jul 2025

Cited by 4 | Viewed by 2577

Abstract

Background and Objectives: General-purpose multimodal large language models (LLMs) are increasingly used for medical image interpretation despite lacking clinical validation. This study evaluates the diagnostic reliability of ChatGPT-4o and Claude 2 in photographic assessment of adolescent idiopathic scoliosis (AIS) against radiological standards. This study examines two critical questions: whether families can derive reliable preliminary assessments from LLMs through analysis of clinical photographs and whether LLMs exhibit cognitive fidelity in their visuospatial reasoning capabilities for AIS assessment. Materials and Methods: A prospective diagnostic accuracy study (STARD-compliant) analyzed 97 adolescents (74 with AIS and 23 with postural asymmetry). Standardized clinical photographs (nine views/patient) were assessed by two LLMs and two orthopedic residents against reference radiological measurements. Primary outcomes included diagnostic accuracy (sensitivity/specificity), Cobb angle concordance (Lin’s CCC), inter-rater reliability (Cohen’s κ), and measurement agreement (Bland–Altman LoA). Results: The LLMs exhibited hazardous diagnostic inaccuracy: ChatGPT misclassified all non-AIS cases (specificity 0% [95% CI: 0.0–14.8]), while Claude 2 generated 78.3% false positives. Systematic measurement errors exceeded clinical tolerance: ChatGPT overestimated thoracic curves by +10.74° (LoA: −21.45° to +42.92°), exceeding tolerance by >800%. Both LLMs showed inverse biomechanical concordance in thoracolumbar curves (CCC ≤ −0.106). Inter-rater reliability fell below random chance (ChatGPT κ = −0.039). Universal proportional bias (slopes ≈ −1.0) caused severe curve underestimation (e.g., 10–15° error for 50° deformities). Human evaluators demonstrated superior bias control (0.3–2.8° vs. 2.6–10.7°) but suboptimal specificity (21.7–26.1%) and hazardous lumbar concordance (CCC: −0.123). Conclusions: General-purpose LLMs demonstrate clinically unacceptable inaccuracy in photographic AIS assessment, contraindicating clinical deployment. Catastrophic false positives, systematic measurement errors exceeding tolerance by 480–1074%, and inverse diagnostic concordance necessitate urgent regulatory safeguards under frameworks like the EU AI Act. Neither LLMs nor photographic human assessment achieve reliability thresholds for standalone screening, mandating domain-specific algorithm development and integration of 3D modalities. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Adolescent Idiopathic Scoliosis)

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Review

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16 pages, 601 KB

Open AccessReview

Impact of Dual Antibiotic Prophylaxis on 90-Day Surgical Site Infection Rates Following Posterior Spinal Fusion for Juvenile Scoliosis: A Single-Center Study of 296 Cases

by Paolo Brigato, Davide Palombi, Leonardo Oggiano, Sergio De Salvatore, Alessandro Rogani, Sergio Sessa and Pier Francesco Costici

Medicina 2025, 61(6), 1046; https://doi.org/10.3390/medicina61061046 - 6 Jun 2025

Cited by 1 | Viewed by 2150

Abstract

Background and Objectives: Surgical site infections (SSIs) significantly impact pediatric spinal deformity surgery. Considering the increased risk of Gram-negative infections in neuromuscular scoliosis (NMS), broader antibiotic coverage could be advantageous. Some studies suggest extending this approach to all scoliosis etiologies to reduce SSI rates. This study evaluates whether a dual antibiotic prophylaxis with cephalosporin and aminoglycoside reduces SSI incidence within 90 days postsurgery in adolescent idiopathic scoliosis (AIS), NMS, and syndromic scoliosis (SS) patients. Materials and Methods: This study included pediatric patients with AIS, NMS, or SS curves, treated with posterior spinal fusion between January 2019 and December 2022, with a minimum two-year follow-up. The primary outcome was early SSI incidence and its correlation with dual antibiotic prophylaxis in pediatric scoliosis surgery. Secondary outcomes included operative data, blood loss, hemoglobin levels, hospital stay, complications, pelvic fixation, and radiographic correction and how these factors could be identified as potential risk factors for SSIs. Descriptive and inferential statistics were used to analyze antibiotic regimen, SSI risk, and perioperative variables using chi-square, Mann–Whitney U, ANOVA, and Cox regression. Significance was set at p < 0.05. Results: The study included 296 patients: 222 with AIS, 46 with NMS, and 28 with SS. Ninety days postsurgery, SSI rates were 1.2% in AIS (0.8% deep, 0.4% superficial), 6.5% in NMS (all superficial), and 3.5% in SS (all superficial). Deep SSIs in AIS were associated with methicillin-resistant Staphylococcus aureus (MRSA). None of the cases required implant removal. Univariate Cox regression did not reveal any statistically significant predictors for SSIs. However, older age at surgery showed a protective trend, while higher preoperative ASA scores seemed to be a negative prognostic factor (respectively p = 0.051 and p = 0.08). Conclusions: Dual antibiotic prophylaxis with cefazolin and amikacin was associated with a lower SSI rate after posterior spinal fusion for scoliosis, with no adverse events. Further studies are needed to refine dosage, timing, and duration. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Adolescent Idiopathic Scoliosis)

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19 pages, 2114 KB

Open AccessSystematic Review

Assessment of Pulmonary Function After Treatment of Scoliosis: Meta-Analysis and Review Article

by Majdi Hashem

Medicina 2025, 61(7), 1127; https://doi.org/10.3390/medicina61071127 - 23 Jun 2025

Viewed by 3586

Abstract

Background and Objectives: Pulmonary function is a key outcome in scoliosis management, as both the condition and its treatments can impact respiratory mechanics. This systematic review aimed to assess the effects of scoliosis interventions on pulmonary function, focusing on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF). Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library to identify studies evaluating pulmonary function before and after scoliosis treatment. Data on respiratory parameters, intervention types, and follow-up periods were extracted. Meta-analyses were performed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. Results: The meta-analysis revealed no significant overall effect of scoliosis interventions on FVC or FEV1. For FVC, the pooled effect size was 0.0126 (95% CI: −0.0161 to 0.0413; p = 0.3728), and for FEV1, it was 0.0034 (95% CI: −0.0452 to 0.0519; p = 0.8869). Heterogeneity was minimal (I² = 0.0%) for both metrics. Individual studies showed variability: some reported increases in FVC and FEV1 by over 1.5 L, while others observed decreases in percent predicted values and absolute volumes. PEF generally improved, with some interventions showing statistically significant gains (p < 0.001). Conclusions: Non-invasive rehabilitation methods, such as breathing exercises and aquatic therapy, were associated with more consistent improvements in pulmonary function. In contrast, the effects of surgical interventions were variable and often not statistically significant. These findings suggest a promising role for conservative therapies in enhancing long-term respiratory outcomes in scoliosis patients, though further high-quality research is warranted. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Adolescent Idiopathic Scoliosis)

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