Search Results (137)

Background/Objectives: Surgical treatment is generally recommended for adolescent idiopathic scoliosis (AIS) when the Cobb angle exceeds 50 degrees even after skeletal maturity or 40 degrees with remaining growth potential. However, limited evidence exists regarding the natural history of curves between 40 and 50 degrees during the late stage of skeletal growth. This study aimed to evaluate the curve progression in AIS patients with a curve between 40 and 50 degrees at Risser stage IV or V. Methods: The inclusion criteria were as follows: (1) AIS patients at the late stage of skeletal growth (Risser IV or V) and a (2) curve between 40 and 50 degrees, with a minimum follow-up of 5 years. Sex, age, the magnitude of the curve, the location of the apex, Risser stage, height, and weight were measured at the baseline and the final follow-up. Curve progression was defined as an increase in the Cobb angle of ≥5 degrees. Patients were also categorized based on whether their final Cobb angle was <50 or ≥50 degrees to evaluate additional risk factors. Results: A total of 97 patients were included, with a mean follow-up of 97 months. Their mean age was 14.6 years at the baseline and 22.6 years at the final follow-up. The mean Cobb angle increased from 42.6 to 45.1 degrees, with a mean change of 2.7 degrees and an annual progression rate of 0.35 degrees. Curve progression was observed in 38 patients (39.2%), and 24 patients (24.7%) reached a final Cobb angle ≥ 50 degrees. Younger age (p = 0.004) and Risser stage IV (p = 0.014) were significantly associated with curve progression. In patients with a final Cobb angle ≥ 50 degrees, Risser stage IV (p = 0.050) and a larger baseline curve magnitude (p = 0.045) were also significant risk factors. Conclusions: In AIS patients at the late stage of skeletal growth, 39.2% experienced significant curve progression. A younger age and Risser stage IV were identified as risk factors for curve progression. A larger baseline curve magnitude and Risser stage IV were also associated with a final Cobb angle ≥ 50 degrees. Full article

Background/Objectives: Adolescent Idiopathic Scoliosis (AIS) is a lateral curvature of the spine combined with rotation and associated postural changes. Curves are classified according to direction and the spinal region, with right thoracic curves being a common presentation. Curve magnitude is measured using Cobb angles on radiographs and is used to monitor curve progression, with one of the main aims of treatment being prevention of progression to surgical levels. Treatment options may include observation, physiotherapeutic scoliosis-specific exercises (PSSE), thoracolumbosacral orthotic (TLSO) bracing, or surgery and are dependent on curve magnitude, risk of progression, and patient goals. Methods: This case series includes five patients (four female and one male, mean age of 14.8 y) who received previous non-surgical treatment without success and had severe right thoracic AIS with an average Cobb angle measurement of 53.4°, involving spinal curve magnitudes that warrant surgical recommendation. Results: These patients’ curves were successfully reduced to nonsurgical levels utilizing a non-surgical, multimodal treatment approach combining 3D corrective TLSO bracing using the ScoliBrace^®, PSSEs, and spinal rehabilitation over an average of 37.0 months. The average Cobb angle reduced from 53.4° to 29.6° (44.6% reduction) after being weaned off treatment. Conclusions: This series has shown successful, clinically significant improvement in Cobb angle and trunk symmetry in five patients with severe AIS using a non-surgical, multimodal approach combining 3D corrective TLSO bracing using the ScoliBrace^® and spinal rehabilitation procedures. Further investigation into this multimodal non-surgical approach for children, parents, and healthcare providers and policymakers seeking an alternative to surgical intervention for AIS is warranted. Full article

Background: Severe scoliosis can lead to chronic low back pain (cLBP) and may progress in adulthood. While day-time bracing is commonly used to alleviate pain and improve function, the role of night-time bracing remains unclear. This study aimed to assess the six-month effectiveness of a custom-made night-time brace in reducing pain in adults with scoliosis, compared to a prefabricated brace worn for 2–4 h during the day. Methods: A retrospective cohort study was conducted at a tertiary outpatient clinic specializing in spinal deformities. Adults with scoliosis (≥30° Cobb) and cLBP were divided into two groups: the study group used a custom-made night-time thoracolumbosacral orthosis (TLSO), while the control group wore a prefabricated brace (Peak) for 2–4 h daily. Pain and functional outcomes were assessed at baseline and after six months. Results: The study group included 25 women (mean age, 62.3 ± 9.5 years; Cobb angle, 60.4 ± 17.7°) who wore the night-time brace for an average of 7.2 ± 2.2 h per night. The control group comprised 20 women (mean age, 67.8 ± 10.5 years; Cobb angle, 61.9 ± 12.6°). At six months, the worst pain significantly improved in the TLSO group compared to the Peak group (F = 6.32, p = 0.0158). However, no statistically significant differences were observed between groups for back pain, leg pain, Core Outcome Measures Index (COMI), or Oswestry Disability Index (ODI). Conclusions: Night-time bracing shows interesting results on pain at six months in adults with severe scoliosis and back pain. These preliminary results open a new perspective that needs further verification and will help design more robust studies to verify what we found and identify the population more responsive to this approach. Full article

Background/Objectives: Spinal muscular atrophy (SMA) is a neuromuscular disorder frequently associated with progressive scoliosis requiring posterior spinal fusion (PSF). While Nusinersen offers significant clinical benefit, its intrathecal administration is challenging in patients with extensive spinal instrumentation and solid fusion. This study aimed to evaluate the safety, feasibility, and patient acceptance of lumbar laminectomy as a method to restore intrathecal access for repeated Nusinersen delivery in this population. Methods: A retrospective review was conducted in eleven patients with SMA who underwent lumbar laminectomy following prior PSF and confirmed radiographic fusion. Surgical data, injection outcomes, and patient-reported experiences were collected. A structured questionnaire assessed technical success, imaging requirements, sedation, functional response, and satisfaction. Results: Nine out of eleven patients (81.8%) successfully initiated intrathecal Nusinersen therapy through the laminectomy window, receiving a mean of 11.7 injections (range: 10–14). Imaging guidance was used in five cases; three required sedation or anesthesia. Intraoperative dural tears occurred in three patients and were managed without complications. Eight out of nine treated patients reported subjective motor improvement and expressed willingness to undergo the procedure again. No hardware revisions or major adverse events were observed during a mean follow-up of 48.8 months. Conclusions: Lumbar laminectomy is a viable and well-tolerated technique to establish intrathecal access in SMA patients with prior PSF. This approach enables sustained drug delivery and may remain clinically relevant as new intrathecal therapies emerge. Full article

Background/Objectives: Scoliosis screening aims to detect spinal deformities early and prevent progression. The Programa de Atención a la Salud de Niños y Adolescentes (PANA) in Spain includes primary care screenings at ages 5–6, 10–11, and 13–14, but its effectiveness remains unverified. First, we evaluated attendance rates in each phase. Second, a nine-year follow-up was used to determine outcomes in adolescents who completed all three phases of PANA. Methods: A retrospective–prospective cohort study was conducted. The retrospective phase analyzed records of 881 schoolchildren screened at a primary healthcare center in Lorca, Spain. The prospective phase re-evaluated 127 adolescents (94.1% of those who completed all three phases) after nine years using a standardized forward bending test (FBT) with scoliometer quantification. Results: Attendance declined from 73.2%, at age 5–6, to 20.5%, at age 13–14. Only 15.3% completed all three phases. At age 13–14, 11.1% had a positive FBT by visual assessment. Non-quantified FBT had low sensitivity (5.9%) but high specificity (96.7%). Nine years later, mean scoliometer-measured vertebral rotation was 3.6 ± 1.7° (thoracic) and 2.5 ± 1.4° (lumbar). Scoliosis suspicion (FBT > 5°) was 15.1%, but applying the FBT > 7° threshold it was reduced to 4%. Conclusions: The PANA program has limited effectiveness due to low attendance and lack of scoliometer use. Visual FBT without quantification increases false positives, reducing diagnostic accuracy. It is recommended that preventive assessments be conducted in schools by primary care physicians. Training in the use of the scoliometer is essential to improve scoliosis detection. Full article

Background/Objectives: Morphological spinal alterations in adolescents, including idiopathic scoliosis (IS) and postural scoliotic attitudes (paramorphisms), may be associated with leg length discrepancy (LLD) and breast asymmetry (BA). This study aimed to assess the prevalence and characteristics of LLD and BA in adolescents with spinal paramorphisms and dysmorphisms (IS), and to explore associations between these asymmetries and spinal curve features. Methods: A cross-sectional observational study was conducted. Adolescents aged 10–18 years were included. LLD was measured clinically via direct tape measurement and, when necessary, ultrasound. BA was assessed via visual inspection. Spinal deformities were characterized via clinical and radiological examination. Results: Among the 44 participants, 26 (60%) had IS and 18 (40%) had postural scoliotic attitudes. LLD was present in 79.5% (mean 0.7 ± 0.6 cm; all mild). BA was observed in 14% of the sample. LLD was more frequent in IS (87%) than in postural scoliotic attitudes (72%). In lumbar postural curves, the shorter limb was consistently ipsilateral to the curve convexity. In IS, no consistent association was found between LLD and curve characteristics. BA was slightly more prevalent in IS (19%) than postural scoliotic attitudes (17%), with no consistent pattern relative to curve convexity. Conclusions: Mild LLD is common in adolescents with spinal asymmetries and reflects general population norms. While LLD may influence compensatory postural curves, it does not appear to affect IS curve patterns or severity. BA is more frequent in IS, but shows variable association with curve features. Considering LLD and BA prevalence in adolescents with spinal asymmetries routine assessment is warranted, though their impact on IS progression is limited. Full article

This report provides a concise selective representative overview of the predictor factors for progression in Idiopathic Scoliosis (IS). The Cobb angle method, rib hump deformity, imaging and advanced techniques for assessing skeletal maturity serve as key elements in evaluating prognostic factors for IS progression based on the patient’s age at diagnosis—particularly in Infantile Idiopathic Scoliosis (IIS), Juvenile Idiopathic Scoliosis (JIS), and Adolescent Idiopathic Scoliosis (AIS). The commonly used approaches for determining skeletal maturity include the assessment of the iliac apophysis and scoliosis curve deterioration, the Sanders skeletal maturity staging system, the distal radius and ulna (DRU) classification for predicting growth spurts and curve progression in IS, as well as the ossification of vertebral epiphyseal rings, the humeral head, and the calcaneal apophysis. Prognostic factors influencing IS progression are further discussed in relation to the patient’s age at onset—whether in infancy, childhood, or adolescence—as well as in both untreated and braced AIS patients. Additionally, the apical convex rib–vertebra angle in AIS is explored as an indicator of progression. Predictors for curve progression at skeletal maturity are outlined, along with various models for forecasting IS deterioration. Lastly, the Rib and Segmental Rib Index, a rib cage deformity parameter, is introduced as a predictor of scoliosis progression. In conclusion, this concise and selective overview of predictor factors for progression in IS highlights the current understanding of IS progression factors. It also introduces the Rib and Segmental Rib Index—a rib cage deformity parameter—as a predictor of IS progression. Full article

Scoliosis is a three-dimensional deformity of the spine that can lead to a series of physical and psychological problems. Appropriate controlling forces should be applied to prevent the curve’s progression and even correct the deformity. The aims of this study were to develop a biomechanical model that can quickly estimate the optimal positions and magnitudes of the controlling forces for treating scoliosis and to analyze the interaction between longitudinal traction and lateral forces. Based on the scoliotic curve information that was extracted and simulated from the computed tomography data of patients, a mathematical model of scoliosis was established via the Timoshenko beam theory. The model could be optimized to provide precise and effective treatment for patients with different scoliosis curve patterns. The relationship between the corrective force position, magnitude, and the treatment effect on scoliosis could be obtained using this model. This study provides a biomechanical theoretical basis for determining the magnitude, position, and sequence of applying controlling forces on spines for patients with scoliosis. Full article

Background: Syringomyelia is a complex neurological disorder characterized by a fluid-filled cavity (syrinx) within the spinal cord, frequently resulting from altered cerebrospinal fluid (CSF) dynamics. While its clinical manifestations are diverse, orthopedic complications such as scoliosis, pes cavus, and Charcot arthropathy may represent early diagnostic clues yet are often under-recognized. Methods: This comprehensive review synthesizes the current literature on the pathophysiology, clinical presentation, diagnostic strategies, and management approaches of syringomyelia, with a specific emphasis on its orthopedic manifestations. Additionally, we present a detailed case of neuropathic shoulder arthropathy associated with advanced syringomyelia. Results: Orthopedic involvement in syringomyelia includes progressive spinal deformities and neurogenic joint destruction, particularly affecting the shoulder and elbow. Scoliosis is frequently observed, especially in association with Chiari malformations, and may precede neurologic diagnosis. Charcot joints result from impaired proprioception and protective sensation. The case presented illustrates the diagnostic challenges and therapeutic dilemmas in managing advanced neuro-orthopedic complications in syringomyelia. Conclusions: Syringomyelia should be considered in the differential diagnosis of atypical musculoskeletal presentations. Early recognition and multidisciplinary management are essential to prevent irreversible orthopedic sequelae. Conservative treatment remains the mainstay in stable cases, while surgery is reserved for progressive disease. Orthopedic assessment plays a pivotal role in the diagnostic pathway and long-term care of affected patients. Full article

This opinion article refers to the “double rib contour sign” and to the rib index (DRCS and RI), to their reliability study results in the chest radiographs of a control group and to their validity study results. These two parameters were introduced by the first author in this report. The introduction of the Segmental Rib Index (SRI) and its relation to spinal deformity is also discussed. The RI has been confirmed to be a strong surrogate for scoliometric readings in idiopathic scoliosis (IS). The clinical applications of the RI are analyzed for the following: (a) the documentation of deformity; (b) the assessment of physiotherapy outcomes (PSSEs); (c) the documentation of the outcomes of brace treatment; (d) the documentation of the pre- and post-operative assessment of thoracic deformity correction in different types of instrumentation; (e) its usage in prognosticating accelerated deterioration in skeletally mature adolescent idiopathic scoliosis (AIS) curves of 40–50 degrees; and (f) its usage in the recognition of the proper rib level for thoracoplasty/costoplasty. The emerging etiological–scoliogenic implications from the use of the DRCS and RI are described. The rotation of the trunk and vertebral bodies as interrelated, but distinct parameters are finally analyzed. Full article

Background: Scoliosis is a disorder characterized by an abnormal spinal curvature, which can lead to negative effects on patients, affecting their quality of life. Given its progressive nature, the classification of the scoliosis severity requires an accurate diagnosis and effective monitoring. The Cobb angle measurement method has been widely considered as the gold standard for a scoliosis assessment. Commonly, an expert assesses scoliosis severity manually by identifying the most tilted vertebrae of the spine. However, this method requires time, effort, and presents limitations in measurement accuracy, such as the intra- and inter-observer variability. Artificial intelligence provides more objective tools that are less sensitive to manual intervention aiming to transform the diagnosis of scoliosis. Objectives: The objective of this study was to address three key research questions regarding automated Cobb angle quantification: “Where is the spine in this radiograph?”, “What is its exact shape?”, and “Is the proposed method accurate?”. We propose the use of Mask R-CNN architecture for spine detection and segmentation in response to the first two questions, and a set of algorithms to tackle the third. Methods: The network’s detection and segmentation performance was evaluated through various metrics. An automated workflow for Cobb angle quantification and severity classification was developed. Finally, statistical methods provided the agreement between manual and automated measurements. Results: A high segmentation accuracy was achieved, highlighting the following: mIoU of 0.8012, and a mean precision of 0.9145. MAE was 2.96° ± 2.60° demonstrating a high agreement. Conclusions: The results obtained in this study demonstrate the potential of the proposed automated approach in clinical scenarios, which provides experts with a clear visualization of each stage in the scoliosis assessment by overlaying the results onto the X-ray image. Full article

Adolescent idiopathic scoliosis (AIS) is treated with various forms of conservative care or surgery, depending on the degree of severity. When AIS is detected early, it can be monitored and initially treated with reduced invasiveness to prevent further progression. AIS manifests itself through deformations of the trunk, which are mostly identified as asymmetries in manual clinical examination. Torsobarography is a new pressure-based surface topographic system for posture analysis and evaluates such associated morphologic asymmetries. The aim of this study is to investigate the diagnostic validity of torsobarography by examining correlation of extracted torsobarographic indices with the Cobb angle and its ability to differentiate between different severities of scoliosis: no scoliosis, mild scoliosis, and moderate scoliosis. A total of 87 subjects (51 females and 36 males) were examined with torsobarography. Six torsobarographic indices were calculated for all subjects: torsobarography angle (TBA), sagittal imbalance index (SII), torso asymmetry index (TAI), shoulder asymmetry angle (SAA), waist asymmetry angle (WAA), and pelvis asymmetry Angle (PAA). These indices were correlated with the Cobb angle, and the differences between severities were statistically analyzed. Three out of six indices (TBA, TAI, and WAA) were able to significantly distinguish between mild and moderate scoliosis. Additionally, those indices showed moderate correlation ($\rho$ = 0.37–0.50) with the Cobb angle measurements. The WAA was the only statistically significant index capable of differentiating between no scoliosis and moderate scoliosis. This study is the first to demonstrate that torsobarography can distinguish between different severities of scoliosis and thus identify a scoliotic deformity that requires bracing over monitoring. Full article

Background/Objectives: Scoliosis is a prevalent comorbidity in Rett syndrome (RTT), often necessitating surgical intervention. This study investigated the impact of a 10-month individualized home exercise program (HEP) on scoliosis progression and gross motor function in girls aged six to 16 years with RTT. Methods: A multiple-baseline single-case design (AABA) was employed with 20 participants. A remotely supervised HEP, based on established principles focused on posture and physical activity, was implemented daily for at least one hour. The primary outcome was the rate of scoliosis progression assessed through the Cobb angle change measured via spinal radiographs at baseline, pre-intervention, and post-intervention. The secondary outcome was the gross motor function. Results: The HEP did not significantly reduce the rate of scoliosis progression. However, individual responses varied, with three participants showing scoliosis reduction. Significant improvements were observed in gross motor function, particularly in standing, walking, and stair-climbing abilities. Conclusions: The HEP did not significantly impact overall scoliosis progression, but a significant improvement was found in gross motor function. Further research into larger sample sizes is needed to confirm the effectiveness of exercise interventions in people with RTT. Full article

Background/Objectives: Bracing is an effective treatment for preventing curve progression in skeletally immature adolescent idiopathic scoliosis (AIS) patients. A novel hybrid brace has been developed to overcome the limitations of conventional rigid and soft braces. This study aimed to evaluate the clinical efficacy of the novel hybrid brace. Methods: We enrolled AIS patients who were candidates for brace treatment: aged 10–18 years, with a coronal Cobb angle of 20–45° and a Risser stage of 0–2. The primary outcome was the rate of successful brace treatment, defined as meeting all three criteria: (1) less than 5° of progression in the Cobb angle during follow-up, (2) less than 45° of Cobb angle at the final follow-up, and (3) avoidance of surgical treatment. Results: A total of 24 patients (1 male, 23 female) with a mean age of 12.2 ± 1.2 years were included in this study. At the initiation of bracing, the major curve had a mean Cobb angle of 34.5 ± 6.3° and an in-brace correction (IBC) rate of 41.5 ± 16.0%. The hybrid brace demonstrated a success rate of 91.7% (22/24) during a mean follow-up period of 22.1 ± 6.4 months. After brace treatment, seven (29.2%) patients showed an improvement of more than 5° in their Cobb angle. When compared to a matched control from a retrospective cohort, the hybrid brace demonstrated a greater success rate (91.7% vs. 83.3%) and a higher proportion of patients with an improved curve (29.2% vs. 12.5%), although statistically insignificant. Conclusions: A novel hybrid brace was effective in preventing curve progression in skeletally immature patients with AIS. Full article

Background and objectives: Idiopathic scoliosis is a three-dimensional spinal deformity characterized by a lateral curvature exceeding 10 degrees in the frontal plane accompanied by vertebral rotation in the transverse plane. Despite extensive research on genetic and neurological factors, its etiology is uncertain. This prospective observational study aims to investigate the relation between the primitive reflexes, specifically, the asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), and spinal Galant reflex (SGR), which play key roles in early motor development and postural control and the severity of idiopathic scoliosis (measured via the Cobb angle and the Nash–Moe rotational quota. Additionally, the study evaluated whether the retention of primitive reflexes correlates with increased progression risk over 12 months of conservative treatment. Materials and Methods: Our study cohort included 162 patients, aged 7–19 years, diagnosed with idiopathic scoliosis, who underwent clinical examination and assessment of retained primitive reflexes using standardized grading systems. Results: A total of 162 patients (95 girls, 67 boys; mean age: 12.73 ± 2.74 years) met the inclusion criteria. In 73.5% of the cases, scoliosis was detected, with the majority occurring in the dorsal region (40.1%). The mean initial Cobb angle was 13.49° ± 7.14°, with no significant change after 12 months of conservative treatment (p = 0.584). Nash–Moe rotation scores were 1 in 52.5% and 2 in 22% of the cases. Retention of the following primitive reflexes were identified at baseline: Moro (19.1%), ATNR (38.3%), STNR (44.4%), and GSR (27.8%). GSR retention significantly correlated with the Cobb angle (p = 0.011; R = 0.233). All the reflex scores decreased significantly after 12 months, but no correlation existed between the retained reflexes and scoliosis progression. Patients with a history of quadrupedal locomotion had significantly lower ATNR (p = 0.002), STNR (p < 0.001), and GSR (p = 0.017) retention. Conclusions: These findings suggest that primitive reflex testing could serve as an early screening tool in scoliosis risk stratification, being a cost-effective, non-invasive instrument for identifying at-risk children before clinically significant deformity develops. Full article