Search Results (57)

Background/Objectives: Coronary Artery Disease (CAD) is one of the leading causes of death in the United States. Although there is a plethora of studies about CAD, there remains a gap in the literature in examining the role of CAD in patients who undergo spine surgery. In this study, we examine the role of CAD in postoperative outcomes in adult patients who underwent surgery for degenerative scoliosis. Methods: The Scoliosis Research Society Database was queried for patients with degenerative scoliosis and divided into two cohorts: CAD and non-CAD. To minimize confounding bias, propensity score matching was done on comorbidities and patient demographics. Outcomes examined included: intraoperative complications, postoperative outcomes, and mortality rate. After matching, there were 139 patients in each group. Results: The CAD group had significantly higher rates of cardiac-related complications (5.8% vs. 0%, p = 0.012). No other intraoperative complications had significant differences between the groups. Interestingly, the non-CAD group had both a higher rate of returning to surgery (46.8% vs. 33.8%, p = 0.038) and antibiotic-related complications (5.8% vs. 0.7%, p = 0.042) respectively. There were no other differences regarding postoperative outcomes, including mortality. Conclusions: Our study found that aside from cardiac-related complications, the CAD group did not have any worse outcomes, and in some cases did better. These results are promising and may be due to more extensive preoperative screening and more risk aversion in patients with CAD. Our findings suggest that if spine surgeons exercise risk management for cardiac complications, CAD patients may benefit greatly from scoliosis surgery at no increased risk. Full article

Background/Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine with multifactorial etiology. Its treatment is conservative and/or surgical. The most commonly used conservative method is a full-time brace. However, nighttime braces have recently gained prominence, offering improved tolerance and a positive impact on health-related quality of life. The main objective of this study was to conduct a narrative review of published articles comparing the effectiveness of Providence nighttime versus full-time brace use to determine whether nighttime use is an effective option for improving therapeutic adherence, health-related quality of life, and psychosocial impact. Methods: A scientific literature search was conducted using the Scopus and PubMed databases. We searched for randomized controlled trials (RCTs), meta-analyses, systematic reviews and retrospective comparative studies reported in English from 2019 to 2024. The literature search was conducted from October to April 2024. Different combinations of the terms and MeSH terms “adolescent”, “idiopathic”, “scoliosis”, “Providence”, “full-time” and “brace” connected with various Boolean operators were included. Results: Overall, 70 articles were reviewed from the selected database. After removing duplicated papers and title/abstract screening, 10 studies were included in our review. The results showed that nighttime brace use has similar results in terms of effectiveness to full-time brace use in mild to moderate curves. However, nighttime brace use improves therapeutic adherence, health-related quality of life and psychosocial impact. Nevertheless, the effectiveness of night braces depends on factors such as curve type, magnitude, and bone maturity. So, in patients with moderate-severe curves and high growth velocity, it is important to reconsider the type of brace, as in these cases night braces alone may be ineffective in slowing the progression of the curve. Conclusions: Providence nighttime brace could be an effective treatment and better tolerated alternative to full-time brace in specific cases. This approach could improve therapeutic adherence. Nevertheless, more controlled and homogeneous studies are needed to establish definitive recommendations. Full article

Osteogenesis imperfecta (OI) type XIV is a rare recessive disorder caused by TMEM38B pathogenic variants that disrupt an endoplasmic reticulum protein essential for calcium homeostasis and bone mineralization. This leads to severe bone fragility, early-onset fractures, skeletal deformities, low bone mass, scoliosis, and variable features like blue sclerae or dental abnormalities. We present a case report of a 21-year-old Italian male with a novel homozygous TMEM38B splice variant (c.112 + 1G > T), detailing the clinical presentation, genetic findings, and therapeutic outcomes. The patient exhibited multiple skeletal deformities and showed a moderate response to bisphosphonate therapy (neridronate). In addition, a systematic review of PubMed and Scopus identified 12 relevant studies from an initial set of 82 publications, encompassing data from 56 patients diagnosed with OI type XIV. Unlike classical collagen-related OI, TMEM38B-related OI necessitates genetic screening beyond classical collagen genes (COL1A1 and COL1A2). While bisphosphonates provide some clinical benefit, persistent fractures underscore the need for long-term management and innovative therapies. This case report and systematic review enhance understanding of OI type XIV and underscore the clinical importance of TMEM38B variants in bone fragility disorders. Full article

Background: Scoliosis is a common musculoskeletal disorder that remains underrecognized in Saudi Arabia, where limited public awareness may delay early detection and treatment. This study assessed public knowledge, support for school-based screening, and attitudes toward treatment. Methods: A nationwide cross-sectional survey was conducted during the 2025 Saudi National Scoliosis Awareness Campaign through public venues and online platforms. A culturally adapted questionnaire assessed demographics, knowledge, symptom recognition, treatment preferences, barriers, and information sources. A total of 2055 responses were analyzed using descriptive statistics and chi-square tests. Results: While 70.9% of participants had heard of scoliosis, only 18.1% reported good understanding. Symptom recognition was limited, with spinal curvature, back pain, and uneven shoulders most often identified. Most respondents supported school-based screening (88.2%) and early detection (92.1%), with a mean preferred screening age of 8 years. Bracing (64.3%) and surgery (53.5%) were more accepted than observation (30.5%), though concerns about pain, effectiveness, and appearance were frequent. Social media was the most common initial information source (34.6%), while healthcare professionals were the preferred future source (79.2%). Reported barriers included lack of awareness (68.2%), difficulty accessing specialists (19.9%), and cost (8.9%). Conclusions: Public support for school-based screening is strong, but baseline knowledge remains limited, and treatment perceptions are shaped by psychosocial and cultural concerns. National campaigns, school curricula, and healthcare-led education, combined with accessible, low-cost screening, may enhance early detection and improve scoliosis management in Saudi Arabia. Full article

Background/Objectives: Although screening for scoliosis is common among adolescents, little is known about its subtypes and their correlations in young adults. This study aimed to investigate the prevalence and classification of scoliosis (functional vs. structural) among female university students in Saudi Arabia and to examine associated factors. Methods: A cross-sectional study was conducted with 263 female students at Taibah University. Screening was performed using Adam’s forward bending test and a scoliometer. Data on age, body mass index, academic year, hand dominance, habitual sitting posture, backpack carriage method, leg-length discrepancy, painful conditions, and family history of scoliosis were collected. The association between scoliosis subtypes and contributing factors was analyzed using descriptive statistics, chi-square test, and Spearman’s correlation. Results: Scoliosis was identified in 94 students (prevalence, 35.7%). Of these, 26.2% had functional scoliosis, whereas 9.5% had structural scoliosis. Functional scoliosis was significantly associated with sitting posture, leg-length discrepancy, and age (p < 0.05), whereas structural scoliosis was associated with family history, habitual sitting posture, and painful conditions (p < 0.05). Conclusions: The high prevalence and differing profiles of scoliosis subtypes underscore the need for routine postural screening in universities. Early identification and ergonomic education may help in selecting appropriate targeted interventions for individuals with functional or structural scoliosis. Full article

Background/Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that can negatively impact on quality of life, pulmonary function, and body image. Its conservative management includes various interventions, among which the Schroth method stands out. This approach is based on three-dimensional corrective exercises and rotational breathing. This review aimed to analyze the effectiveness of the Schroth method, applied either alone or in combination with other conservative therapies, on variables such as Cobb angle, angle of trunk rotation (ATR), pulmonary function, and health-related quality of life in patients with AIS. Methods: A scientific literature search was conducted using the PubMed database. We searched for randomized controlling trials (RCTs), systematic reviews, and meta-analyses reported in English from 2020 to 2025. Different combinations of the terms and MeSH terms “adolescent”, “idiopathic”, “scoliosis”, and “Schroth” connected with various Boolean operators. Results: Overall, 82 articles were reviewed from the selected database. After removing duplicated papers and title/abstract screening, 13 studies were included in our review. The results showed that the Schroth method proved effective in reducing the Cobb angle and ATR, particularly in patients with mild curves and in early stages of skeletal growth. Improvements were also observed in health-related quality of life and aesthetic perception, and to a lesser extent, in pulmonary function. Moreover, therapeutic adherence and treatment continuity were important to maintaining long-term benefits. Conclusions: The Schroth method could be an effective treatment associated with orthopedic treatment, yielding satisfactory results. Its implementation requires structured programs, professional supervision, and strategies to enhance therapeutic adherence. Nevertheless, to validate its long-term effectiveness, we need more homogeneous studies with longer follow-up durations. Full article

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

Scoliosis is one of the most common spinal deformities, which affects millions of people worldwide. Bracing and physiotherapy exercises represent the first-line, non-invasive approaches for managing scoliosis. In recent years, the use of wearable devices has spread as a novel approach to the treatment of scoliosis. However, their effectiveness in treatment planning and outcomes has not been thoroughly evaluated. This manuscript provides a scoping review of the classification and application of wearable devices and the role of artificial intelligence (AI) in interpreting the data collected by wearable devices and guiding the treatment. A systematic search was carried out on Scopus, Web of Science, PubMed, and EMBASE for studies published between January 2020 and February 2025. A total of 269 studies were screened, and 88 articles were reviewed in depth. Inclusion criteria encompassed articles focusing on wearable devices integrated into smart braces, rehabilitation systems for scoliosis management, AI and machine-learning (ML) applications in scoliosis treatment, virtual reality (VR), and telemedicine for scoliosis care. The literature shows that the use of wearable devices can enhance scoliosis treatment by improving the efficiency of braces and enabling remote monitoring in rehabilitation programs. However, more research is needed to evaluate user compliance, long-term effectiveness, and the need for personalized interventions. Future advancements in artificial intelligence, microsensor technology, and data analytics may enhance the efficacy of these devices, which can lead to more personalized and accessible scoliosis treatment. 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: Spinal asymmetries and postural deviations are common concerns in young athletes, particularly those engaged in sports requiring repetitive and asymmetrical movements. Soccer, as a dynamic sport, involves high levels of trunk rotation, rapid directional changes, and frequent loading asymmetry, which may predispose players to spinal deviations. This study aimed to investigate the regional prevalence of primary and secondary angle trunk rotation (ATR) in adolescent male soccer players across different age groups. Methods: A total of 502 male participants (291 soccer players and 211 nonathletes) aged 11 to 14 years were included in the study. Participants underwent scoliosis screening using a scoliometer following Adam’s forward bending test. ATR measurements were recorded at the thoracic and lumbar spinal regions, with primary ATR (ATR-A) and secondary ATR (ATR-B) assessed separately. A chi-square test (χ²) evaluated the association between training level and the regional prevalence of ATR across different age groups. Results: No significant differences were observed in the regional prevalence of ATR-A and ATR-B in the 11-year-old group. However, by age 12, significant differences emerged in ATR-A prevalence (χ²(3) = 16.469, p = 0.001), while ATR-B remained nonsignificant (χ²(2) = 4.040, p = 0.133). In the 13- and 14-year-old groups, significant associations were found for both ATR-A (χ²(3) = 57.219, p < 0.001; χ²(4) = 34.157, p < 0.001) and ATR-B (χ²(3) = 31.481, p < 0.001; χ²(2) = 17.805, p < 0.001), with moderate to strong effect sizes. Conclusions: While no significant differences were observed in younger players, 13- and 14-year-old soccer players exhibited a significantly higher prevalence of ATR than nonathletes. The findings suggest that soccer players exhibited a higher prevalence of spinal asymmetries, particularly in older age groups, with lumbar ATR being more pronounced. The study highlights an increasing trend of spinal asymmetries with training level among young soccer players, likely due to the cumulative effects of asymmetric movement patterns. These findings emphasize the need for early detection and corrective interventions to mitigate potential long-term musculoskeletal imbalances in adolescent soccer players. 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: This opinion paper provides a brief overview of the history of school scoliosis screening programs following the introduction. Methods: It outlines the international administrative policies of these programs, their impact on the frequency of surgical procedures, and the effects of discontinuing school-based scoliosis screenings. Results: The primary focus is on analyzing the role of “false positive” cases detected during the Adam’s bending test, which has contributed to the discontinuation of these programs in certain countries. This focused discussion is based on the impact of growth on the relationship between spinal and rib cage deformities. Furthermore, we propose the selection of the optimal age range for screening, considering the correlation between idiopathic scoliosis prevalence and geographical latitude. Conclusions: Lastly, we emphasize the importance of continuing scoliosis screening programs in schools. 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

Background: Idiopathic scoliosis (IS) is a common spinal deformity affecting 0.5% to 5.2% of children worldwide, with a higher reported range in Spain (0.7–7.5%). Early detection through screening is crucial to prevent the progression of mild cases to severe deformities. Clinical methods such as the ADAM test and trunk rotation angle (TRA) are widely used, but the development of three-dimensional (3D) surface topography (ST) technologies has opened new avenues for non-invasive screening. The objectives of this study were (1) to perform clinical and ST-based scoliosis screening in a sample of healthy children involved in club sports, (2) to estimate the agreement between clinical and ST screening methods, (3) to describe the prevalence of scoliosis by sport, sex, and age, and (4) to evaluate the diagnostic performance of both screening approaches using available radiographs as a reference standard. Methods: A total of 343 children (58.7% males, 41.3% females; mean age 11.69 ± 2.05 years) were screened using both clinical and ST methods. Clinical screening included the ADAM test and TRA measurement, while ST screening was performed using BackSCNR^®, a markerless 3D scanning software. The children with positive screening results were recommended to obtain radiographs to confirm the diagnosis. Kappa agreement, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for both screening modalities using radiographic results as the gold standard. Results: The prevalence of scoliosis was 3.2% (n = 11) based on radiographic confirmation. The prevalence by sport was highest in swimming (17.6%), with minimal differences by sex (males 3.6%, females 2.5%). The clinical screening showed a sensitivity of 73%, specificity of 97%, PPV of 47%, NPV of 99%, and accuracy of 96%. The ST screening showed a sensitivity of 36%, specificity of 99%, PPV of 80%, NPV of 97%, and accuracy of 97%. The kappa values indicate a moderate influence of chance for both methods (clinical κ = 0.55; ST κ = 0.48). The balanced accuracy was 84% for the clinical screening and 68% for the ST screening. Conclusions: The clinical screening method showed superior sensitivity and balanced accuracy compared to ST screening. However, ST screening showed higher specificity and PPV, suggesting its potential as a complementary tool to reduce the high positive predictive value. These results highlight the importance of combining screening methods to improve the accuracy of the early detection of IS in physically active children, with the radiographic confirmation of the positive screened cases remaining essential for accurate diagnosis. Full article

Background: Anorectal malformations (ARMs) are a common pediatric surgical problem with an incidence of 1:1500 to 1:5000 live births. The phenotypical spectrum extends from anal stenosis to imperforate anus with or without anal fistula to persistent cloaca. They can manifest as either non-syndromic or syndromic conditions. Various environmental and genetic risk factors have been elucidated. The widespread use of genetic screening tests for the investigation of developmental disorders increased the recognition of copy number variants (CNVs) of the 1q21.1 region. Duplications have also been associated with a multitude of congenital anomalies, such as heart disease, short stature, scoliosis, urogenital, and ARMs, and they have also been found in healthy individuals. The aim of this manuscript is to contribute to the definition of the phenotype associated with 1q21.1 duplications. Case presentation: The present case describes a male, referred to us for an ARM, in whom array—comparative genomic hybridization (array-CGH) identified 1q21.1 duplication inherited from his healthy mother. No other genetic test was performed on the patient. Conclusions: We propose considering genetic evaluation and analysis in patients with only one congenital malformation in order to eventually make an early diagnosis and a better quality of treatments. Full article