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The relationship between minor coronal asymmetry of the spine and measures of spinal sagittal shape in adolescents without visible scoliosis

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

The relationship between minor coronal asymmetry of the spine and measures of spinal sagittal shape in adolescents without visible scoliosis

Adrian Gardner, Fiona Berryman, Paul Pynsent  

Sci Re. 2023 Mar 15;13(1):4294. doi: 10.1038/s41598-023-31237-z.

Abstract

The purpose of this work is to identify what features of overall spinal sagittal shape are associated with coronal asymmetry in those without scoliosis. Using a longitudinal analysis of Integrated Shape Imaging System 2 (ISIS2) surface topography images of those without scoliosis, measures of coronal asymmetry, along with measures of spinal sagittal shape (kyphosis, lordosis and sagittal imbalance, which is a measure of the position of the top of the thoracic spine relative to the sacrum) were analysed using linear mixed effect models (LMEM), which is a method of analysing the components of a complex model (such as that describing overall spinal shape), to ascertain the relative relationships between the parameters. Data was also analysed when subdivided for the anatomical level of coronal asymmetry (thoracic or thoracolumbar/lumbar pattern). There were 784 measures from 196 children. Kyphosis had little effect on coronal asymmetry for males and females, lordosis increased with coronal asymmetry in females only and sagittal imbalance increased with coronal asymmetry in males only. The results of the LMEM modelling were that the parameters related to coronal asymmetry were lordosis and sagittal imbalance. In thoracic coronal asymmetry, whilst lordosis was predominant, kyphosis played more of a role. In thoracolumbar/lumbar coronal asymmetry, lordosis and sagittal imbalance were the larger coefficients. Coronal asymmetry of the spine in those without scoliosis is related to features of spinal sagittal shape, particularly lordosis and sagittal imbalance. This knowledge adds to the understanding of the aetiology of adolescent idiopathic scoliosis.

https://pubmed.ncbi.nlm.nih.gov/36922571/

Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article

Marissa Muccio, Osnat Atun-Einy, Michal Kafri, Sandra L Kaplan 

Phys Occup Ther Pediatr 2023 Mar 15;1-18.doi: 10.1080/01942638.2023.2186198

Abstract

Aim: This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration.

Methods: Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework.

Conclusions and implications: As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.

Keywords: Motor learning and control; physiotherapeutic scoliosis specific exercises; scoliosis; spine; therapeutic exercise.

https://pubmed.ncbi.nlm.nih.gov/36922700/

Patients with Adolescent Idiopathic Scoliosis Have Higher Metabolic Cost during High-Intensity Interval Training

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Patients with Adolescent Idiopathic Scoliosis Have Higher Metabolic Cost during High-Intensity Interval Training

Rufina Wing-Lum Lau, Rachel Lai-Chu Kwan, Jack Chun-Yiu Cheng, Stanley Sai-Chuen Hui, Tsz-Ping Lam 

Int J Eviron Res Public Health 2023 Jan 25;20(3):2155. doi: 10.3390/ijerph20032155

Abstract

Background: Patients with adolescent idiopathic scoliosis (AIS) are found to have a lower level of physical activity, and may have reduced exercise capacity due to spinal deformity. Previous study showed the benefits of high-intensity interval training (HIIT), named E-Fit, which is specifically designed for patients with AIS to improve musculoskeletal health and psychological well-being. To optimize the beneficial effects of training, the current study aimed to investigate the appropriate exercise intensity and metabolic demand in patients with AIS when performing E-Fit.

Methods: In all, 22 female subjects, 10 diagnosed with AIS and 12 gender-matched healthy controls, aged between 10 and 16 years, were recruited. Subjects were instructed to perform two trials of a seven min E-Fit. Breath-by-breath gas exchange parameters including oxygen consumption (VO2), heart rate (HR) and the rate of perceived exertion (PRE) were measured during exercise. Demographic data and clinical features of AIS and body composition were obtained. Metabolic demand between AIS and control groups was compared using MANOVA with covariates adjustment.

Results: Patients with AIS had an earlier onset of menarche (p = 0.01), higher visceral adipose tissue (p = 0.04) and percentage body fat (p = 0.03) as compared to controls. Patients with AIS showed a significantly higher adjusted means of VO2 average in both the first (p = 0.014) and second trials (p = 0.011) of E-Fit. The adjusted mean of the highest measured VO2 was higher than healthy controls and reached statistical significance in the second trial (p = 0.004). Both the AIS and control group exercised at a similar percentage of VO2 peak (64.26% vs. 64.60%).

Conclusion: Patients with AIS showed higher oxygen consumption during E-Fit than heathy controls, which might indicate a higher metabolic cost. Patients with AIS could carry out exercise at a moderate exercise intensity similar to that of healthy controls, but special considerations in designing an exercise program, such as frequent rest intervals, would be useful to avoid fatigue among patients with AIS.

Keywords: adolescent idiopathic scoliosis; exercise; high-intensity interval training; metabolic cost; oxygen consumption.

https://pubmed.ncbi.nlm.nih.gov/36767522/

Adherence to treatment: the abstract for Sosort Conference

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“Adherence to Physiotherapeutic Scoliosis-Specific Exercises during adolescence: voices of patients and their families. A qualitative content analysis” is one of the 8 studies being presented by ISICO during the forthcoming SOSORT international conference in Melbourne, Australia.
Its purpose was to explore the experience with PSSE of adolescents with spinal deformities and their parents, and their insights on how to assess the quality and frequency of PSSE performed at home.
The study is the exploratory phase of the development of a new Rasch-consistent questionnaire to assess adherence to PSSE in adolescents with spinal deformities. 

“The efficacy of specific exercises for scoliosis is closely linked to patient adherence to the treatment programme,” says Dr Irene Ferrario, ISICO psychologist and author of the study. “Treatment adherence is a complex concept, as it is the result of the interaction of various factors associated with patients, families, therapists and the treatment itself. Managing to identify the factors that promote or prevent treatment adherence is crucial in order to help youngsters get the best possible result. In this study, we set out to look at how our patients and their parents get on with scoliosis exercises, and examine their ideas on how the quality and the quantity of exercises done at home might be assessed”.

How did we collect the data? The researchers sent 2699 patients a questionnaire made up of open questions designed to collect thoughts and experiences with respect to adherence to a home exercise programme; 110 adolescents and 93 parents filled in the questionnaire anonymously. On the basis of what they wrote, we identified the five main categories of factors that can facilitate or hinder treatment adherence: “Organisation of time and space”, “Help tools”, “Understanding the therapeutic goals”, “Loneliness”, and “Nature of the exercises”.  

The most commonly reported facilitating factors were: using an app specially developed by ISICO, being able to listen to your favourite music while doing the exercises, being able to decide when to schedule the home sessions, and certain characteristics of the exercises (e.g., easy, fun, not requiring specific instruments). The factors most commonly deemed to hinder treatment adherence were lack of time, lack of motivation, lack of feedback from the physiotherapist, and type of exercises (i.e., boring ones).

“Patients and their families know what can help or interfere with their adherence to a home exercise programme for scoliosis” Dr Ferrario concludes. “Listening to what they have to say about the various factors that can hinder or facilitate them in this regard can help physiotherapists to develop exercise programmes tailored to patients’ specific needs and offer solutions and strategies to overcome common problems, thereby helping youngsters to more easily achieve the goals of the treatment.”

Spinal Manual Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Spinal Manual Therapy for Adolescent Idiopathic Scoliosis: 

A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Yan Sun, Yong Zhang, Haoning M, Mingsheng Tan, Zhihai Zhang 

Biomed Res Int. 2023 Jan 4;2023:7928429.doi: 10.1155/2023/7928429.eCollection 2023.

Abstract

Objective: We conducted this meta-analysis to provide better evidence of the efficacy of manual therapy (MT) on adolescent idiopathic scoliosis (AIS).

Methods: All RCTs of MT for the management of patients with AIS were included in the present study. The treatment difference between the experimental and control group was mainly MT. The outcomes consisted of the total effective rate, the Cobb angle, and Scoliosis Research Society-22 (SRS-22) questionnaire score. Electronic database searches were conducted from database inception to July 2022, including the Cochrane Library, PubMed, Web of Science, Embase, Wanfang Data, CNKI, and VIP. The pooled data were analyzed using RevMan 5.4 software.

Results: Four RCTs with 213 patients in the experimental group were finally included. There are 2 studies of standalone MT in the experimental group and 3 studies of MT with identical conservative treatments in the control group. Three trials reported total effective rate, and a statistically significant difference was found (P = 0.004). Three trials reported Cobb angle, and a statistical difference was found (P = 0.01). Then, sensitivity analysis showed that there was a significant difference in the additional MT subgroup (P < 0.00001) while not in the standalone MT subgroup (P= 0.41). Three trials reported SRS-22 scores (P = 0.55) without significant differences.

Conclusion: There is insufficient data to determine the effectiveness of spinal manipulation limited by the very low quality of included studies. High-quality studies with appropriate design and follow-up periods are warranted to determine if MT may be beneficial as an adjunct therapy for AIS. Currently, there is no evidence to support spinal manipulation.

https://pubmed.ncbi.nlm.nih.gov/36644168/

Morphological differences in scoliosis curvatures as a cause of difficulties in its early detection based on angle of trunk inclination

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Morphological differences in scoliosis curvatures as a cause of difficulties in its early detection based on angle of trunk inclination

Marek Kluszczyński, Dariusz Mosler, Jacek Wąsik 

BMC Musculoskelet Disord. 2022 Nov 2;23(1):948. doi: 10.1186/s12891-022-05878-6

Abstract

Introduction: The three dimensional deformation of the spine in scoliosis is specific for a given child with regard to the number and length of curvatures, their degree of rotation and the size of the curvature angle. Early diagnosis of scoliosis in a clinical examination according to the Adams test depends on the correlation between the angle of trunk inclination (ATI) and the Cobb angle and the adopted diagnosis criterion. The aim of the study was to demonstrate the need to adopt different diagnostic criteria for ATI depending on the age and location of scoliosis. Moreover, the observed differences in the ATI/Cobb correlation became the basis for the proposal to introduce the concept of low, medium and high-rotated of curvature to the clinical description of scoliosis.

Materials and methods: The group consisted of 229 children who were first examined, aged 6 to 17 years, with an average age of -11.57 years (SD ± 3.26), with symptoms of idiopathic scoliosis. The correlation of the criteria for the diagnosis of scoliosis in the ATI 7° clinical trial with a Cobb angle of 10° three dimensional in the X-ray image was used to distinguish three types of curvature/scoliosis, i.e., low, medium and high rotation. The frequencies of each type were compiled for three age groups and three scoliosis locations. Moreover, the degree of vertebral rotation according to the Perdriolli (AVR) of curvature was correlated with the Cobb angle and ATI. A one-way logistic regression model was used to assess the effectiveness of scoliosis detection in children based on the measurement of the ATI angle alone and the measurement of both ATI and Cobb angles.

Results: Low-rotated curves were most often found in the age groups of 6-9 and 10-12 years in 65.6% and 71.4% of patients, respectively (p < 0.05). Medium-rotated curvatures were most common in the age group of 13-17 years – 51.6%. With regard to the localization of scoliosis, the low-rotated curvatures were significantly more frequently (p < 0.05) found in the lumbar and thoracolumbar spine. Moreover, the univariate regression model for ATI showed that we could detect scoliosis best by taking the cut-off point of 5° and the mathematically determined Cobb angle was 9.5°. Patients with ATI ≥ 7° had significantly higher AVR values ​​than those with ATI < 7°, and the ATI/AVR correlation was of average strength.

Conclusion: The specific morphology of the scoliotic curvature of the child’s spine may be manifested by the difference in the ATI/Cobb correlation depending on the location of the scoliosis and change with age. The curvatures of the scoliosis that form can be low, medium and high-rotated, and the low-rotated curvatures were most often found in the 6-9- and 10-12-year-old groups and in the lumbar and thoracolumbar section. To increase the rate of early diagnosis of scoliosis, the results suggest the need to adopt two ATI criteria for the diagnosis of scoliosis at screening, 5° for age of 6-12 years, and when asymmetry affects the lumbar and thoracolumbar section, and 7° for the remaining children.

Keywords: Adams test; Early detection of scoliosis; Scoliosis; Vertebral rotation.

https://pubmed.ncbi.nlm.nih.gov/36324093/

Outcomes evaluating quality of life and their measurement properties in early-onset Scoliosis: a systematic review

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Outcomes Evaluating Quality of Life and Their Measurement Properties in Early-onset Scoliosis:

A Systematic Review

Charles Baird, James Archer, Adrian Gardner, Alison Rushton, Nicola R Heneghan 

Journal Pediatric Orthopedic. 2022 Oct 1;42(9) : e917-e924. doi: 10.1097/BPO.0000000000002161. Epub 2022 Apr 13.

Abstract

Introduction: Early-onset scoliosis (EOS) is a spinal deformity affecting children under the age of 10. Understanding the impact of EOS on quality of life can be achieved through appropriate patient/carer-reported outcome measures (PROMs). The aim of this systematic review was to identify, evaluate and summarize the evidence for the measurement properties of health-related quality of life (HR-QoL) outcome measures in the EOS population.

Methods: A 2-stage search methodology was conducted across the PubMed, MEDLINE, EMBASE, EMCARE, PsychINFO, and CINAHL databases. Search 1 identified PROMs used to evaluate the quality of life in EOS, and search 2 identified studies of the measurement properties of these PROMs. Two reviewers performed searching, study screening and selection and assessed studies for risk of bias using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. One reviewer performed data extraction. Evidence for each measurement property per PROM was summarized and evaluated using a modified GRADE approach.

Results: Search 1 identified 19 (10 disease-specific, 9 generic) PROMs that have been used to assess HR-QoL or a relevant domain in the EOS population. Search 2 identified only one PROM (the 24-item Early-Onset Scoliosis Questionnaire, EOSQ) with eligible studies (n=4) evaluating measurement properties. There is low-quality evidence for sufficient content validity, very low-quality evidence for sufficient reliability and low-quality evidence for sufficient criterion validity, specifically regarding the pulmonary function domain) of the EOSQ. Construct validity and responsiveness were rated as indeterminate. There were no studies on measurement error.

Conclusions: Our search strategy found that measurement properties have only been evaluated for one PROM, the EOSQ. There is low-quality evidence for sufficient measurement properties for the EOSQ in patients under the age of 10 with EOS. Further research is needed to improve the quality of evidence for EOSQ measurement properties and investigate other PROMs in this population.

Level of evidence: Level II.

https://pubmed.ncbi.nlm.nih.gov/36123903/

Morphological changes of Intervertebral Disc detectable by T2-weighted MRI and its correlation with curve severity in Adolescent Idiopathic Scoliosis

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Morphological changes of Intervertebral Disc detectable by T2-weighted MRI and its correlation with curve severity in Adolescent Idiopathic Scoliosis

Kwong Hang Yeung, Gene Chi Wai Man, Min Deng, Tsz Ping Lam, Jack Chun Yiu Cheng, 
Ka Chi Chan, Winnie Chiu Wing Chu

BMC Musculoskelet Disord. 2022 Jul 10;23(1):655. doi: 10.1186/s12891-022-05561

Abstract

Background: Our previous studies found disproportionate anteroposterior vertebral size is associated with severity of the scoliotic curves in adolescent idiopathic scoliosis (AIS) patients. Subsequent studies showed wedging of vertebral bodies (VB) had less contribution than intervertebral discs (IVD) to the anterior-posterior vertebral column length discrepancy in severe-AIS. However, the exact morphological changes of IVD were not clearly defined. This study aimed to evaluate the morphological and pathological changes of IVD and VB in AIS girls and healthy female controls.

Methods: This study included 33 age-matched female controls and 76 AIS girls with a right-sided thoracic curvature. Wedge angle, height ratio and distance ratio of VB and IVD were measured on the best midline coronal and sagittal planes from reformatted MRI spine. Volumes of VB, IVD and nucleus pulposus (NP) were also evaluated on volumetric images. One-way ANOVA with Bonferroni correction and Pearson correlation tests were used.

Results: There was significant difference in wedge angle and height ratio of VB and IVD between AIS and controls. In severe-AIS, the position of NP was significantly shifted to the convexity when compared with non-severe AIS and controls. Whereas, the volume of IVD and NP in severe-AIS was found to be significantly smaller. In addition, Cobb angle was significantly correlated with wedge angle and height ratio, and inversely correlated with the volume of NP.

Conclusions: In addition to wedging of VB and IVD, there was significantly reduced volume of IVD and NP in AIS patients with severe curve, insinuating the mechanical effect of scoliosis leads to a compression on both IVD and NP before significant disc desiccation occurs. We postulate that the compression of IVD and NP can contribute to curve progression in severe-AIS, these patients are more prone to disc degeneration in adulthood if no operative treatment is offered. Further longitudinal study on these parameters is still warranted.

Keywords: Adolescent idiopathic scoliosis; Healthy controls; Intervertebral disc; Magnetic Resonance Imaging; Nucleus pulposus; T2-weighted; Vertebral wedging; Volume.

https://pubmed.ncbi.nlm.nih.gov/35818045/

The Relationship Between Compliance of Physiotherapeutic Scoliosis Specific Exercises and Curve Regression With Mild to Moderate Adolescent Idiopathic Scoliosis

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

The Relationship Between Compliance of Physiotherapeutic Scoliosis Specific Exercises and Curve Regression With Mild to Moderate Adolescent Idiopathic Scoliosis

Yunli Fan, Michael Kt To, Guan-Ming Kuang, Jason Pui Yin Cheung

Global Spine J. 2022 Jun 28;21925682221109565.doi:10.1177/21925682221109565. PMID: 35762385

Abstract

Study design: Retrospective Case-control Study.

Objectives: To determine the requisite exercise compliance (EC) of physiotherapeutic scoliosis-specific exercise (PSSE) for achieving curve regression; to analyze whether the apical translation (AT), apical wedging (AW), and apical rotation (AR) of the major curve improve with regression effect.

Methods: Between 2019 and 2021, a total of 763 patients undertook a 6-month PSSE treatment. This resulted 426 compliable and 302 uncompliable patients remained available for analysis. For compliable patients, 213 with curve regression and 213 age-/sex-matched with curve stabilization/deterioration at the 6-month, were eligible for regression analysis to detect the relationship between EC and regression effect at the 6-month; receiver operating characteristic (ROC) curve analysis and Youden’s index were applied to identify the threshold of EC leading to curve regression at the 6-month. The AT, AW, and AR of the major curve were compared before and after 6-month PSSE to investigate the radiographic parameters that improved with regression effect.

Results: EC was correlated with regression effect (odds ratio: 19.9, 95% confidence interval: 11.3-35.0, P < .001) and the cutoff threshold of EC was 4.4 h/week for 6 months to realize such an effect. AT was improved by 47.6% with curve regression, in which 152 cases remained curve regression and no case progressed into the operative threshold at the 1.5- to 2-year.

Conclusions: A 6-month PSSE protocol of 4.4 hours per week was potentially leading to curve regression in treating mild to moderate scoliosis. An improvement in AT of the major curve was observed with the regression effect.

Keywords: adolescent idiopathic scoliosis; apical rotation; apical translation; apical wedging; cobb angle; curve regression; exercise compliance; physiotherapeutic scoliosis specific exercise.

https://pubmed.ncbi.nlm.nih.gov/35762385/

Curve type, flexibility, correction, and rotation are predictors of curve progression in patients with adolescent idiopathic scoliosis undergoing conservative treatment: a systematic review

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Curve type, flexibility, correction, and rotation are predictors of curve progression in patients with adolescent idiopathic scoliosis undergoing conservative treatment : a systematic review

Lester P K Wong, Prudence W H Cheung, Jason P Y Cheung 

Bone Joint, 2022 Apr. PMID: 35360948 PMCID: PMC9020521DOI: 10.1302/0301-620X.104B4.BJJ-2021-1677.R1

Abstract

Aims: The aim of this study was to review the current evidence surrounding curve type and morphology on curve progression risk in adolescent idiopathic scoliosis (AIS).

Methods: A comprehensive search was conducted by two independent reviewers on PubMed, Embase, Medline, and Web of Science to obtain all published information on morphological predictors of AIS progression. Search items included ‘adolescent idiopathic scoliosis’, ‘progression’, and ‘imaging’. The inclusion and exclusion criteria were carefully defined. Risk of bias of studies was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. In all, 6,286 publications were identified with 3,598 being subjected to secondary scrutiny. Ultimately, 26 publications (25 datasets) were included in this review.

Results: For unbraced patients, high and moderate evidence was found for Cobb angle and curve type as predictors, respectively. Initial Cobb angle > 25° and thoracic curves were predictive of curve progression. For braced patients, flexibility < 28% and limited in-brace correction were factors predictive of progression with high and moderate evidence, respectively. Thoracic curves, high apical vertebral rotation, large rib vertebra angle difference, small rib vertebra angle on the convex side, and low pelvic tilt had weak evidence as predictors of curve progression.

Conclusion: For curve progression, strong and consistent evidence is found for Cobb angle, curve type, flexibility, and correction rate. Cobb angle > 25° and flexibility < 28% are found to be important thresholds to guide clinical prognostication. Despite the low evidence, apical vertebral rotation, rib morphology, and pelvic tilt may be promising factors. Cite this article: Bone Joint J 2022;104-B(4):424-432.

Keywords: Adolescent idiopathic scoliosis; Bracing; Cobb angle; Correction; Curve progression; Flexibility; Medline; Morphology; Prognostic Studies; Rib; Rotation; Systematic review; bone age; pelvic tilt; randomized controlled trials; thoracic kyphosis; univariate analysis; vertebrae.

https://pubmed.ncbi.nlm.nih.gov/35360948/