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Trunk endurance differences between female adolescents with and without idiopathic scoliosis

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Hanh Thi Nguyen, Thanh-Van Le, Tan Minh Pham, Hieu Kim Huynh, Philippe Mahaudens,  Ngoc-Minh Nguyen

Spine Deform. 2025 Mar 21.doi: 10.1007/s43390-025-01075-2. Online ahead of print.

ABSTRACT

Purpose: This study compared trunk muscle endurance between female adolescents with idiopathic scoliosis (AIS) and non-AIS groups.

Methods: This cross-sectional study included 91 females. Trunk muscle endurance was assessed using the Ito-Shirado and Biering-Sørensen tests. Anthropometric and radiographic data were collected. The Mann-Whitney U test compared endurance and abdominal-to-paraspinal endurance ratio between groups. Spearman’s correlation assessed relationships between endurance and participant characteristics.

Results: The AIS group’s performance on the Ito-Shirado and Biering-Sørensen tests was 57% and 68% of the non-AIS group’s test durations, respectively (p = 0.001). However, there was no significant difference in the abdominal-to-paraspinal endurance ratio between the two groups (p = 0.7). Additionally, a low negative correlation was observed between paraspinal muscle endurance and both weight (rho = – 0.29, p = 0.006)) and BMI (rho = – 0.3, p = 0.005) in the AIS group, while abdominal endurance correlated negatively with height (rho = – 0.25, p = 001).

Discussion: Females with AIS exhibit significantly reduced endurance in both paraspinal and abdominal muscles compared to healthy controls, despite maintaining a similar abdominal-to-paraspinal endurance ratio. The findings suggest the need for trunk muscle endurance evaluation and training in rehabilitation programs for individuals with AIS.

Keywords: Abdominal-To-Paraspinal endurance ratio; Adolescent idiopathic scoliosis; Biering-Sørensen; Ito-Shirado; Trunk endurance.

https://pubmed.ncbi.nlm.nih.gov/40117064/

Machine learning algorithms for predicting future curve using first and second visit data in female adolescent idiopathic scoliosis patients

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Shuhei Ohyama, Satoshi Maki, Toshiaki Kotani, Yosuke Ogata, Tsuyoshi Sakuma, Yasushi Iijima, Tsutomu Akazawa, Kazuhide Inage, Yasuhiro Shiga, Masahiro Inoue, Takahito Arai, Noriyasu Toshi, Soichiro Tokeshi, Kohei Okuyama, Susumu Tashiro, Noritaka Suzuki, Yawara Eguchi, Sumihisa Orita, Shohei Minami, Seiji Ohtori

Eur Spine. 2025 Feb 4.doi: 10.1007/s00586-025-08680-9. Online ahead of print.

Abstract

Purpose: This study was designed to develop a machine learning (ML) model that predicts future Cobb angle in patients with adolescent idiopathic scoliosis (AIS) using minimal radiographs and simple questionnaires during the first and second visits.

Methods: Our study focused on 887 female patients with AIS who were initially consulted at a specialized scoliosis center from July 2011 to February 2023. Patient data, including demographic and radiographic data based on anterior-posterior and lateral whole-spine radiographs, were collected at the first, second, and final visits. ML algorithms were employed to develop individual regression models for future Cobb angles of each curve type (proximal thoracic: PT, main thoracic: MT, and thoracolumbar/lumbar: TLL) using PyCaret in Python. Multiple models were explored and analyzed, with the selection of optimal models based on the coefficient of determination (R2) and median absolute error (MAE).

Results: For the future curve of PT, MT, and TLL, the top-performing models exhibit R2 of 0.73, 0.63, and 0.61 and achieve MAE of 2.3°, 4.0°, and 4.2°.

Conclusions: The ML-based model using items commonly evaluated at the first and second visits accurately predicted future Cobb angles in female patients with AIS.

Keywords: Adolescent idiopathic scoliosis; Classification model; Machine learning algorithms; Prediction model; Regression model.

https://pubmed.ncbi.nlm.nih.gov/39903251/

Validating rasterstereography to evaluate thoracic kyphosis in patients with Scheuermann’s disease

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Ulysse Coneys, Anne Tabard-Fougère, Nathaly Gavira, Romain Dayer 

Spine Deform. 2024 Nov 4. doi: 10.1007/s43390-024-00955-3. Online ahead of print

Abstract

Purpose: Evaluate the validity of rasterstereography compared to low-dose, biplanar spine radiography for assessing thoracic kyphosis (TK) angles in Scheuermann’s disease patients.

Methods: This prospective study included all the Scheuermann’s disease patients consulting our clinic from 2016 to 2018. Recruited patients underwent two-dimensional low-dose biplanar anteroposterior full-length spine radiography and rasterstereography on the same day. Relationships between the TK angles measured were evaluated using Pearson correlation coefficients. Agreement between radiographic and rasterstereographic TK angles was evaluated using two-way intraclass correlation coefficients (ICCs) and Bland-Altman plots. Proportional biases were assessed using the slope regression lines fitted to Bland-Altman plots.

Results: The mean demographic and radiological characteristics of the 52 patients (20 girls; 39%) included were: age 13.1 ± 2 years; BMI 17.3 ± 2.8; and TK max. 50.4° ± 10°. Rasterstereographic TK angles were strongly correlated with radiographic TK angles evaluated from T2-T12 (r = 0.677) and from C7-Max (r = 0.704), with ‘good’ agreement (ICC > 0.75). A proportional bias was revealed in the slope regression line fitted to the Bland-Altman plot from the C7-Max radiography and the rasterstereography measurements (p = 0.034) but not from the T2-T12 and rasterstereographic TK angles (p = 0.997).

Conclusion: Rasterstereography is a reliable means of quantifying TK angles in Scheuermann’s disease patients. It could directly reduce the number of radiographic scans patients need over time, minimising their radiation exposure.

Keywords: Radiation-free; Rasterstereography; Scheuermann’s disease; Thoracic kyphosis; Validation study.

https://pubmed.ncbi.nlm.nih.gov/39688706/

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

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Siegmund Lang, Jacopo Vitale, Fabio Galbusera, Tamás Fekete, Louis Boissiere, Yann Philippe Charles, Altug Yucekul, Caglar Yilgor, Susana Núñez-Pereira, Sleiman Haddad , Alejandro Gomez-Rice, Jwalant Mehta, Javier Pizones, Ferran Pellisé, Ibrahim Obeid, Ahmet Alanay, Frank Kleinstück, Markus Loibl ; ESSG European Spine Study Group

Spine Deform. 2024 Nov 4. doi: 10.1007/s43390-024-00955-3. Online ahead of print

Abstract

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

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

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

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

Keywords: Adolescent idiopathic scoliosis (AIS); Artificial intelligence (AI); Large language models (LLMs); Patient education; Spine surgery.

https://pubmed.ncbi.nlm.nih.gov/39495402/

What imaging does my AIS patient need? A multi-group survey of provider preferences

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Jenny L Zheng, Ying Li, Grant Hogue, Megan Johnson, Jason B Anari, Maia D Regan, Keith D Baldwin 

Spine Deform. 2024 Nov 4. doi: 10.1007/s43390-024-00995-9. Online ahead of print.

Abstract

Introduction: Adolescent idiopathic scoliosis (AIS) is a common diagnosis managed by pediatric orthopedic surgeons with nonoperative radiographic monitoring representing a cornerstone of treatment. Differences in practices and techniques for obtaining radiographic studies contribute to variation, cost of care, and hamper data aggregation. We surveyed several large organizations dedicated to children’s orthopedics or scoliosis care to obtain a consensus for radiographic evaluation of AIS.

Methods: A REDCap-based survey was developed across four institutions and beta-tested by staff and fellows from a single institution. The finalized survey was distributed to members of POSNA, PSSG, and SOSORT, and shared on social media. Participants were asked to rank the importance of various datapoints in radiographic assessment of the spinal deformity, skeletal maturity, and study indications during initial, subsequent, preoperative, and final office visits for AIS. Response rate for the overall group was 26%.

Results: Cobb angle was considered the most important (> 94%) radiographic index across all time points. For positioning, 46% of respondents favored arms bent touching clavicles as the ideal positioning for X-rays, and another 24% favored arms down with palms forward (Table 2). The majority of respondents obtain lateral X-rays at the first visit (99%) and at the preoperative visit (70%). At the preoperative visit, sagittal contour (86%), apex location (85%), and Lenke classification (73%) were considered important factors to record. Flexibility studies are primarily obtained at the preoperative visit (89%) and 81% of respondents prefer bending films as the flexibility technique of choice. Regarding measures of skeletal maturity, Sanders bone age was considered to be the most important by over 70% of respondents across initial, subsequent, preoperative and brace wean visits (Fig. 2). MRIs were obtained routinely by 34% of respondents and only when the patient had a concerning symptom or finding for 67% of respondents.

Conclusions: Despite large variations in radiographic examination of AIS, large areas of agreement were found. It is important to establish standards for positioning patients, evaluating skeletal maturity, and obtaining assessments including lateral views, flexibility studies, and advanced imaging. Establishing common practices for radiographic evaluation of AIS will allow for less variation in care and for critical questions to be answered through registry formation and large multicenter data collection.

Significance: This study establishes current practitioner opinion on the radiographic evaluation of the AIS patient. Minimum data sets are useful for data aggregation and answering research questions in the face of data variability.

Level of evidence: Level V.

Keywords: Adolescent idiopathic scoliosis; Imaging; Nonoperative; Radiography; Survey.

https://pubmed.ncbi.nlm.nih.gov/39495401/

Scientific Exercise Approach to Scoliosis in Adolescents With Mild Idiopathic Scoliosis: A Controlled Clinical Trial

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Gözde Yagcı, Halil Gökhan Demirkıran 

J Manipulative Physiol Ther. 2024 Oct 14:S0161-4754(24)00053-8.doi:10.1016/j.jmpt.2024.08.015

Abstract

Objective: This study aimed to investigate the effectiveness of Scientific Exercise Approach to Scoliosis (SEAS) protocol for patients with mild adolescent idiopathic scoliosis (AIS).

Method: (A controlled clinical trial) This preliminary study included 32 patients with AIS, aged 10 to 16 years, with Cobb angles ranging from 12° to 25°. The participants were divided into 2 groups: the SEAS group (n = 21) and standard care (n = 11). We assessed Cobb angles via radiographs, axial trunk rotation using the Adams test, spinal deformity from various perspectives with the Spinal Appearance Questionnaire (SAQ), and health-related quality of life with the Scoliosis Research Society-22 (SRS-22) questionnaire, both before and after 1 year of treatment.

Results: Repeated measure-ANOVA revealed significant group x time interactions for various parameters: Cobb angle (F1,30 = 35.757; P < .001), axial trunk rotation (F1,30 = 39.595; P < .001), SAQ appearance domain for the physiotherapist (F1,30 = 53.943; P < .001), SAQ appearance (F1,30= 14.054; P = .001), expectations (F1,30 = 9.103; P = .005) domains, the total score (F1,30 = 23.574; P < .001) for the child, and the SAQ appearance domain for the parent (F1,29 = 5.412; P = .027). There were no significant differences in SRS-22 scores between the 2 groups. The success rates for the SEAS group and the standard care group were 100% and 72.7%, respectively.

Conclusion: After 1 year, the group of patients with mild AIS who received the SEAS method showed greater improvements in the Cobb angle, axial trunk rotation, and spinal appearance than those who received standard care. This preliminary study suggests that larger trials should be completed.

Keywords: Body; Exercise Therapy; Physical Appearance; Quality of Life; Scoliosis.

https://pubmed.ncbi.nlm.nih.gov/39412452/

Prognostic model development for risk of curve progression in adolescent idiopathic scoliosis: a prospective cohort study of 127 patients

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Marlene Dufvenberg, Anastasios Charalampidis, Elias Diarbakerli, Birgitta Öberg , Hans Tropp, Anna Aspberg Ahl, Daphne Wezenberg, Henrik Hedevik, Hans Möller, Paul Gerdhem, Allan Abbott

Acta Ortho. 2024 Sep 13:95:536-544.doi: 10.2340/17453674.2024.41911

Abstract

Background and purpose: The study’s purpose was to develop and internally validate a prognostic survival model exploring baseline variables for adolescent idiopathic scoliosis curve progression.

Methods: A longitudinal prognostic cohort analysis was performed on trial data (n = 135) including girls and boys, Cobb angle 25-40°, aged 9-17 years, remaining growth > 1 year, and previously untreated. Prognostic outcome was defined as curve progression of Cobb angle of > 6° prior to skeletal maturity. 34 candidate prognostic variables were tested. Time-to-event was measured with 6-month intervals. Cox proportional hazards regression survival model (CoxPH) was used for model development and validation in comparison with machine learning models (66.6/33.3 train/test data set). The models were adjusted for treatment exposure.

Results: The final primary prognostic model included 127 patients, predicting progress with acceptable discriminative ability (concordance = 0.79, 95% confidence interval [CI] 0.72-0.86). Significant prognostic risk factors were Risser stage of 0 (HR 4.6, CI 2.1-10.1, P < 0.001), larger major curve Cobb angle (HRstandardized 1.5, CI 1.1-2.0, P = 0.005), and higher score on patient-reported pictorial Spinal Appearance Questionnaire (pSAQ) (HRstandardized 1.4, CI 1.0-1.9, P = 0.04). Treatment exposure, entered as a covariate adjustment, contributed significantly to the final model (HR 3.1, CI 1.5-6.0, P = 0.001). Sensitivity analysis displayed that CoxPH maintained acceptable discriminative ability (AUC 0.79, CI 0.65-0.93) in comparison with machine learning algorithms.

Conclusion: The prognostic model (Risser stage, Cobb angle, pSAQ, and menarche) predicted curve progression of > 6° Cobb angle with acceptable discriminative ability. Adding patient report of the pSAQ may be of clinical importance for the prognosis of curve progression.

https://pubmed.ncbi.nlm.nih.gov/39287215/

The application of machine learning methods for predicting the progression of adolescent idiopathic scoliosis: a systematic review

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Lening Li, Man-Sang Wong 

Skeletal Radiol. 2024 Aug;53(8):1517-1528.doi: 10.1007/s00256-024-04592-9. Epub 2024 Feb 21.

Abstract

Predicting curve progression during the initial visit is pivotal in the disease management of patients with adolescent idiopathic scoliosis (AIS)-identifying patients at high risk of progression is essential for timely and proactive interventions. Both radiological and clinical factors have been investigated as predictors of curve progression. With the evolution of machine learning technologies, the integration of multidimensional information now enables precise predictions of curve progression. This review focuses on the application of machine learning methods to predict AIS curve progression, analyzing 15 selected studies that utilize various machine learning models and the risk factors employed for predictions. Key findings indicate that machine learning models can provide higher precision in predictions compared to traditional methods, and their implementation could lead to more personalized patient management. However, due to the model interpretability and data complexity, more comprehensive and multi-center studies are needed to transition from research to clinical practice.

Keywords: Adolescent idiopathic scoliosis; Machine learning; Prediction.

https://pubmed.ncbi.nlm.nih.gov/39118179/

Distances and angles in standing long-leg radiographs: comparing conventional radiography, digital radiography, and EOS

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Christof Birkenmaier, Louise Levrard , Carolin Melcher , Bernd Wegener, Jens Ricke, Boris M Holzapfel, Andrea Baur-Melnyk , Dirk Mehrens 

Skeletal Radiol. 2024 Aug;53(8):1517-1528.doi: 10.1007/s00256-024-04592-9. Epub 2024 Feb 21.

Abstract

Objective: Distances and angles measured from long-leg radiographs (LLR) are important for surgical decision-making. However, projectional radiography suffers from distortion, potentially generating differences between measurement and true anatomical dimension. These phenomena are not uniform between conventional radiography (CR) digital radiography (DR) and fan-beam technology (EOS). We aimed to identify differences between these modalities in an experimental setup.

Materials and methods: A hemiskeleton was stabilized using an external fixator in neutral, valgus and varus knee alignment. Ten images were acquired for each alignment and each modality: one CR setup, two different DR systems, and an EOS. A total of 1680 measurements were acquired and analyzed.

Results: We observed great differences for dimensions and angles between the 4 modalities. Femoral head diameter measurements varied in the range of > 5 mm depending on the modality, with EOS being the closest to the true anatomical dimension. With functional leg length, a difference of 8.7% was observed between CR and EOS and with the EOS system being precise in the vertical dimension on physical-technical grounds, this demonstrates significant projectional magnification with CR-LLR. The horizontal distance between the medial malleoli varied by 20 mm between CR and DR, equating to 21% of the mean.

Conclusions: Projectional distortion resulting in variations approaching 21% of the mean indicate, that our confidence on measurements from standing LLR may not be justified. It appears likely that among the tested equipment, EOS-generated images are closest to the true anatomical situation most of the time.

Keywords: Cone-beam; Conventional radiography; Digital radiography; Distortion; EOS; Fan-beam; Lower extremity; Projectional distortion; Slot-scanner; Valgus; Varus.

https://pubmed.ncbi.nlm.nih.gov/38378861/

Immediate vs Gradual Brace Weaning Protocols in Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial

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Prudence Wing Hang Cheung, Oi Kiu Olivia Chan, Hao Wu, Marcus Kin Long Lai, Lester Po Kwan Wong, Shiyu Tang, Jason Pui Yin Cheung 

JAMA Pediatr. 2024 Jul 1;178(7):657-668.doi: 10.1001/jamapediatrics.2024.1484

Abstract

Importance: Lack of evidence and consensus for brace weaning protocol in adolescent idiopathic scoliosis (AIS) results in clinicians prescribing gradual weaning in the hope of avoiding curve deterioration after weaning. However, gradual weaning contributes to prolonged brace wear, which can affect spinal stiffness and health-related quality of life (HRQoL).

Objective: To determine whether gradual weaning results in better curve magnitude and truncal balance maintenance after brace weaning vs immediate brace removal for patients with AIS.

Design, setting, and participants: This was an open-labeled randomized clinical trial commenced in April 2017 with 24-month follow-up completed in January 2023. Outcome assessors were masked to weaning protocol assigned. The study took place at a territory-wide tertiary scoliosis clinic serving the largest number of referrals in the local population. Patients with AIS ready to wean off of brace wear were eligible (402 were screened; 33 were excluded [15 for <18 hours/day of brace-wear compliance before weaning, 11 were treated with Milwaukee brace, and 7 declined to participate]; and 369 were included), and those who were treated with a custom molded thoracolumbosacral orthosis and had reached skeletal maturity were consecutively recruited.

Interventions: Patients were randomized to gradual weaning protocol (n = 176) with an additional 6 months of nighttime wear before completely stopping or immediate weaning protocol (n = 193) with immediate brace removal at recruitment.

Main outcomes and measures: Changes in major curve Cobb angle and truncal balance from the time of weaning to 6-month, 12-month, and 24-month follow-up. HRQoL was also assessed using the refined Scoliosis Research Society 22-item and EuroQol 5-dimension questionnaires.

Results: A total of 369 patients (mean [SD] age, 14.9 [1.1] years; 304 [83.4%] girls) were randomized with 284 (77.0%) completing 24-month longitudinal follow-up. Immediate and gradual weaning groups had no significant differences in change of major Cobb angle at postweaning 6-month (difference, -0.6°; 95% CI, -1.4 to 0.2; P = .17), 12-month (difference, -0.3°; 95% CI, -1.2 to 0.6; P = .47), and 24-month (difference, -0.3°; 95% CI, -1.2 to 0.7; P = .60) follow-up. The number of curve progression, nonprogression, and rebound cases were comparable (χ22 = 2.123; P = .35). Postweaning changes in truncal balance and HRQoL demonstrated no significant differences between groups.

Conclusions: Gradual weaning did not demonstrate superiority to immediate weaning with predefined criteria of Cobb angle and truncal balance maintenance and HRQoL after brace weaning. Gradual and immediate weaning achieved very similar maintenance of brace outcomes in AIS. We therefore recommend the consideration of immediate brace weaning, which aims to benefit patients with earlier time for increased exercises and activity level.

Trial registration: ClinicalTrials.gov Identifier: NCT03329716.

https://pubmed.ncbi.nlm.nih.gov/38829664/