Clinical Outcomes of 111 Patients with Early Onset Idiopathic Scoliosis (EOIS) Receiving Brace Treatment: A Longitudinal Retrospective Cohort Study.

Introduction: Bracing is one of the first-line treatment for early-onset idiopathic scoliosis (EOIS) to control curves from progression. This study aimed to explore the determinants that govern bracing effectiveness in EOIS. Methods: One hundred and eleven patients with EOIS (mean age of 8.6 ± 1.25 at diagnosis) received bracing treatment and had a final follow-up beyond skeletal maturity were identified from records between 1988 and 2021. Demographic data and clinical features of spinal curvature were obtained for correlation analyses to determine the associations between curve outcomes and clinical features. Results: Most patients were female (85.6%) and had a major curve on the left side (67%). The mean baseline Cobb angle of major curves was 21.73 ± 7.92°, with a mean Cobb angle progression of 18.05 ± 19.11°. The average bracing duration was 5.3 ± 1.9 years. Only 26 (23.4%) of them underwent surgery. The final Cobb angle and curve progression at the final follow-up with a Cobb angle of ≥50° were positively correlated with the initial Cobb angle (r = 0.206 and r = 0.313, respectively) and negatively correlated with maturity parameters. The lumbar curve type was found to correlate with a smaller final Cobb angle. Conclusions: The majority of patients had a final Cobb angle < 50°, which was considered a successful bracing outcome. The final Cobb angle correlated with the initial Cobb angle and curve types observed in EOIS.

Handgrip strength assessment at baseline in addition to bone parameters could potentially predict the risk of curve progression in adolescent idiopathic scoliosis.

Introduction: Adolescent idiopathic scoliosis (AIS) is characterized by deranged bone and muscle qualities, which are important prognostic factors for curve progression. This retrospective case-control study aims to investigate whether the baseline muscle parameters, in addition to the bone parameters, could predict curve progression in AIS. Methods: The study included a cohort of 126 female patients diagnosed with AIS who were between the ages of 12 and 14 years old at their initial clinical visit. These patients were longitudinally followed up every 6 months (average 4.08 years) until they reached skeletal maturity. The records of these patients were thoroughly reviewed as part of the study. The participants were categorized into two sub-groups: the progressive AIS group (increase in Cobb angle of ≥6°) and the stable AIS group (increase in Cobb angle <6°). Clinical and radiological assessments were conducted on each group. Results: Cobb angle increase of ≥6° was observed in 44 AIS patients (34.9%) prior to skeletal maturity. A progressive AIS was associated with decreased skeletal maturity and weight, lower trunk lean mass (5.7%, p = 0.027) and arm lean mass (8.9%, p < 0.050), weaker dominant handgrip strength (8.8%, p = 0.027), deranged cortical compartment [lower volumetric bone mineral density (vBMD) by 6.5%, p = 0.002], and lower bone mechanical properties [stiffness and estimated failure load lowered by 13.2% (p = 0.005) and 12.5% (p = 0.004)]. The best cut-off threshold of maximum dominant handgrip strength is 19.75 kg for distinguishing progressive AIS from stable AIS (75% sensitivity and 52.4% specificity, p = 0.011). Discussion: Patients with progressive AIS had poorer muscle and bone parameters than patients with stable AIS. The implementation of a cut-off threshold in the baseline dominant handgrip strength could potentially be used as an additional predictor, in addition to bone parameters, for identifying individuals with AIS who are at higher risk of experiencing curve progression.

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

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.

Effects of a Home-Based Exercise Intervention (E-Fit) on Bone Density, Muscle Function, and Quality of Life in Girls with Adolescent Idiopathic Scoliosis (AIS): A Pilot Randomized Controlled Trial.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) patients have lower physical activity levels than normal adolescents, and there is an association with poorer bone and muscle health. This study evaluated the effects of a home-based exercise intervention (E-Fit) on bone mineral density (BMD), muscle function, and quality of life (QoL) in AIS-affected girls. METHODS: A total of 40 AIS females aged 11 to 14 years were randomly assigned to the E-Fit or control group. The E-Fit group performed modified 7-min high-intensity interval training (HIIT) 5 days per week for 6 months. Outcome measures including BMD using dual-energy X-ray absorptiometry (DXA), muscle strength and endurance tests, physical activity levels, and QoL using self-reported questionnaires were assessed at baseline and at 6-month and 12-month follow-up. RESULTS: In total, 14 patients in the E-Fit and 16 in the control group completed the study. The E-Fit group showed a marginally significant interaction effect in the whole body areal BMD at the 6- (p = 0.096) and 12-month follow-ups (p = 0.085). The left arm lean mass in the E-Fit group showed a statistically significant interaction effect between the 6- and 12-month follow-ups (p = 0.046). The E-Fit group showed improvements in physical activity participation, as measured by the Modified Baecke Questionnaire (MBQ), with a significant interaction effect in work index (p = 0.043), sport index (p = 0.050), and total score (p = 0.016) from baseline to the 12-month follow-up. Improvement on self-image were noted in E-Fit group across time. CONCLUSIONS: The present results provided some evidence to support the positive benefits of E-Fit for bone health and muscle function in AIS girls.

Relationship between low back pain and lumbar multifidus size at different postures.

STUDY DESIGN: A prospective study of multifidus images. OBJECTIVE.: To compare the change of the cross-sectional area (CSA) of multifidus in subjects with and without chronic low back pain (LBP) at different postures. SUMMARY OF BACKGROUND DATA: Ultrasound imaging was shown to be useful in assessing acute LBP patients at rest only. METHODS AND MEASURES: Thirty-five male adults participated, including 19 normal and 16 chronic LBP patients. The CSAs of multifidus were assessed on ultrasound images acquired on both sides of the L4 and L5 levels with the subjects in prone lying, upright standing, and 25 degrees and 45 degrees forward stooping. RESULTS: In the control group, the CSA of multifidus increased from prone lying to upright standing and then gradually decreased from 25 degrees to 45 degrees forward stooping. However, a reverse pattern of the CSA changes was identified in patients with chronic LBP. CONCLUSION: Multifidus contracts maximally at upright standing in the normal group, while maximum contraction of the muscle occurs at 25 degrees forward stooping in the patient group. The role of multifidus may be altered in the stabilization of the lumbar spine of chronic LBP patients. Assessment of the change in muscle size reacting to different postures is found to be helpful.