Regional disparity in epidemiological characteristics of adolescent scoliosis in China: Data from a screening program.

Objective: We investigated regional disparities in rates of scoliosis among adolescents in western and eastern China and the dominant factors underlying these disparities. Methods: This cross-sectional study used data from a school scoliosis screening program conducted in two typical areas: Yangpu District of Shanghai (eastern China) and Tianzhu Tibetan Autonomous County of Gansu Province (western China), during October 2020 to February 2021. Participants included adolescents aged 12-16 years (4,240 in Shanghai and 2,510 in Gansu Province). School scoliosis screening data were obtained on age, sex, height, weight and BMI, and region as well. We screened angles of trunk rotation in level of proximal thoracic (T1-T4), main thoracic (T5-T12), and lumbar (T12-L4) by the forward bend test with scoliometer. An angle of trunk rotation ≥5° was used as the criterion to identify suspected scoliosis. Results: The proportion of suspected scoliosis was lower in Shanghai (6.9%) than in Gansu (8.6%). Angle of trunk rotation tended to increase with age in Shanghai, peaking at 15 years, but decreased with age in Gansu, and bottomed at 15 years. The angle of trunk rotation in the proximal thoracic, main thoracic, and lumbar part of the spine appeared to be larger in Gansu adolescents and in Shanghai female adolescents. Age was a relevant factor in angle trunk rotation in regression models and interacted with region as well. Conclusion: We found regional and age- and sex-related disparities in rates of suspected scoliosis.

Risk Factors, Lifestyle and Prevention among Adolescents with Idiopathic Juvenile Scoliosis: A Cross Sectional Study in Eleven First-Grade Secondary Schools of Palermo Province, Italy.

Adolescent idiopathic scoliosis (AIS) has an incidence of 2-3% in the general population and a multifactorial etiology. The present study aims to analyze modifiable risk factors and their interactions in the development of AIS in order to increase knowledge about the disease and to prevent the evolution of AIS in young students with tailored public health strategies. A cross-sectional study was conducted over two consecutive school years among students attending 11 first-grade secondary schools in the province of Palermo, Italy. A self-administered questionnaire that investigated socio-demographical, physical and anamnestic characteristics and habits, focusing on possible risk factors associated with idiopathic scoliosis, was administered. In addition, a clinical evaluation was performed with Adams' test and Bunnel's inclinometer. Suspected AIS cases were associated with the practice of high-risk sports (p < 0.05), weekly physical activity lasting ≥3 h (p < 0.05), lower back pain (p < 0.001), posture disorders (p < 0.01) and having had no contact with a physician (p < 0.01). Practice of high-risk sports (adj OR = 1.83; CI 95% 1.11-4.76) and suffering of posture disorders (adj OR = 1.67; CI 95% 1.12-3.60) showed a significant association with a confirmed diagnosis of AIS (Cobb angle ≥ 10° at X-ray). The risk factors associated with AIS are still unclear. Therefore, it is crucial to identify early modifiable and multiple risk factors to prevent the evolution of scoliosis in school-age children.

Three-dimensional depth sensor imaging to identify adolescent idiopathic scoliosis: a prospective multicenter cohort study.

Adolescent idiopathic scoliosis is the most ordinary pediatric spinal disease that causes a three-dimensional deformity. Early detection of this potentially progressive deformity is considered crucial. The purpose of the present study was to report the potential for accurately diagnosis of adolescent idiopathic scoliosis using a newly developed, automated, noninvasive asymmetry-recognition system for the surface of the human back using a three-dimensional depth sensor. We included 170 subjects with suspected adolescent idiopathic scoliosis in this study. Outcomes measured included patient demographics, Cobbe angles from radiographic measurements, and asymmetry indexes. The coefficient of correlation between the asymmetry index and the Cobb angle was 0.85. For the prediction of scoliosis >10°, the area under the curve was 0.98, sensitivity was 0.97, specificity was 0.93, positive predictive value was 0.99, negative predictive value was 0.72, accuracy was 0.97, positive likelihood ratio was 13.55, and negative likelihood ratio was 0.04. The posterior test probability for the positive screen >10° was 98.9% if the asymmetry index was >1.268, three times in a row. This novel system automatically evaluated the back asymmetry. Therefore, this study demonstrates the outstanding discriminative ability of this newly developed system for deciding whether an examinee should undergo additional radiography to define scoliosis. This system can be used as an alternative to the forward bend test and scoliometer measurement in clinics. Future studies should seek to confirm these findings in a larger group and involve mass school scoliosis screening programs within the context of a multicenter trial.

Prevalence and goal attainment with spinal orthoses for children with cerebral palsy.

PURPOSE: Analyze the goals for treatment and attained goals for spinal orthoses in children with cerebral palsy (CP), and describe the use of spinal orthoses in relation to age, sex, gross motor function, and scoliosis. METHODS: Cross-sectional data for all children born between 2000 and 2014 and registered in the Swedish CP registry were analyzed in relation to age, sex, Gross Motor Function Classification System (GMFCS), and scoliosis. Treatment goals were to 1) prevent deformity; 2) improve stability/positioning; 3) improve head control; and 4) improve arm/hand function. RESULTS: Overall, 251 of the 2800 children (9%) used spinal orthoses, and the frequency increased significantly with age and GMFCS level; 147 of the 251 children had scoliosis. Several treatment goals were reported for most children. The most common goal was improved stability/positioning (96%), followed by head control (51%) and arm/hand function (38%). Only one third of the children used spinal orthoses to prevent deformities. The rate of goal attainment was 78-87% for the functional outcomes and 57% for the prevention of deformities. CONCLUSION: Although the goal of using spinal orthosis to prevent curvature progression remains important, we found that its functional benefits (stability, head control, arm/hand function) were of greater importance.

Estrogen promotes the onset and development of idiopathic scoliosis via disproportionate endochondral ossification of the anterior and posterior column in a bipedal rat model.

This study aimed to verify the effects of estrogen on the onset and development of adolescent idiopathic scoliosis and the mechanisms associated with these effects by constructing a pubescent bipedal rat model. Experiments were conducted to investigate whether scoliosis progression was prevented by a Triptorelin treatment. One hundred twenty bipedal rats were divided into female, OVX (ovariectomy), OVX + E2, Triptorelin, sham, and male groups. According to a spinal radiographic analysis, the scoliosis rates and curve severity of the female and OVX + E2 groups were higher than those in the OVX, Triptorelin, and male groups. The measurements obtained from the sagittal plane of thoracic vertebrae CT confirmed a relatively slower growth of the anterior elements and a faster growth of the posterior elements between T11 and T13 in the female and OVX + E2 groups than in the OVX and Triptorelin groups. Histomorphometry and immunohistochemistry revealed a significantly longer hypertrophic zone of the vertebral cartilage growth plates that expressed more type X collagen and less type II collagen in the OVX and Triptorelin groups than in the female and OVX + E2 groups. Ki67 immunostaining confirmed an increase in the proliferation of vertebral growth plate chondrocytes in the OVX group compared with the female and OVX + E2 groups. In conclusion, estrogen obviously increased the incidence of scoliosis and curve severity in pubescent bipedal rats. The underlying mechanism may be a loss of coupling of the endochondral ossification between the anterior and posterior columns. Triptorelin decreased the incidence of scoliosis and curve magnitudes in bipedal female rats.

The Effect of Immediate Breast Reconstruction on Thoracic Spine Alignment After Unilateral Mastectomy.

BACKGROUND: Long-term posture change after unilateral mastectomy in breast cancer patients can affect spinal alignment during the postoperative period. We evaluated the effect of immediate breast reconstruction on body posture after surgery by analyzing spinal alignment with radiographic studies. MATERIALS AND METHODS: Preoperative and 2-year postoperative chest radiographs of 116 patients who received immediate breast reconstruction with unilateral mastectomy and 250 patients who underwent unilateral mastectomy without reconstruction were retrospectively reviewed. Cobb angle, the direction of spinal curvature, upper and lower ends of the thoracic curve, and curve length were measured and compared between both groups. Additional patient information including age, height, weight, body mass index, and side of surgery were collected via chart review. RESULTS: There was a significant difference in the Cobb angle between the preoperative and 2-year postoperative chest radiographs between the immediate breast reconstruction group and mastectomy group. Without considering curvature change, the difference was -0.593° in the reconstruction group and 2.698° in the mastectomy-alone group (P = .02), and considering curvature change, the difference was 0.335° and 3.972° in the reconstruction and mastectomy-alone group, respectively (P < .01). CONCLUSION: The amount of change in postoperative spinal alignment was significantly smaller in the immediate breast reconstruction group compared with patients who received only unilateral mastectomy without reconstruction. We suggest that immediate breast reconstruction positively affects spinal alignment, leading to better posture and physical function.

Risk factors for thoracic and spinal deformities following lung resection in neonates, infants, and children.

PURPOSE: We aimed to identify the risk factors for thoracic and spinal deformities following lung resection during childhood and to elucidate whether thoracoscopic surgery reduces the risk of complications after lung resection. METHODS: We retrospectively examined the medical records of all pediatric patients who underwent lung resection for congenital lung disease at our institution between 1989 and 2014. RESULTS: Seventy-four patients underwent lung resection during the study period and were followed-up. The median age of the patients at the time of surgery was 5 months (range 1 day-13 years), and 22 were neonates. Thoracotomy and thoracoscopy were performed in 25 and 49 patients, respectively. Thoracic or spinal deformities occurred in 28 of the 74 patients (37%). Univariate analyses identified thoracotomy, being a neonate (age: <1 month) at the time of surgery, and being symptomatic at the time of surgery as risk factors for these deformities. However, a multivariate analysis indicated that only thoracotomy and being a neonate were risk factors for deformities. CONCLUSIONS: Thoracoscopic surgery reduced the risk of thoracic and spinal deformities following lung resection in children. We suggest that, where possible, lung resection should be avoided until 2 or 3 months of age.

Alteraciones de la alineación vertebral / Changes in spinal alignment

Las desalineaciones de la columna vertebral constituyen un motivo de consulta muy frecuente en atención primaria y servicios especializados. Las etiologías son diversas e influyen múltiples factores: en la adolescencia, la desalineación más frecuente es la escoliosis, de causa idiopática (80%) y normalmente asintomática. En la edad adulta, la causa más frecuente es la degenerativa. Es importante conocer la historia natural y detectar posibles factores predictivos de progresión. El correcto diagnóstico de las deformidades vertebrales requiere de estudios radiológicos concretos. El grado de deformidad determina el tipo de tratamiento. El objetivo es prevenir la progresión de la deformidad, recuperar la flexibilidad y el balance del cuerpo (AU)

Spinal misalignments are a common reason for consultation at primary care centers and specialized departments. Misalignment has diverse causes and is influenced by multiple factors: in adolescence, the most frequent misalignment is scoliosis, which is idiopathic in 80% of cases and normally asymptomatic. In adults, the most common cause is degenerative. It is important to know the natural history and to detect factors that might predict progression. The correct diagnosis of spinal deformities requires specific imaging studies. The degree of deformity determines the type of treatment. The aim is to prevent progression of the deformity and to recover the flexibility and balance of the body (AU)

Exemplification of Movement Patterns and Their Influence on Body Posture in Younger School-Age Children on the Basis of an Authorial Program "I Take Care of My Spine".

Exemplification of movement patterns is most noticeable in the youngest pupils group. Generally, children do not know which patterns are correct and which ones are risk factors. After correcting and stabilizing some improper patterns, a child can perform their daily activities without constant cognizance of their appropriateness. The concept of this research is included in a paradigm for the quality research conducted as action-research, which assumed a quality and efficiency improvement of health education in Polish schools.The main aim of this study was to encourage pupils, their parents and teachers to perform pro-health behaviors oriented toward maintaining an appropriate body posture. First, the study aimed to assess the postures of children involved in the authorial program "I take care of my spine" in comparison with a group of children without diagnosed postural defects and not involved in the curriculum.The examinations covered a group of 144 children (group A) ages 7 to 9 years (mean 7.60 ±â€Š0.64 years) with appropriate body postures recognized in the screening test, which was conducted at a school where the curriculum "I take care of my spine" was launched. The control group included 222 healthy children at a similar age who attended schools where the curriculum was not implemented. The examinations were performed 2 times, as follows: the first time occurred before the program "I take care of my spine" was launched (initial examination), and the second time after 9 to 10 months of full participation in the program's activities and after 1 year of observation of children from group B (final examination).A significant improvement of posturometric parameters in the main group and worsening of the parameters in the control group were noted. The results in examined groups of children and diversification of the results were linked to implementing the prevention program in the main group. In the group of children involved in the postural prevention program, the weight of school bags was significantly reduced.This objective was particularly important for students because the manner of movement pattern exemplification will influence children's lives in the future, and in a wider perspective, it will play a crucial role in assessing their quality of life as adults.

Role of Enhanced Central Leptin Activity in a Scoliosis Model Created in Bipedal Amputated Mice.

STUDY DESIGN: An experimental study to investigate the role of enhanced central leptin activity in a bipedal mouse scoliosis model. OBJECTIVE: To investigate the influence of enhanced central leptin activity on the development of scoliosis in mice, and to support Burwell's hypothesis that central leptin dysfunction is involved in the etiopathogenesis of idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Significantly lower level of circulating leptin and higher level of soluble leptin receptor have been reported in adolescent idiopathic scoliosis compared with healthy adolescents, suggesting possible association between abnormal central leptin level and dysfunction. METHODS: Amputation of forelimbs and tail was performed on 50 male C3H/HeJ mice at the age of 3 weeks. Then, the mice were randomly divided into 2 groups: Group A consisted of 25 mice treated with injection into the hypothalamus with lentivirus vectors that overexpressed leptin; and Group B involved the remaining 25 mice receiving intracerebral injection with the control vectors. Radiographs were obtained at 20th week to determine the presence of spinal deformity. The incidence of scoliosis and curve magnitude were compared between groups. RESULTS: The body weight was initially found to be slightly lower in mice of Group A when compared with Group B. Significantly higher peripheral serum leptin level was found in leptin-overexpressing mice than control mice. Scoliosis developed in 23 mice of Group A (92%), with an average Cobb angle of 30.2°, and in 13 of Group B (52%), with an average Cobb angle of 18.4°, respectively. A higher incidence (P = 0.002) and more severe curve (P <0.001) were observed in Group A. CONCLUSION: In this bipedal mouse scoliosis model, enhanced central leptin activity might not only increase the risk of developing a scoliosis, but also contribute to the progression of scoliosis. LEVEL OF EVIDENCE: N/A.

Cribado de la escoliosis idiopática del adolescente / Adolescent idiopathic scoliosis screening

En el presente trabajo se aportan los resultados obtenidos de la revisión del tema del cribado de la escoliosis idiopática del adolescente. No existe acuerdo entre las distintas sociedades científicas implicadas en este problema sobre si se debe o no realizar cribado universal sistemático de esta patología. Tras elaborar un marco analítico donde se encuadran las preguntas clínicas que se tratan de responder, se repasan los conceptos de magnitud del problema e historia natural del proceso. Se valoran los estudios sobre las pruebas de cribado y la eficacia del tratamiento. Se refieren los datos existentes sobre la eficacia de los programas de cribado, su balance riesgo-beneficio y su coste-efectividad. Se informa sobre las recomendaciones de los grupos de expertos a nivel internacional. El grupo PrevInfad considera que los riesgos del cribado universal de la escoliosis idiopática del adolescente son mayores que los beneficios y sugiere no realizar el cribado sistemático (AU)

The present paper provides the results of the review on adolescent idiopathic scoliosis screening. There is no agreement among the different scientific societies involved on the issue of recommending or not the universal systematic screening of this condition. An analytic framework is provided with the involved clinical questions to be answered. The prevalence and natural history are described. The studies on screening tests and treatment effectiveness are appraised. The existent data on effectiveness of screening programs are provided, as well as their risk-benefits balance and cost-effectiveness. The recommendations of international expert groups are reported. The group PrevInfad considers that the risks of universal adolescent idiopathic scoliosis screening outweigh the benefits so we suggest not to do systematic screening (AU)

Osteoma osteoide como causa de escoliosis cervical dolorosa / Osteoid osteoma as a cause of painful cervical scoliosis

El osteoma osteoide es un tumor óseo benigno de tipo osteoblástico, que representa el 11% de los tumores óseos benignos. Su localización más frecuente es la diáfisis de huesos largos (fémur y tibia), aunque puede afectar otras localizaciones como la columna vertebral. Afecta con más frecuencia a los varones y en edades comprendidas entre los 7-25 años. Clínicamente se caracteriza por dolor continuo de predominio nocturno que suele remitir con AAS. Debe hacerse el diagnóstico diferencial con el osteoblastoma, metástasis y osteomielitis entre otros. El diagnóstico se realiza mediante pruebas de imagen TC (de elección), RNM o gammagrafía. El tratamiento de elección es la resección quirúrgica, aunque en ocasiones se puede realizar la electrocoagulación percutánea con radiofrecuencia. Presentamos un caso clínico de osteoma osteoide como causa de escoliosis cervicodorsal dolorosa (AU)

Osteoid osteoma is an osteoblastic type of benign bone tumor that represents 11% of benign bone neoplasms. It is most frequently found in the diaphysis of the long bones (the femur and tibia), although other areas can be affected, such as the spine. It is most frequently found in male patients aged between 7 and 25 years. This entity is clinically characterized by continuous pain, mainly at night, which can be lessened by the use of acetylsalicylic acid. A differential diagnosis should be made with osteoblastoma, metastasis and osteomyelitis, among other entities. The diagnostic test of choice is computed tomography, while magnetic resonance imaging and scintigraphy are also useful. The treatment of choice is surgical resection, although percutaneous electrocoagulation with radio frequency can sometimes be performed (AU)

Practical aspects of pediatric proton radiation therapy.

Many radiotherapy centers desire proton therapy (PrT) because the unique physical dosimetry allows for improved dose distribution in some clinical situations. These benefits are best described in skull base and many pediatric lesions. However, there are significant challenges to PrT that are overlooked or simply ignored when centers embark on the PrT journey particularly as it applies to pediatric patients.In this review, we review the Indiana University Health Proton Therapy Center experience regarding benefits and drawbacks of PrT for pediatric patients. In conclusion, centers aspiring to PrT capacity should be aware not only of the well-described benefits in some clinical scenarios, but also the significant challenges to the modality in its practical clinical application.

A review of pinealectomy-induced melatonin-deficient animal models for the study of etiopathogenesis of adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is a common orthopedic disorder of unknown etiology and pathogenesis. Melatonin and melatonin pathway dysfunction has been widely suspected to play an important role in the pathogenesis. Many different types of animal models have been developed to induce experimental scoliosis mimicking the pathoanatomical features of idiopathic scoliosis in human. The scoliosis deformity was believed to be induced by pinealectomy and mediated through the resulting melatonin-deficiency. However, the lack of upright mechanical spinal loading and inherent rotational instability of the curvature render the similarity of these models to the human counterparts questionable. Different concerns have been raised challenging the scientific validity and limitations of each model. The objectives of this review follow the logical need to re-examine and compare the relevance and appropriateness of each of the animal models that have been used for studying the etiopathogenesis of adolescent idiopathic scoliosis in human in the past 15 to 20 years.

La calidad de la información sobre escoliosis disponible online en español. Un estudio de evaluación / The quality of information on scoliosis available online in spanish. An evaluation study

Introducción. Más de un 50% de padres y/o pacientes utilizan Internet para informarse sobre aspectos de la escoliosis idiopática. Material y métodos. En 5 buscadores populares (Google, Yahoo, Bing, Lycos, Ask) se introdujo el término de búsqueda «escoliosis» y los primeros 20 resultados de cada buscador fueron utilizados para el estudio. Tras rechazar las duplicidades, archivos de vídeos o imagen, se obtuvo una lista de 25 webs, adecuadas para el análisis. La calidad se evaluó según 3 escalas: DISCERN (calidad de la información médica; rango de menor a mayor calidad es de 15 a 80), HONcode (criterios de acreditación de calidad de páginas web; rango de de menor a mayor es de 15 a 0), y grado de idoneidad de la información para padres y pacientes con escoliosis idiopática (rango de menor a mayor es de 0 a 9). Resultados. DISCERN: media 38 (DE = 10,48); el 24% de las páginas superaba el percentil 75 (> 45). HONcode: media 6,9 (DE = 1,8); el 28% de las páginas superaba el percentil 75 (< 5,5). Grado de idoneidad: media 4,3 (DE = 1,75); el 24% de las páginas superaban el percentil 75 (> 5). Conclusiones. En términos generales la calidad de la información es aceptable, pero muy pocas páginas pueden considerarse idóneas para padres y pacientes con escoliosis idiopática (AU)

Introduction. More than 50% of parents and/or patients use Internet to learn about aspects of idiopathic scoliosis. Material and methods. The search term «scoliosis» was introduced into five popular search engines (Google, Yahoo, Bing, Lycos, Ask). The first 20 results of each one were used for the analysis. After rejecting duplicates, video or image files, a list of 25 websites that were adequate for analysis was obtained. Quality was assessed with three scales: DISCERN (Quality of medical information; range of low to high quality with 15 to 80) HONcode (Quality of accreditation web criteria; range of low to high quality of 15 to 0), and Degree of Adequacy of information for parents and patients with idiopathic scoliosis (range of low to high quality going of 0 to 9). Results. DISCERN: median 38 (SD=10.48); 24% of pages exceeded the 75th percentile (>45). HONcode: median 6.9 (SD=1.8); 28% of pages exceeded the 75th percentile (<5.5). Degree of Adequacy: median 4.3 (DS=1.75); 24% pages exceeded the 75th percentile (>5). Conclusions. In general terms, the quality of the information is acceptable. However, very few pages can be considered as suitable for parents and patients with idiopathic scoliosis (AU)

Exploración de columna y cadera. Cómo manejar la escoliosis / Spine and hip examination. How to manage scoliosis

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