Search

Background: In the general population the prevalence of adolescent idiopathic scoliosis (AIS) is 2–3%. There is growing awareness of how AIS affects the quality of life of patients. However, the extent of the societal burden AIS poses remains poorly understood. Therefore, this study aimed to determine the societal burden of AIS. Methods: A cross-sectional burden of disease study was conducted using a bottom-up, prevalence-based approach. Patients with AIS or guardians of a child diagnosed with AIS residing in the Netherlands were eligible for inclusion. The survey was distributed between June - December 2022 and was completed once by each participant. Costs were assessed using the institute for Medical Technology Assessment - Medical Consumption and Productivity Cost Questionnaires. The health-related quality of life (HRQoL) was assessed using the EuroQol 5D-5L/EuroQol 5D Youth and the Scoliosis Research Society-22 revised questionnaires. Costs and HRQoL were identified, measured, and valued. Results: Participants (n = 229) were predominantly female (92%), on average 35 years old, and were employed (65%). The societal cost for a patient with AIS in the Netherlands was €12,275 per year. The largest costs were estimated for the healthcare and productivity losses. The mean utility score for adults was 0.7 (SD 0.20). Severe pain was experienced by 10% of the adult participants and 44% reported to experience moderate pain/discomfort. Statistically significant differences between different age groups were present for the sector costs and HRQoL. Conclusions: AIS negatively impacts societal costs and the HRQoL. Reducing the burden that is posed on the productivity sector by AIS and further improving the HRQoL for AIS patients is needed. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis in children between the ages of 10 and 16. Nevertheless, risk factors for AIS, especially adjustable ones, are still poorly understood. This study seeks to examine the associations of lifestyle and social environment factors with AIS in Syrian schoolchildren. This matched case-control study uses survey data from a school-based scoliosis screening approach. We utilized logistic regression models to estimate the relative risk of AIS prevalence for each variable in the analysis. A multivariate logistic regression was performed to investigate the independent influence of each component on AIS development, with odds ratios (ORs) adjusted for the important factors. Overall, 1102 participants from 22 schools were included in this study, comprising 551 AIS cases and 551 controls. Mean age of the study population was 13.5 years ± 1.08. Six hundred and twenty (56.3%) of the study subjects were girls. After adjusting for other significant factors, age between 13 and 15 years (OR = 2.45; 95% CI, 1.37–6.17), inappropriate desk heights, either too low (OR = 1.53, 95% CI 1.12–1.85) or too high (OR = 1.46, 95% CI 1.13–1.87), standing with anterior pelvic tilt (OR = 1.97, 95% CI 1.46–3.43), and sleeping on the right side (OR = 1.92, 95% CI 1.54–2.23), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.73 (95% CI 0.43–0.94) for sitting normally, and 0.63 (95% CI 0.31–0.97) for sitting positions change. This study investigated the correlation between desk heights and AIS and revealed that incorrect desk heights were associated with more AIS risk. To prevent schoolchildren from developing AIS, stakeholders should consider installing height-adjustable desks in the classroom, changing students' sitting positions on an ongoing basis, and establishing training courses that assist students in keeping proper sitting postures. [ABSTRACT FROM AUTHOR]

Introduction: Scoliosis is a pathological spine structure deformation, predominantly classified as "idiopathic" due to its unknown etiology. However, it has been suggested that scoliosis may be linked to polygenic backgrounds. It is crucial to identify potential Adolescent Idiopathic Scoliosis (AIS)-related genetic backgrounds before scoliosis onset. Methods: The present study was designed to intelligently parse, decompose and predict AIS-related variants in ClinVar database. Possible AIS-related variant records downloaded from ClinVar were parsed for various labels, decomposed for Dinucleotide Compositional Representation (DCR) and other traits, screened for high-risk genes with statistical analysis, and then learned intelligently with deep learning to predict high-risk AIS genotypes. Results: Results demonstrated that the present framework is composed of all technical sections of data parsing, scoliosis genotyping, genome encoding, machine learning (ML)/deep learning (DL) and scoliosis genotype predicting. 58,000 scoliosis-related records were automatically parsed and statistically analyzed for high-risk genes and genotypes, such as FBN1 , LAMA2 and SPG11. All variant genes were decomposed for DCR and other traits. Unsupervised ML indicated marked inter-group separation and intra-group clustering of the DCR of FBN1 , LAMA2 or SPG11 for the five types of variants (Pathogenic, Pathogeniclikely, Benign, Benignlikely and Uncertain). A FBN1 DCR-based Convolutional Neural Network (CNN) was trained for Pathogenic and Benign/ Benignlikely variants performed accurately on validation data and predicted 179 high-risk scoliosis variants. The trained predictor was interpretable for the similar distribution of variant types and variant locations within 2D structure units in the predicted 3D structure of FBN1. Discussion: In summary, scoliosis risk is predictable by deep learning based on genomic decomposed features of DCR. DCR-based classifier has predicted more scoliosis risk FBN1 variants in ClinVar database. DCR-based models would be promising for genotype-to-phenotype prediction for more disease types. [ABSTRACT FROM AUTHOR]

Background/Objectives: Adolescents with idiopathic scoliosis require emotional support to change their experience of their desired body shape and to feel optimistic about the cosmetic results of surgical treatment. Recently, the use of virtual reality in psychological assessment and treatment has given specialists a technology that appears particularly well-suited for addressing body image disorders. The study objectives were two-fold. Firstly, we aimed to evaluate changes within the body image of scoliosis patients pre- and postoperatively. Secondly, we aimed to investigate if differences in body image exist in scoliosis females after implementing cognitive-behavioral therapy. Methods: Thirty-six total scoliosis patients participated in the 1st and 2nd study phases. The psychotherapy took place before and after surgery and during the patient's stay in the hospital. Body image was assessed using a virtual reality-based application, "Avatar Scoliosis 3D". Results: Regarding body image dissatisfaction evaluated via virtual tasks, the difference between the desired by patients and actual (based on the radiographic parameters) body shape is significant preoperatively in both scoliosis samples: with and without therapy (p < 0.000001 and p < 0.000001, respectively). Conclusions: The results of the present study may have important implications for developing standards for body image disorder treatments in scoliosis patients. We revealed that irrespective of received therapeutic support, scoliosis patients accurately estimate their body shape pre- and postoperatively, and they feel dissatisfied with their body preoperatively but not postoperatively. [ABSTRACT FROM AUTHOR]

Background: Patients with adolescent idiopathic scoliosis (AIS) has been reported to exhibit impaired postural stability. Posterior correction and fusion using four-dimensional (4D) anatomical spinal reconstruction techniques may improve postural stability to correct the spine for optimal anatomical alignment. This prospective study aimed to determine the effect of posterior correction and fusion using a 4D anatomical spinal reconstruction technique on postural stability in the eye-open and eye-closed standing position in patients with thoracic AIS. Methods: Thirty-three patients with AIS, excluding those with Lenke type 5C AIS, participated in the study. The mean and standard deviation of the minimum values of the time-to-boundary (TTB) were determined. All patients were asked to perform the quiet standing position under the eye-open and eye-closed condition on a force plate preoperatively and at 1 week and 2 years postoperatively. The TTB value was calculated from the velocity and distance to the foot boundary of the acquired center-of-pressure data. Results: Under the eye-closed condition, the mean and standard deviation of the minimum TTB were significantly higher at 2 years postoperatively than preoperatively and at 1 week postoperatively. The mean and standard deviation of the minimum TTB values were significantly lower at 1 week postoperatively than preoperatively. Conclusions: The results of this study suggest that surgery using the 4D anatomical spinal reconstruction technique reduces postural stability immediately after surgery; however, it improves postural stability at 2 years compared to the preoperative values. [ABSTRACT FROM AUTHOR]

Background: The gold standard treatment for adolescent idiopathic scoliosis (AIS) is posterior spinal fusion (PSF). However, long-term consequences of PSF can include reduced spinal flexibility, back pain, and intervertebral disc degeneration. Vertebral body tethering (VBT) is a non-fusion alternative that preserves motion. We investigated the outcomes of VBT for the treatment of thoracolumbar (TL) major AIS in the largest single-surgeon series with a minimum 2-year follow-up (FU). Methods: We performed a retrospective single-center review. Inclusion criteria were AIS, Lenke 5/6 curvature, and skeletally immature Variables were compared using Student's t-tests, Wilcoxon rank sum tests, Chi-square, and Fisher's exact tests. Results: A total of 37 consecutive patients, age 14.1 ± 1.6 years, 86.5% F, 35.9 ± 11.5-month FU, were examined. Overall, 27 patients (73%) had Lenke 5 and 10 (27%) had Lenke 6 curvatures. Instrumentation of the TL curve alone was performed in 59.5%, and thoracic (T) and TL in 40.5% of patients. Overall, 45.9% of patients had two tethers placed in the TL spine; no patients had double tethers placed at the main thoracic curves. The TL (51 ± 8° to 20 ± 11°; p < 0.0001) and T (37 ± 13° to 17 ± 10°; p < 0.0001) curvatures improved from baseline to the latest FU. Overall, 89% of patients achieved major Cobb < 35°; the three patients who did not experienced at least one cord breakage or required PSF. T5-T12 kyphosis increased (p = 0.0401) and lumbar lordosis was maintained (p = 0.9236). Both the TL inclinometer (16 ± 4º to 4 ± 2°; p < 0.0001) and T (6 ± 4° to 4 ± 3°; p = 0.0036) measurements improved. There was a 49% tether breakage rate as follows: 60% for single-cord TL constructs and 35% for double cords (p = 0.0991). There was an 8.1% re-operation rate as follows: one conversion to T PSF and revision of the TL tether; one release of the T tether and revision of the TL tether; one screw revision for radiculopathy. One patient was re-admitted for poor pain control. Conclusions: Patients with TL major curvature treated with VBT experienced a high rate of clinically successful outcomes with maintenance of lumbar lordosis and relatively low complication rates at the latest FU. [ABSTRACT FROM AUTHOR]

Background: Although recent observational studies and clinical trials have indicated a strong association between the gut microbiota and spinal stenosis diseases, the causal relationship between them remains unclear. Methods: Based on large-scale genome-wide association studies, we employed two-sample Mendelian randomization (MR) to analyse the causal relationships between the gut microbiota (GM) and 3 spinal stenosis diseases: adolescent idiopathic scoliosis (AIS), lumbar spondylolisthesis (LS), and spinal stenosis (SS). MR analysis was performed using the inverse variance weighting (IVW) method as the primary approach, supplemented by MR-Egger regression, weighted median, and weighted mode analyses. MR-PRESSO and MR-Egger regression were employed to assess horizontal pleiotropy. Cochran's Q test was used to evaluate heterogeneity. Further leave-one-out sensitivity analysis was conducted to ascertain the reliability of the causal relationships. Results: The IVW method identified 9 gut microbiota taxa (9 genera) that were causally related to AIS, 14 taxa (4 phyla, 2 classes, 2 orders, 1 family, and 5 genera) to LS, and 4 taxa (2 classes, 1 order, and 1 genus) to SS. The Cochrane Q test results did not indicate heterogeneity. Moreover, both the MR-Egger intercept test and the MR-PRESSO global test demonstrated that our findings were robust against potential horizontal pleiotropy. Furthermore, leave-one-out analysis provided additional evidence supporting the reliability of our identified causal relationships. Conclusion: Our findings have substantiated the potential causal impact of specific GM taxa on AIS, LS, and SS, thereby offering novel insights into the mechanisms mediated by the gut microbiota in these three diseases and laying the foundation for targeted preventive measures in further research. [ABSTRACT FROM AUTHOR]

Background context: Physical activities such as walking and climbing stairs are pervasive in human daily life. Individuals with scoliosis frequently encounter dysfunction in their muscle recruitment. Multiple studies have corroborated the presence of muscle dysfunction in individuals diagnosed with scoliosis. However, there is currently a noteworthy research gap regarding the exploration of changes in muscle characteristics and disparities from those observed in individuals without scoliosis during everyday activities, specifically stair climbing. Purpose: This study aims to examine the unique patterns of muscle activity during daily life in individuals with scoliosis and distinguish the specific differences between scoliosis patients and the healthy controls. The findings of this study are significantly important for the future accurate assessment of scoliosis and the development of rehabilitation treatment plans. Study design: Case–control study. Sample size: Twenty eight idiopathic scoliosis patients and twenty eight controls. Outcome measures: Root Mean Square(RMS), Maximum Voluntary Isometric Contraction(MVIC)%, RMS ratio(RMS convex / RMS concave). Methods: The surface electromyography (sEMG) device used in this study was the Delsys Trigno, with a sampling frequency of 1500 Hz. It recorded the activation level, peak contraction, and average activation level of the erector spinae (at T6, T10, and L3 levels), gluteus maximus, gluteus medius, external oblique, and rectus abdominis muscles during three different types of locomotion for both the 28 individuals with idiopathic scoliosis and the 28 control participants. Results: The movement patterns of the idiopathic scoliosis patients significantly differ from those of the normal population during level walking and ascending or descending stairs. In level walking, there is an asymmetry in the activation levels of the T6 and L3 erector spinae muscles, with lower activation on the convex side compared to the concave side. Similarly, during stair ascent, the activation of the T6 and T10 erector spinae muscles is asymmetric, with higher activation on the convex side than the concave side. Moreover, during stair descent, the activation of the T6 erector spinae muscle is asymmetric, with higher activation on the convex side than the concave side. Conclusions: During level walking and stair activities, idiopathic scoliosis patients exhibit pronounced abnormal movement patterns that significantly differ from those of the control group. Under different activity conditions such as level walking, ascending and descending stairs, idiopathic scoliosis patients demonstrate abnormal muscle activation in different segments of the spine. It is crucial for clinicians to prioritize the symmetry of muscle activation in the spinal region of idiopathic scoliosis patients and consider incorporating symmetry training for these muscles. [ABSTRACT FROM AUTHOR]

Objective: The associations between the ratio of blood high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) (hs-CRP/HDL-C ratio) and outcomes in patients with acute ischemic stroke (AIS) have yet to be established. This study is the first to examine the relationship between the hs-CRP/HDL-C ratio and three-month unfavorable outcomes in patients with AIS. Methods: This secondary analysis utilized data from a prospective cohort study involving 1559 AIS patients recruited at a South Korean hospital between January 2010 and December 2016. We constructed a binary logistic regression model to explore the association between the hs-CRP/HDL-C ratio and unfavorable outcomes in patients with AIS. An attempt was made to use a generalized additive model (GAM) with smooth curve fitting to elucidate potential nonlinear interactions. Furthermore, inflection points were identified via a recursive method, and binary logistic regression models were developed for each side of these inflection points. Ultimately, a log-likelihood ratio test was used to identify the most appropriate model for explaining the connection between the hs-CRP/HDL-C ratio and unfavorable outcomes in patients with AIS. Results: The incidence of unfavorable outcomes was 24.5%, with a median hs-CRP/HDL-C ratio of 3.64. After accounting for other factors, the binary logistic regression model revealed a statistically significant positive association between the hs-CRP/HDL-C ratio and the likelihood of poor outcomes in AIS patients (OR = 1.013, 95% CI: 1.005–1.022; P = 0.002). A nonlinear relationship was observed, with the first inflection point of the hs-CRP/HDL-C ratio at 42.74. Each 1-unit increase in the hs-CRP/HDL-C ratio was associated with a 2.4% greater risk of unfavorable outcomes (OR = 1.024, 95% CI: 1.011–1.038, P < 0.001). Conclusion: This study provides evidence of a positive and nonlinear correlation between the hs-CRP/HDL-C ratio and poor three-month functional outcomes in AIS patients. When the hs-CRP/HDL-C ratio was less than 42.74, a positive association was observed with the risk of unfavorable outcomes. This finding offers a reference for optimizing early individualized therapy and aids in clinical counseling for patients with AIS. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion With the rising incidence of pulmonary nodules (PNs), lung adenocarcinoma in situ (AIS) is a critical early stage of lung cancer, necessitating accurate diagnosis for early intervention. This study applies artificial intelligence (AI) for quantitative imaging analysis to differentiate AIS from atypical adenomatous hyperplasia (AAH) and minimally invasive adenocarcinoma (MIA), aiming to enhance clinical diagnosis and prevent misdiagnosis.The study analyzed 1215 PNs with confirmed AAH, AIS, and MIA from six centers using the Shukun AI diagnostic module. Parameters evaluated included demographic data and various CT imaging metrics to identify indicators for clinical application, focusing on the mean CT value's predictive value.Significant differences were found in several parameters between AAH and AIS, with nodule mass showing the highest predictive value. When comparing AIS to MIA, total nodule volume was the best predictor, followed by the maximum CT value.The mean CT value has limited discriminative power for AIS diagnosis. Instead, the maximum CT value and maximum 3D diameter are recommended for clinical differentiation. Nodule mass and volume of solid components are strong indicators for differentiating AIS from AAH and MIA, respectively. [ABSTRACT FROM AUTHOR]

Background: Brace therapy's influence on adolescent idiopathic scoliosis's (AIS) natural course is inconclusive. Methods: Brace-treated AIS patients from 2016 to 2020 were examined regarding four endpoints at brace weaning: surgery need, curve progress ≥ 6° and > 45°, and curve improvement ≥ 6°. Prediction variables' influence was computed for the all-patients group and three subgroups (Subgroup 1: fulfilling the Scoliosis Research Society's [SRS] criteria, Subgroup 2: initial Cobb angle < 25°, Subgroup 3: initial Cobb angle > 40°). According to the data characteristics, parametric and non-parametric tests and binary logistic regression were performed. Results: The research included 69 patients. Overall, after brace weaning surgery was recommended for 20.3% of them, curve progression was ≥ 6° in 23.2%, the Cobb angle was beyond 45° in 11.6%, and the Cobb angle improved by ≥ 6° in 20.3%. Patients needing surgery had a significantly higher initial Cobb angle (38.8° ± 9.8° vs 27.8° ± 7.6°, p < 0.001), lower Risser stages (p = 0.010), and higher Nash and Moe degrees (p = 0.030). Patients with curve progress ≥ 6° were younger at first curve notification (12.4 ± 1.5 vs 13.7 ± 1.7 years, p = 0.011) and older at menarche (13.4 ± 1.1 vs 12.6 ± 1.2 years, p = 0.037). Furthermore, 21.6% of all Risser 3 and 4 patients had still curve progress ≥ 6°. In-brace correction was significantly higher in patients with curve improvement ≥ 6° vs < 6° (54.0% ± 31.2% vs 31.9% ± 30.7%; p = 0.019). Nine patients fulfilled the SRS criteria, 22 had initial Cobb angles < 25°, and 11 had > 40°. Real brace wear (RBW) in all groups had no significant effect on outcome. Two significant subgroup differences were found: Surgery recommendation and curve progression beyond 45° were significantly more frequent in the initial Cobb angle > 40° subgroup. Conclusions: Brace effectiveness can be assumed because curve improvement was achieved in nearly one-fifth with sufficient in-brace correction. However, no significant influence of RBW on the outcome endpoints was demonstrated. To clarify conflicting results, big data management, including untreated patients, must be employed to further research AIS's multifactorial influenced aetiology and course. Meanwhile, it is worth starting bracing in AIS in practice also beyond the SRS's criteria. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion There has been no definitive conclusion on the selection of the lowest instrumented vertebra (LIV) in Lenke 5C adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to evaluate whether it is enough to stop distal fusion at L3 in mild to moderate Lenke 5C AIS patients with posterior selective lumbar fusion, Ponte osteotomies and segmental direct vertebra rotation and to analyze the risk factors for postoperative complications in patients selecting L3 as the LIV.A retrospective review was conducted on 106 Lenke 5C AIS patients who underwent corrective surgery in our institution from 2010 to 2021, with a minimum 2‐year follow‐up. The LIV was L3 or L4. According to the LIV, patients were initially divided into Group I (the LIV was L3) and Group II (the LIV was L4). Then, Group I was further divided into a complication group and a non‐complication group. Demographics, radiological parameters, postoperative complications, and clinical outcomes were recorded. Univariate analysis and multivariate logistic analysis were used to identify the risk factors for postoperative complications in patients with L3 as the LIV.There were no significant differences in the demographics, radiological parameters, postoperative complications, or clinical outcomes between Group I and Group II (p > 0.05), and the outcomes were satisfactory in both groups. The main postoperative complications were distal adding‐on (11 cases), coronal imbalance (16 cases), proximal junctional kyphosis (2 cases), and internal fixation failure (4 cases). Logistic regression analysis revealed that age and postoperative C7‐CSVL were independent predictors of postoperative complications when selecting L3 as the LIV.Terminating the distal fusion level at L3 was practical for mild to moderate Lenke 5C AIS patients. For patients selecting L3 as the LIV, younger patients should be cautious, and maintaining postoperative coronal balance is necessary for avoiding postoperative complications. [ABSTRACT FROM AUTHOR]

Background/Objectives: The distorted vertebral body has been studied in scoliosis; however, there is little knowledge about the difference between neuromuscular and idiopathic scoliosis. This study aimed to investigate the vertebral body morphology in patients with spastic quadriplegic cerebral palsy and scoliosis (CP scoliosis) and compare them with those of apex- and Cobb angle-matched patients with adolescent idiopathic scoliosis (AIS). Methods: Thirty-four patients with CP scoliosis and thirty-two patients with AIS were included. The pedicle diameter, chord length, and vertebral body rotation were evaluated at one level above the apex, one level below the apex, and at the apex using a reconstructed computed tomography scan. The apex of the curve and Cobb angle were too diverse between patients with CP scoliosis or AIS. Eighteen patients were matched in each group according to the apex and Cobb angle (within 5-degree differences) of the major curve, and compared between matched groups (mCPscoliosis vs. mAIS). Results: In the comparison of the apex and Cobb angle-matched groups, there was no statistical difference in the Cobb angle between mCPscoliosis (80.7 ± 13.8 degrees) and mAIS (78.6 ± 13.6 degrees, p = 0.426), and the vertebral body rotation (25.4 ± 15.4° in mCPscoliosis vs. 24.4 ± 6.5° in mAIS, p = 0.594). There was no difference in the pedicle diameters of either the convex (3.6 ± 1.1 mm in mCPscoliosis vs. 3.3 ± 1.2 mm in mAIS, p = 0.24) or concave side (3.1 ± 1.2 mm in mCPscoliosis vs. 2.7 ± 1.6 mm in mAIS, p = 0.127). However, the patients in the mCPscoliosis group were younger (12.7 ± 2.5 years vs. 14.6 ± 2.4 years, p = 0.001), and the chord length was shorter on the convex (38.0 ± 5.0 mm vs. 40.4 ± 4.9 mm, p = 0.025) and concave (37.7 ± 5.2 mm vs. 40.3 ± 4.7 mm, p = 0.014) sides compared with those of the mAIS group. Conclusions: With a similar apex and Cobb angle, the vertebral body rotation and pedicle diameter in patients with CP scoliosis were comparable to those with AIS; however, the chord length was shorter in CP scoliosis. For the selection of the pedicle screw in CP scoliosis, the length of the pedicle screw should be more considered than the diameter. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of unknown etiology that commonly affects adolescents, imposing significant socioeconomic burdens. Effective management necessitates a comprehensive approach that takes into account multiple factors, including growth potential and psychological issues. Despite significant advancements in AIS management, several questions regarding optimal treatment strategies persist. Recent technological advancements are transforming the treatment landscape, encompassing advancements in bracing, robotic-assisted deformity corrections, and other interventions. This review explores current issues debated in the literature concerning the treatment of AIS, focusing on contemporary high-level evidence (e.g., meta-analyses and randomized controlled trials). Furthermore, this review explores cutting-edge developments and future directions in AIS management, including the integration of artificial intelligence and augmented reality. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We aimed to determine the role of plasma alpha- and beta-synuclein levels and other routine inflammatory parameters in the diagnosis, outcome, and mortality of acute ischemic stroke (AIS). METHODS: In our study, serum alpha- and beta-synuclein levels and clinical data were prospectively evaluated in 93 subjects (43 controls and 50 AIS patients) admitted to the emergency department. The outcome status and prognostic classification were performed according to the modified Rankin Scale (mRS) scores on the 30th day from hospital admission. RESULTS: The mean age of the subjects was 70.6 ± 11 years. Thirty-eight percentage were female. Plasma α-synuclein levels in the AIS group (33.6 ± 8.5 ng/mL) were significantly higher than those in the control group (4.22 ± 2.1 ng/mL) (P < 0.001). Plasma β-synuclein levels in the AIS group (13.07 ± 2.7 ng/mL) were significantly higher than those in the control group (2.17 ± 1.4 ng/mL) (P < 0.001). There was no significant difference in alpha- and beta-synuclein levels between the subgroups formed according to the 30th-day results of the patients using the mRS scores (P = 0.813 and 0.812, respectively). CONCLUSION: The serum alpha- and beta-synuclein concentrations of patients with AIS at admission were significantly higher than the healthy control group. At admission, serum alpha- and beta-synuclein levels do not have definitive clinically predictive value in predicting stroke progression and outcome in patients with AIS. [ABSTRACT FROM AUTHOR]

Background: Lumbar spondylolysis is a common cause of low back pain in adolescents. A lot of adolescent idiopathic scoliosis with concomitant spondylolysis has been reported before, but only two cases with acquired spondylolysis following long fusion for scoliosis were reported. We described another similar rare case and discussed its causes and treatment options in this paper. Case Presentation: A 17‐year‐old female underwent growing rod implantation, growing rod extension, and final long spinal fusion for idiopathic scoliosis. Then, she suffered from low back pain with a VAS of 1‐2 points and gradually aggravated to a VAS of 7‐8 points at 3.5 years after the final fusion. The X‐ray images showed that there was L4‐S1 instability. And the CT scan images showed new bilateral spondylolysis of L5. Conclusions: These findings suggested that distal mechanical stress might cause spondylolysis of the distal vertebra following long fusion for scoliosis. Surgeons should keep instrumentation as short as possible and avoid choosing a low lumbar as LIV when they decide on the fusion levels. [ABSTRACT FROM AUTHOR]

Background/Objectives: Scoliosis is a condition that involves deformation of the spine in the coronal plane and commonly appears in childhood or adolescence, significantly limiting a person's life. The cause is multifactorial, and treatment aims to improve the spinal curvature, prevent major pathologies, and enhance aesthetics. The objective of this review was to determine whether high-velocity low-amplitude (HVLA) spinal manipulation is more effective than other treatments for children with idiopathic scoliosis (IS). Methods: The PubMed, Web of Science, Scopus and PEDro databases were searched for both clinical trials and cohort studies. Methodological quality was assessed via the PEDro scale (for clinical trials) and the Newcastle–Ottawa scale (for observational studies). The protocol of this systematic review was registered in PROSPERO (CRD42024532442). Results: Five studies were selected for review. The results indicated moderate improvements in pain and the Cobb angle and limited improvements in quality of life. Conclusions: HVLA spinal manipulation does not seem to have significant effects on reducing spinal deformity in IS patients, nor does it significantly impact quality of life. However, this therapy may have significant effects on reducing pain in these patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Adolescent Idiopathic Scoliosis (AIS) affects individuals aged 10–18 years and is characterized by spinal deformity, three-dimensional axis deformation, and vertebral rotation. Schroth method exercises and braces have been shown to reduce the Cobb angle and halt spinal deformity progression. The aim of this study was to investigate the impact of a 12-month, supervised Schroth exercise program on scoliosis severity and quality of life in adolescents with AIS. Materials and Methods: Eighty adolescents with AIS (aged 10–17 years) were prescribed a brace and were divided into two groups. The intervention group followed a supervised Schroth exercise program three times a week for 12 months in addition to wearing a brace. The control group used only the brace. Outcomes included the Cobb angle of the main curvature and the sum of curves using radiography, the maximum angle of trunk rotation (ATR maximum, using a scoliometer), and quality of life with the Scoliosis Research Society-22 (SRS-22) questionnaire. Evaluations were conducted at baseline, after 12 months, and 6 months post-intervention. A multivariate analysis of covariance (MANCOVA) was used for statistical analysis (p-Value < 0.05). Results: The intervention group showed statistically significant improvement compared to the control group in the 12th month in Cobb angle (mean differences, 95% CI: −3.65 (−5.81, −1.53), p-Value < 0.001, Cohen's d = 0.30), ATR maximum (mean differences, 95% CI: −3.05 (−3.86, −2.23), p-Value < 0.001, Cohen's d = 0.74), and SRS-22 score (mean differences, 95% CI: 0.87 (0.60, 1.13), p-Value < 0.001, Cohen's d = 0.58). Differences in ATR maximum and SRS-22 score remained significant at the 18-month measurement. No significant differences were found between groups in the sum of curves (p-Value > 0.05). Conclusions: A 12-month supervised Schroth exercise program in AIS patients undergoing brace treatment significantly improves scoliosis severity (Cobb angle and ATR maximum) and quality of life. Improvements were greater than those in shorter-duration studies, suggesting a linear dose–response relationship. Further clinical studies are needed to clarify the impact of long-term Schroth programs. [ABSTRACT FROM AUTHOR]

Background: Adolescent idiopathic scoliosis (AIS) corrective surgery may involve significant blood loss and blood transfusion requirements. Antifibrinolytic agents such as tranexamic acid (TXA) have been used to reduce blood loss, but its optimal dose is uncertain. The objective of this study is to determine the estimated blood loss and rate of blood transfusion between two groups of AIS patients receiving TXA as a single bolus versus bolus followed by infusion in scoliosis surgery. Methods: This was a retrospective analysis of a single bolus versus bolus followed by infusion of TXA in AIS surgery. AIS patients undergoing posterior spinal fusion (PSF) from December 2018 to September 2019 at a tertiary university hospital were identified. Inclusion criteria were patients aged between 10 and 21 years who received either a single bolus of 30 mg/kg TXA (Group A) or a single bolus of 30 mg/kg followed by continuous infusion of 10 mg/kg/h of TXA (Group B). Patient demographics, operative data, estimated blood loss, blood transfusion rate, and complications were recorded. Results: A total of 129 AIS patients were included. All operative surgeries were performed by two senior consultants. The mean age was 14.8 ± 3.4 years old, and 89.1% were female. The Cobb angle, number of fusion levels, number of screws, length of skin incision, and duration of surgery were comparable between the two groups. There was no difference in the total estimated blood loss between the two groups: 723.3 ± 279.4 mL (range: 175.0–1607.0 mL) in Group A and 819.4 ± 302.6 mL (range: 330.0–1556.0 mL) in Group B (p = 0.065). There were no complications, and none received blood transfusion. Conclusion: TXA when administered as a single bolus or bolus followed by infusion in AIS patients undergoing PSF surgery was associated with similar estimated total surgical blood loss and blood transfusion requirement. [ABSTRACT FROM AUTHOR]

Background: There have been some studies on the occurrence of ESR1 and 2 polymorphisms and AIS, but some data extraction is wrong, and there are no studies on the progress of AIS. Methods: Computer searches were conducted on PubMed, EMBASE, ScienceDirect and Scopus from the establishment of the database to April 2024. Cross-sectional and case-control studies on estrogen receptor ESR1, two single nucleotide polymorphisms, and the occurrence and development of AIS were collected, and statistical analysis was performed using the Revman 5.3 software. Results: In the comparison of the association between single nucleotide polymorphisms of estrogen receptors ESR1 and 2 and the occurrence and development of AIS, eight studies were included, including 2706 cases and 1736 controls.The results showed that the AA genotype [OR = 0.50,95%Cl(0.34,0.72),P = 0.0003] at the XbaI locus of ESR1,CC genotype [OR = 1.67,95%Cl(1.16,2.42), P = 0.006], C allele [OR = 1.28,95%Cl(1.03,1.59),P = 0.03], and T allele [OR = 0.78,95%] Cl(0.63,0.97),P = 0.03] at the PvuII locus of ESR1 and TT genotype [OR = 0.50,95%Cl(0.26,0.93),P = 0.03] at the AlwNI locus of ESR2 showed statistically significant differences between the progressive and stable AIS patients. Conclusion: Single nucleotide polymorphisms of ESR1 and ESR2 were not related to the occurrence of AIS; however, some of them were related to the progression of AIS. [ABSTRACT FROM AUTHOR]

Posterior spinal instrumented fusion (PSIF) is a treatment option for adolescent spinal deformity. PSIF leads to loss of spinal segment motion. It is unclear the extent to which spinal stiffness is perceived by adolescent patients after fusion. Focus groups of adolescents between ages 11 and 21 years who underwent PSIF for spinal deformity were performed. Focus groups were evaluated for common themes, and a 36-question survey was designed. Survey responses were analyzed relative to last instrumented vertebra (LIV) and Scoliosis Research Society-22 (SRS-22) scores. Five focus groups were held with 18 patients in total. Three main themes were identified by participants: 56% identified difficulty bending forward, 44% identified difficulty hunching while sitting, and 56% identified difficulty with twisting motions. Patients with more distal LIV reported significant more difficulty with self-care/grooming (P =.014) and chores (P <.001). SRS-22 function/activity scores correlated well with survey categories in self-care/grooming (r =.61; P =.049) and recreation (r =.69; P =.019). Focus groups suggest that spinal stiffness is frequently perceived and leads to alteration in daily tasks in adolescents after spinal fusion. [ABSTRACT FROM AUTHOR]

Background: Positive effects of brace treatments in adolescent idiopathic scoliosis patients on gait were proven. Aim: Therefore, this study examined whether the influence of brace therapy in combination with Schroth therapy influencing the plantar pressure distribution, pre and post intensive rehabilitative inpatient treatment. Design: Prospective cohort study, longitudinal. Setting: Scoliosis rehabilitation clinic "Asklepios Katharina-Schroth-Klinik" (Bad Sobernheim, Germany). Population: Twenty (14f/6m) patients (12–16 years) had a medically diagnosed moderate idiopathic scoliosis (Cobb angle 20–50°, Median 30°) and an indication for combined brace and Schroth therapy with an inpatient stay (4 weeks) at the Asklepios Katharina Schroth Clinic (Germany). Methods: At the beginning (T1) and at the end of the stay (T2), the plantar pressure distribution with (A) and without wearing a brace (B) was recorded (walking distance 10 m). Results: No significant differences between the left and right foot were found at baseline (T1). The T1 - T2 comparison of one foot revealed significant differences (p ≤ 0.05 − 0.001, respectively) for (A): mean pressure right midfoot, loaded area total left foot, left midfoot, left inner ball of foot, right midfoot, impulse total right foot, right midfoot and for (B): mean pressure right midfoot, right outer ball of foot, loaded area total right foot, right heel, right midfoot, impulse right heel, right midfoot, right outer ball of foot. Conclusions: A combined brace and Schroth therapy maintains the initial symmetrical plantar pressure distribution over the duration of four weeks since the significant differences fall within the range of measurement error. Clinical rehabilitation impact: The insole measuring system can be used to objectively support therapeutic gait training as part of rehabilitation and to assess insole fitting based on foot shape. Due to its convenient handling and rapid data acquisition, it may be a suitable method for interim or follow-up diagnostics in the treatment of idiopathic scoliosis. [ABSTRACT FROM AUTHOR]

Background: Meeting the 24-hour movement behavior (24-HMB) guideline helps enhance quality of life (QOL) of adolescents. This study aimed to assess the associations between the 24-HMB (physical activity, screen time, sleep) and QOL among adolescents with idiopathic scoliosis. Methods: A cross-sectional study was conducted between September 2021 and September 2023. 24-HMB, QOL and demographic variables were collected through a self-reported questionnaire. Linear regression models and stratified analyses were used to explore statistical associations between the 24-HMB and QOL. Results: A total of 1073 participants aged 10–18 years with a spinal Cobb angle between 10° and 40° were included. Overall, 20 participants (1.9%) met all three behavioral guidelines, and 272 participants (25.3%) met none. Compared to those who did not meet any of the guidelines, adolescents meeting both screen time and sleep duration (β = 4.10, 95% CI: 2.02–6.18, P < 0.001) and all 3 guidelines (β = 4.39, 95% CI: 0.27–8.51, P = 0.037) had higher QOL scores. Stratified analyses showed that the above associations were more pronounced in adolescents without back pain or with good self-image. Conclusions: These findings highlight the importance of adopting and maintaining healthy behavioral habits in order to improve QOL among adolescents with idiopathic scoliosis, especially in those without back pain or with good self-image. [ABSTRACT FROM AUTHOR]

Background: Current research lacks comprehensive investigation into the biomechanical changes in the spinal cord and nerve roots during scoliosis correction. This study employs finite element analysis to extensively explore these biomechanical variations across different Cobb angles, providing valuable insights for clinical treatment. Methods: A personalized finite element model, incorporating vertebrae, ligaments, spinal cord, and nerve roots, was constructed using engineering software. Forces and displacements were applied to achieve Cobb angle improvements, designating T1/2-T4/5 as the upper segment, T5/6-T8/9 as the middle segment, and T9/10-L1/2 as the lower segment. Simulations under traction, pushing, and traction + torsion conditions were conducted, and biomechanical changes in each spinal cord segment and nerve roots were analyzed. Results: Throughout the scoliosis correction process, the middle spinal cord segment consistently exhibited a risk of injury under various conditions and displacements. The lower spinal cord segment showed no significant injury changes under traction + torsion conditions. In the early correction phase, the upper spinal cord segment demonstrated a risk of injury under all conditions, and the lower spinal cord segment presented a risk of injury under pushing conditions. Traction conditions posed a risk of nerve injury on both sides in the middle and lower segments. Under pushing conditions, there was a risk of nerve injury on both sides in all segments. Traction + torsion conditions implicated a risk of injury to the right nerves in the upper segment, both sides in the middle segment, and the left side in the lower segment. In the later correction stage, there was a risk of injury to the upper spinal cord segment under traction + torsion conditions, the left nerves in the middle segment under traction conditions, and the right nerves in the upper segment under pushing conditions. Conclusion: When the correction rate reaches 61–68%, particular attention should be given to the upper-mid spinal cord. Pushing conditions also warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve. Traction conditions require attention to nerve roots bilaterally in the middle and lower segments, while traction combined with torsion conditions necessitate focus on the right-side nerve roots in the upper segment, both sides in the middle segment, and the left-side nerve roots in the lower segment. [ABSTRACT FROM AUTHOR]

Objective: To intelligently evaluate the invasiveness of pure ground-glass nodules with multiple classifications using deep learning. Methods: pGGNs in 1136 patients were pathologically confirmed as lung precursor lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)], minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IAC). Four different models [EfficientNet-b0 2D, dual-head ResNet_3D, a 3D model combining three features (3D_3F), and a 3D model combining 19 features (3D_19F)] were constructed to evaluate the invasiveness of pGGNs using the EfficientNet and ResNet networks. The Obuchowski index was used to evaluate the differences in diagnostic efficiency among the four models. Results: The patients with pGGNs (360 men, 776 women; mean age, 54.63 ± 12.36 years) included 235 cases of AAH + AIS, 332 cases of MIA, and 569 cases of IAC. In the validation group, the areas under the curve in detecting the invasiveness of pGGNs as a three-category classification (AAH + AIS, MIA, IAC) were 0.8008, 0.8090, 0.8165, and 0.8158 for EfficientNet-b0 2D, dual-head ResNet_3D, 3D_3F, and 3D_19F, respectively, whereas the accuracies were 0.6422, 0.6158, 0.651, and 0.6364, respectively. The Obuchowski index revealed no significant differences in the diagnostic performance of the four models. Conclusions: The dual-head ResNet_3D_3F model had the highest diagnostic efficiency for evaluating the invasiveness of pGGNs in the four models. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance (IR) can predict the prognosis of patients suffering from cerebrovascular disorders. The triglyceride-glucose (TyG) index and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio have been confirmed to be easy and reliable indicators of IR. However, the relationships between the TyG index or TG/HDL-C ratio and early neurological deterioration (END) after thrombolysis in patients with acute ischemic stroke (AIS) are uncertain. Methods: A retrospective analysis of 1,187 patients diagnosed with AIS who underwent intravenous thrombolysis between January 2018 and February 2024 was performed. Post-thrombolysis END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score of ≥4 within 24 h after thrombolysis. Logistic regression analysis was performed to explore the relationships of the TyG index and TG/HDL-C ratio with post-thrombolysis END. Receiver operating characteristic (ROC) analysis was used to assess the ability of the TyG index and TG/HDL-C ratio to discriminate post-thrombolysis END. Results: Among the 1,187 recruited patients, 179 (15.08%) were diagnosed with post-thrombolysis END, and 1,008 (84.92%) were diagnosed with non-END. A binary logistic regression model indicated that the TyG index (odds ratio [OR], 2.015; 95% confidence interval [CI] 1.964-2.414, p = 0.015) and TG/HDL-C ratio (OR, 1.542; 95% CI, 1.160-2.049, p = 0.004) were independent factors for post- thrombolysis END. The area under the curve (AUC) values for the TyG index, TG/HDL-C ratio, and TyG index combined with the TG/HDL-C ratio for post- thrombolysis END were 0.704, 0.674, and 0.755, respectively. Conclusion: This study indicates that the TyG index and TG/HDL-C ratio can be used as prognostic factors to predict post-thrombolysis END. [ABSTRACT FROM AUTHOR]

Objective: To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making. Methods: One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up. Results: Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively). Conclusion: Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C. [ABSTRACT FROM AUTHOR]

Background and objectives: In the era of personalized medicine, standard protocols regarding the management of acute ischemic stroke (AIS) focus on time targets alone without tailoring the protocol to the specific patient and hospital characteristics to increase IV thrombolysis rates and improve outcomes for these patients by considering organizational differences and patient-related factors that influence adherence to target times at the emergency department level. With this in mind, we evaluate the effect of achieving ED time targets from standard protocol and patient-related risk factors on the intravenous (IV) thrombolysis rate in patients with AIS in the therapeutic window. Materials and Methods: For our research, we enrolled people who arrived at the ED with signs of recent AIS with an onset of less than 4.5 h. Initially, 355 patients were included in the study, but through careful screening, only 258 were considered eligible to participate. Of the final group of 258 patients, only 46 received intravenous thrombolysis treatment. Results: In our study, when we are analyzing ED times in patients admitted with stroke symptoms in the therapeutic window, we found statistically significantly decreased ED times for patients that performed IV thrombolysis compared to patients not performing as follows: a median of 100 min in onset-to-ED door time (p < 0.001), a door-to-physician time (ED doctor) of 4 min (p = 0.009), door-to-blood-samples of 5 min (p = 0.026), a door-to-CT time of 15.5 min (p = 0.009), and door-to-CT results of 37 min (p < 0.001). In addition, patients who received intravenous thrombolysis were found to be significantly older (p < 0.001), with lower height and weight (p < 0.001 for both) and lower Glasgow Coma Scale (GCS) scores (9 ± 4.94 vs. 13.85 ± 2.41, p < 0.001). The logistic regression analysis indicated that the onset-to-ED time (p < 0.001) and the door-to-physician time (p = 0.014) for emergency medicine physicians are significant predictors of the likelihood of administering thrombolysis. By analyzing the impact of comorbidities, we observed that dyslipidemia, chronic arterial hypertension, and diabetes mellitus are significant predictive factors for performing IV thrombolysis (the presence of dyslipidemia and diabetes mellitus are predictive factors for performing IV thrombolysis, while the presence of arterial hypertension is not). Conclusions: The ED time targets that significantly influenced IV thrombolysis in our study were the onset-to-ED door time and the time it takes for the ED doctor to assess the AIS patient (door-to-physician time). The IV thrombolysis rate for these patients was 17.83%, lower than expected despite achieving most ED time targets, with the presence of chronic arterial hypertension as a significant predictive patient-related factor for not performing it. Even though our reported hospital's thrombolysis rate is favorable compared to international reports, there is always room for improvement. Based on our study results, it is necessary that new protocols to customized standard protocols and ED time targets for increasing IV thrombolysis rate in patients with AIS in the therapeutic window, focusing more on patient-related factors and type of hospitals, granting personalized medicine its right. Based on our study results, it is necessary that new protocols customize standard protocols and ED time targets for increasing IV thrombolysis rate in patients with AIS in the therapeutic window, focusing more on patient-related factors and type of hospitals, granting personalized medicine its right. [ABSTRACT FROM AUTHOR]

Central cord syndrome (CCS) is the most prevalent and debated incomplete spinal cord injury (SCI) syndrome, with its hallmark feature being more pronounced weakness of the upper extremities than of the lower extremities. Varying definitions encapsulate multiple clinical features under the single umbrella term of CCS, complicating evaluation of its frequency, prognosis discussions, and outcomes research. Often, people with CCS are excluded from research protocols, as it is thought to have a favorable prognosis, but the vague nature of CCS raises doubts about the validity of this practice. The objective of this study was to categorize CCS into specific subsets with clear quantifiable differences, to assess whether this would enhance the ability to determine if individuals with CCS or its subsets exhibit distinct neurological and functional outcomes relative to others with incomplete tetraplegia. This study retrospectively reviewed individuals with new motor incomplete tetraplegia from traumatic SCI who enrolled in the Spinal Cord Injury Model Systems (SCIMS) database from 2010 to 2020. Through an assessment of the prevailing criteria for CCS, coupled with data analysis, we used two key criteria, including the severity of distal upper extremity weakness (i.e., hands and fingers) and extent of symmetry, to delineate three CCS subsets: full CCS, unilateral CCS, and borderline CCS. Of the 1490 participants in our sample, 17.5% had full, 25.6% had unilateral, and 9% had borderline CCS, together encompassing >50% of motor incomplete tetraplegia cases. Despite the increased sensitivity and specificity of these subsets compared with existing quantifiable criteria, substantial variability in clinical presentation was still observed. Overall, individuals meeting CCS subset criteria showed a higher likelihood of American Spinal Injury Association (ASIA) Impairment Scale (AIS) D grade than those with motor incomplete tetraplegia without CCS. Upper Extremity Motor Score (UEMS) for those with CCS was lower on admission, a difference that diminished by discharge, whereas their Lower Extremity Motor Score (LEMS) consistently remained higher than for those without CCS. However, these neurological distinctions did not result in significant functional differences, as lower and upper extremity functional outcomes at discharge were mostly similar, with some differences observed within those with AIS D grade. The AIS grade, rather than the diagnosis of CCS, remains the foremost determinant influencing neurological and functional outcomes. We recommend that future studies consider incorporating motor incomplete tetraplegia into their inclusion/exclusion criteria, instead of relying on criteria specific to CCS. Although there remains clinical value in characterizing an injury pattern as CCS and perhaps using the different subsets to better characterize the impairments, it does not appear to be a useful research criterion. [ABSTRACT FROM AUTHOR]

Introduction: Prior studies suggested that neuromuscular factors might be involved in the pathogenesis of adolescent idiopathic scoliosis (AIS). The neuromuscular junction (NMJ) is the important pivot where the nervous system interacts with muscle fibers, but it has not been well characterized in the paraspinal muscles of AIS. This study aims to perform the quantitative morphological analysis of NMJs from paraspinal muscles of AIS. Methods: AIS patients who received surgery in our center were prospectively enrolled. Meanwhile, age‐matched congenital scoliosis (CS) and non‐scoliosis patients were also included as controls. Fresh samples of paraspinal muscles were harvested intraoperatively. NMJs were immunolabeled using different antibodies to reveal pre‐synaptic neuronal architecture and post‐synaptic motor endplates. A confocal microscope was used to acquire z‐stack projections of NMJs images. Then, NMJs images were analyzed on maximum intensity projections using ImageJ software. The morphology of NMJs was quantitatively measured by a standardized 'NMJ‐morph' workflow. A total of 21 variables were measured and compared between different groups. Results: A total of 15 AIS patients, 10 CS patients and 5 normal controls were enrolled initially. For AIS group, NMJs in the convex side of paraspinal muscles demonstrated obviously decreased overlap when compared with the concave side (34.27% ± 8.09% vs. 48.11% ± 10.31%, p = 0.0036). However, no variables showed statistical difference between both sides of paraspinal muscles in CS patients. In contrast with non‐scoliosis controls, both sides of paraspinal muscles in AIS patients demonstrated significantly smaller muscle bundle diameters. Conclusions: This study first elucidated the morphological features of NMJs from paraspinal muscles of AIS patients. The NMJs in the convex side showed smaller overlap for AIS patients, but no difference was found in CS. This proved further evidence that neuromuscular factors might contribute to the mechanisms of AIS and could be considered as a novel potential therapeutic target for the treatment of progressive AIS. [ABSTRACT FROM AUTHOR]

Background: It is known that neuroanatomical and neurofunctional changes observed in the brain, brainstem and cerebellum play a role in the etiology of adolescent idiopathic scoliosis (AIS). This study aimed to investigate whether volumetric measurements of brain regions can be used as predictive indicators for AIS through machine learning techniques. Methods: Patients with a severe degree of curvature in AIS (n = 32) and healthy individuals (n = 31) were enrolled in the study. Volumetric data from 169 brain regions, acquired from magnetic resonance imaging (MRI) of these individuals, were utilized as predictive factors. A comprehensive analysis was conducted using the twelve most prevalent machine learning algorithms, encompassing thorough parameter adjustments and cross‐validation processes. Furthermore, the findings related to variable significance are presented. Results: Among all the algorithms evaluated, the random forest algorithm produced the most favorable results in terms of various classification metrics, including accuracy (0.9083), AUC (0.993), f1‐score (0.970), and Brier score (0.1256). Additionally, the most critical variables were identified as the volumetric measurements of the right corticospinal tract, right corpus callosum body, right corpus callosum splenium, right cerebellum, and right pons, respectively. Conclusion: The outcomes of this study indicate that volumetric measurements of specific brain regions can serve as reliable indicators of AIS. In conclusion, the developed model and the significant variables discovered hold promise for predicting scoliosis development, particularly in high‐risk individuals. [ABSTRACT FROM AUTHOR]

Study Design: Systematic literature review and meta-analysis. Objectives: Predicting patient risk of intraoperative neuromonitoring (IONM) alerts preoperatively can aid patient counselling and surgical planning. Sielatycki et al established an axial-MRI-based spinal cord classification system to predict risk of IONM alerts in scoliosis correction surgery. We aim to systematically review the literature on operative and radiologic factors associated with IONM alerts, including a novel spinal cord classification. Methods: A systematic review and meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search identifying all observational studies comparing patients with and without IONM alerts was conducted. Suitable studies were included. Patient demographics, radiological measures and operative factors were collected. Results: 11 studies were included including 3040 patients. Relative to type 3 cords, type 1 (OR =.03, CI =.01-.08, P <.00001), type 2 (OR =.08, CI =.03, P <.00001) and all non-type 3 cords (OR =.05, CI =.02-.16, P <.00001) were associated with significantly lower odds of IONM alerts. Significant radiographic measures for IONM alerts included coronal Cobb angle (MD = 10.66, CI = 5.77-15.56, P <.00001), sagittal Cobb angle (MD = 9.27, CI = 3.28-14.73, P =.0009), sagittal deformity angle ratio (SDAR) (MD = 2.76, CI = 1.57-3.96, P <.00001) and total deformity angle ratio (TDAR) (MD = 3.44, CI = 2.27-4.462, P <.00001). Clinically, estimated blood loss (MD = 274.13, CI = −240.03-788.28, P =.30), operation duration (MD = 50.79, CI = 20.58-81.00, P =.0010), number of levels fused (MD =.92, CI =.43-1.41, P =.0002) and number of vertebral levels resected (MD =.43, CI =.01-.84, P =.05) were significantly greater in IONM alert patients. Conclusions: This study highlights the relationship of operative and radiologic factors with IONM alerts. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Objective: To elucidate the risk factors of intraoperative neurophysiological monitoring (IONM) alert during deformity correction surgery for adolescent idiopathic scoliosis (AIS) and to describe the outcomes of patients who underwent staged correction surgery due to IONM alert during the initial procedure. Methods: We reviewed 1 024 patients with idiopathic scoliosis who underwent deformity correction and were followed-up for ≥1 year. The pre-and postoperative Cobb angle of the major structural curve, operative time, estimated blood loss (EBL), number of levels fused, event that caused the IONM alert, and intervention required for the recovery of the signal were recorded. Patients who received IONM alerts (alert group) and those who did not (non-alert group) during the operation were compared. Results: Compared to the non-alert group, the alert group had a significantly greater preoperative Cobb angle of the major structural curve (P <.001), number of levels fused (P =.003), operative time (P <.001), and EBL (P <.001). The percentage of correction did not significantly differ between the 2 groups (P =.348). Eight patients (.8%) underwent a staged operation because the IONM signal alert hindered correction of the deformity. The percentage of correction of patients who underwent staged operation was 64.9 ± 15.1%, and no permanent neurologic deficits occurred. Conclusion: A greater magnitude of preoperative deformity and surgical extent increases the risk of cord injury identified by IONM alerts during correction of deformities in patients with AIS. However, in patients in whom the IONM alert cannot be recovered or reproduced by proceeding with deformity correction, surgeons can minimize the risk by aborting the initial procedure and completing the correction using staged operations. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective comparative study. Objectives: This study compares supine vs bending flexibility radiographs and evaluates their ability to predict residual postoperative lumbar curvature after selective thoracic fusion for Lenke 1 and 2 curves across different lumbar modifiers (A, B, and C) in adolescent idiopathic scoliosis (AIS). Methods: This was a retrospective review of AIS Lenke 1 and 2 patients who underwent posterior fusion. All patients had preoperative flexibility radiographs including side-bending and supine posteroanterior (PA) films, in addition to pre- and post-operative standing PA and lateral radiographs. We used SurgiMap 2.0 software for all radiographic measurements. Pearson correlations and linear regression models were developed in SAS. Results: A total of 86 patients were included mean age 14.9 years and follow-up 72.3 months. Preoperative supine lumbar Cobb angle and preoperative side-bending Cobb angles had similar, positive correlations with postoperative lumbar Cobb angle, r =.55 (P <.001) and r =.54 (P <.001), respectively. Three regression models were built to predict postoperative lumbar Cobb angles from preoperative information: Model S (R2 =.39) uses preoperative supine lumbar curve; Model B (R2 =.44) uses preoperative side-bending lumbar curve; Model SB (R2 =.49) uses both preoperative supine and side-bending lumbar curves. Model S and B performed just as well as Model SB. Conclusion: Either supine or side-bending radiographs alone may be used to estimate mean residual postoperative lumbar curvature after selective posterior thoracic fusion, but little is to be gained by taking both supine and side-bending radiographs. [ABSTRACT FROM AUTHOR]

Abstract Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity in the younger population. The surgical management for these patients improved constantly over the last year and might not be comparable to modern treatment strategies. However, under this aspect the present investigation updates and discusses current evidence regarding the long-term outcome of the surgical management of AIS. All the clinical studies which evaluated the long-term outcomes of spinal fusion were considered. Level of evidence, clinical and radiological data, results of health-related questionnaires and surgery-associated complications during long-term follow-up, e.g., proximal and distal junctional kyphosis (PJK/DJK), and adjacent segment degeneration (ASD), are presented. Data concerning the following patient-reported outcomes measures were collected: Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) Outcome Questionnaire, visual analogue scale (VAS), and short form-12 and 36 (SF-12/SF-36). Overall, data from 1115 patients were included. Of them, 324 underwent anterior and 791 posterior spinal fusion. One study focuses on a combined anterior/posterior fusions. The mean follow-up was 22.6 years (posterior fusion: 24.6 years, anterior fusion: 18.31 years). Seven studies focus on the thoracic segments, while 12 focus on the lumbar spine. Data on imaging was reported in 13 studies and those on PROMs in 15 investigations. In conclusion, there is low quality and paucity of long-term data on AIS. However, the long-term results of the implicated studies on AIS patients in this review appear to be satisfactory, although there are limitations in the outcome compared to healthy comparison cohorts. Adjacent degenerations appear to be the most common mechanical complication after long-segment fusions, despite their influence on the outcome remains unclear. With regard to pregnancies, there are slightly increased cesarean section rates, which could be explained by deviations in the sagittal profile.

Abstract Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis in children between the ages of 10 and 16. Nevertheless, risk factors for AIS, especially adjustable ones, are still poorly understood. This study seeks to examine the associations of lifestyle and social environment factors with AIS in Syrian schoolchildren. This matched case-control study uses survey data from a school-based scoliosis screening approach. We utilized logistic regression models to estimate the relative risk of AIS prevalence for each variable in the analysis. A multivariate logistic regression was performed to investigate the independent influence of each component on AIS development, with odds ratios (ORs) adjusted for the important factors. Overall, 1102 participants from 22 schools were included in this study, comprising 551 AIS cases and 551 controls. Mean age of the study population was 13.5 years ± 1.08. Six hundred and twenty (56.3%) of the study subjects were girls. After adjusting for other significant factors, age between 13 and 15 years (OR = 2.45; 95% CI, 1.37–6.17), inappropriate desk heights, either too low (OR = 1.53, 95% CI 1.12–1.85) or too high (OR = 1.46, 95% CI 1.13–1.87), standing with anterior pelvic tilt (OR = 1.97, 95% CI 1.46–3.43), and sleeping on the right side (OR = 1.92, 95% CI 1.54–2.23), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.73 (95% CI 0.43–0.94) for sitting normally, and 0.63 (95% CI 0.31–0.97) for sitting positions change. This study investigated the correlation between desk heights and AIS and revealed that incorrect desk heights were associated with more AIS risk. To prevent schoolchildren from developing AIS, stakeholders should consider installing height-adjustable desks in the classroom, changing students’ sitting positions on an ongoing basis, and establishing training courses that assist students in keeping proper sitting postures.

Abstract Background In the general population the prevalence of adolescent idiopathic scoliosis (AIS) is 2–3%. There is growing awareness of how AIS affects the quality of life of patients. However, the extent of the societal burden AIS poses remains poorly understood. Therefore, this study aimed to determine the societal burden of AIS. Methods A cross-sectional burden of disease study was conducted using a bottom-up, prevalence-based approach. Patients with AIS or guardians of a child diagnosed with AIS residing in the Netherlands were eligible for inclusion. The survey was distributed between June - December 2022 and was completed once by each participant. Costs were assessed using the institute for Medical Technology Assessment - Medical Consumption and Productivity Cost Questionnaires. The health-related quality of life (HRQoL) was assessed using the EuroQol 5D-5L/EuroQol 5D Youth and the Scoliosis Research Society-22 revised questionnaires. Costs and HRQoL were identified, measured, and valued. Results Participants (n = 229) were predominantly female (92%), on average 35 years old, and were employed (65%). The societal cost for a patient with AIS in the Netherlands was €12,275 per year. The largest costs were estimated for the healthcare and productivity losses. The mean utility score for adults was 0.7 (SD 0.20). Severe pain was experienced by 10% of the adult participants and 44% reported to experience moderate pain/discomfort. Statistically significant differences between different age groups were present for the sector costs and HRQoL. Conclusions AIS negatively impacts societal costs and the HRQoL. Reducing the burden that is posed on the productivity sector by AIS and further improving the HRQoL for AIS patients is needed.

Abstract Background Brace therapy’s influence on adolescent idiopathic scoliosis’s (AIS) natural course is inconclusive. Methods Brace-treated AIS patients from 2016 to 2020 were examined regarding four endpoints at brace weaning: surgery need, curve progress ≥ 6° and > 45°, and curve improvement ≥ 6°. Prediction variables’ influence was computed for the all-patients group and three subgroups (Subgroup 1: fulfilling the Scoliosis Research Society’s [SRS] criteria, Subgroup 2: initial Cobb angle 40°). According to the data characteristics, parametric and non-parametric tests and binary logistic regression were performed. Results The research included 69 patients. Overall, after brace weaning surgery was recommended for 20.3% of them, curve progression was ≥ 6° in 23.2%, the Cobb angle was beyond 45° in 11.6%, and the Cobb angle improved by ≥ 6° in 20.3%. Patients needing surgery had a significantly higher initial Cobb angle (38.8° ± 9.8° vs 27.8° ± 7.6°, p 40°. Real brace wear (RBW) in all groups had no significant effect on outcome. Two significant subgroup differences were found: Surgery recommendation and curve progression beyond 45° were significantly more frequent in the initial Cobb angle > 40° subgroup. Conclusions Brace effectiveness can be assumed because curve improvement was achieved in nearly one-fifth with sufficient in-brace correction. However, no significant influence of RBW on the outcome endpoints was demonstrated. To clarify conflicting results, big data management, including untreated patients, must be employed to further research AIS’s multifactorial influenced aetiology and course. Meanwhile, it is worth starting bracing in AIS in practice also beyond the SRS’s criteria.

Background: Low-density screw constructs yield significant radiographic and clinical improvements with reduced risk of neurological complications. This study aimed to investigate the relationship between coronal Cobb angle and pelvic incidence (PI) in the correction of adolescent idiopathic scoliosis (AIS) using a low-density construct, as well as the association between PI and functional outcomes. PATIENTS AND METHODS: This prospective cohort study involved 60 posteriorly instrumented AIS patients, aged 10–16 years, with Cobb angles ranging from 45° to 90° of various Lenke types. Radiological assessments were conducted pre- and postsurgery at 1, 3, 6, 12, and 24 months. Functional evaluation utilized the Scoliosis Research Society score form (SRS-30). Results: A positive correlation was observed between screw density and operation time, blood loss, and degree of correction with SRS change (P = 0.004). No correlation was found between screw density and hospital stay, loss of correction, correction rate, SRS change, change in PI, or Cobb angle. Conclusions: Correction of AIS through a posterior approach using a low-density construct can lead to satisfactory curve correction, impacting spinopelvic parameters. However, PI alone does not directly influence patient functional outcomes assessed by SRS-30. Low-density implant constructs reduce operative time, blood loss, costs, and complication risks.

Introduction: Human pose estimation, a computer vision technique that identifies body parts and constructs human body representations from images and videos, has recently demonstrated high performance through deep learning. However, its potential application in clinical photography remains underexplored. This study aimed to establish photographic parameters for patients with adolescent idiopathic scoliosis (AIS) using pose estimation and to determine correlations between these photographic parameters and corresponding radiographic measures. Methods: We conducted a study involving 42 patients with AIS who had undergone spinal correction surgery and conservative treatment. Preoperative photographs were captured using an iPhone 13 Pro mounted on a tripod positioned at the head of an X-ray tube. From the outputs of pose estimation, we derived five photographic parameters and subsequently conducted a statistical analysis to assess their correlations with relevant conventional radiographic parameters. Results: In the sagittal plane, we identified significant correlations between photographic and radiographic parameters measuring trunk tilt angles. In the coronal plane, significant correlations were found between photographic parameters measuring shoulder height and trunk tilt and corresponding radiographic measurements. Conclusions: The results suggest that pose estimation, achievable with common mobile devices, offers potential for AIS screening, early detection, and continuous posture monitoring, effectively mitigating the need for X-ray radiation exposure. Level of Evidence: 3.

Objective To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making. Methods One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]

Abstract Background There have been some studies on the occurrence of ESR1 and 2 polymorphisms and AIS, but some data extraction is wrong, and there are no studies on the progress of AIS. Methods Computer searches were conducted on PubMed, EMBASE, ScienceDirect and Scopus from the establishment of the database to April 2024. Cross-sectional and case-control studies on estrogen receptor ESR1, two single nucleotide polymorphisms, and the occurrence and development of AIS were collected, and statistical analysis was performed using the Revman 5.3 software. Results In the comparison of the association between single nucleotide polymorphisms of estrogen receptors ESR1 and 2 and the occurrence and development of AIS, eight studies were included, including 2706 cases and 1736 controls.The results showed that the AA genotype [OR = 0.50,95%Cl(0.34,0.72),P = 0.0003] at the XbaI locus of ESR1,CC genotype [OR = 1.67,95%Cl(1.16,2.42), P = 0.006], C allele [OR = 1.28,95%Cl(1.03,1.59),P = 0.03], and T allele [OR = 0.78,95%] Cl(0.63,0.97),P = 0.03] at the PvuII locus of ESR1 and TT genotype [OR = 0.50,95%Cl(0.26,0.93),P = 0.03] at the AlwNI locus of ESR2 showed statistically significant differences between the progressive and stable AIS patients. Conclusion Single nucleotide polymorphisms of ESR1 and ESR2 were not related to the occurrence of AIS; however, some of them were related to the progression of AIS.

Abstract Background Positive effects of brace treatments in adolescent idiopathic scoliosis patients on gait were proven. Aim Therefore, this study examined whether the influence of brace therapy in combination with Schroth therapy influencing the plantar pressure distribution, pre and post intensive rehabilitative inpatient treatment. Design Prospective cohort study, longitudinal. Setting Scoliosis rehabilitation clinic “Asklepios Katharina-Schroth-Klinik” (Bad Sobernheim, Germany). Population Twenty (14f/6m) patients (12–16 years) had a medically diagnosed moderate idiopathic scoliosis (Cobb angle 20–50°, Median 30°) and an indication for combined brace and Schroth therapy with an inpatient stay (4 weeks) at the Asklepios Katharina Schroth Clinic (Germany). Methods At the beginning (T1) and at the end of the stay (T2), the plantar pressure distribution with (A) and without wearing a brace (B) was recorded (walking distance 10 m). Results No significant differences between the left and right foot were found at baseline (T1). The T1 - T2 comparison of one foot revealed significant differences (p ≤ 0.05 − 0.001, respectively) for (A): mean pressure right midfoot, loaded area total left foot, left midfoot, left inner ball of foot, right midfoot, impulse total right foot, right midfoot and for (B): mean pressure right midfoot, right outer ball of foot, loaded area total right foot, right heel, right midfoot, impulse right heel, right midfoot, right outer ball of foot. Conclusions A combined brace and Schroth therapy maintains the initial symmetrical plantar pressure distribution over the duration of four weeks since the significant differences fall within the range of measurement error. Clinical rehabilitation impact The insole measuring system can be used to objectively support therapeutic gait training as part of rehabilitation and to assess insole fitting based on foot shape. Due to its convenient handling and rapid data acquisition, it may be a suitable method for interim or follow-up diagnostics in the treatment of idiopathic scoliosis.

Abstract Background Meeting the 24-hour movement behavior (24-HMB) guideline helps enhance quality of life (QOL) of adolescents. This study aimed to assess the associations between the 24-HMB (physical activity, screen time, sleep) and QOL among adolescents with idiopathic scoliosis. Methods A cross-sectional study was conducted between September 2021 and September 2023. 24-HMB, QOL and demographic variables were collected through a self-reported questionnaire. Linear regression models and stratified analyses were used to explore statistical associations between the 24-HMB and QOL. Results A total of 1073 participants aged 10–18 years with a spinal Cobb angle between 10° and 40° were included. Overall, 20 participants (1.9%) met all three behavioral guidelines, and 272 participants (25.3%) met none. Compared to those who did not meet any of the guidelines, adolescents meeting both screen time and sleep duration (β = 4.10, 95% CI: 2.02–6.18, P

Abstract Background Current research lacks comprehensive investigation into the biomechanical changes in the spinal cord and nerve roots during scoliosis correction. This study employs finite element analysis to extensively explore these biomechanical variations across different Cobb angles, providing valuable insights for clinical treatment. Methods A personalized finite element model, incorporating vertebrae, ligaments, spinal cord, and nerve roots, was constructed using engineering software. Forces and displacements were applied to achieve Cobb angle improvements, designating T1/2-T4/5 as the upper segment, T5/6-T8/9 as the middle segment, and T9/10-L1/2 as the lower segment. Simulations under traction, pushing, and traction + torsion conditions were conducted, and biomechanical changes in each spinal cord segment and nerve roots were analyzed. Results Throughout the scoliosis correction process, the middle spinal cord segment consistently exhibited a risk of injury under various conditions and displacements. The lower spinal cord segment showed no significant injury changes under traction + torsion conditions. In the early correction phase, the upper spinal cord segment demonstrated a risk of injury under all conditions, and the lower spinal cord segment presented a risk of injury under pushing conditions. Traction conditions posed a risk of nerve injury on both sides in the middle and lower segments. Under pushing conditions, there was a risk of nerve injury on both sides in all segments. Traction + torsion conditions implicated a risk of injury to the right nerves in the upper segment, both sides in the middle segment, and the left side in the lower segment. In the later correction stage, there was a risk of injury to the upper spinal cord segment under traction + torsion conditions, the left nerves in the middle segment under traction conditions, and the right nerves in the upper segment under pushing conditions. Conclusion When the correction rate reaches 61–68%, particular attention should be given to the upper-mid spinal cord. Pushing conditions also warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve. Traction conditions require attention to nerve roots bilaterally in the middle and lower segments, while traction combined with torsion conditions necessitate focus on the right-side nerve roots in the upper segment, both sides in the middle segment, and the left-side nerve roots in the lower segment.

Chong Zhao,&ast; Shuaiqi Zhu,&ast; Yan Liang, Shuai Xu Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yan Liang; Shuai Xu, Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, People’s Republic of China, Tel +86-010-88324110 ; +86-18811792718, Email liangyan7503@163.com; xushuairmyy@pku.edu.cnPurpose: To characterize the asymmetrical loss of bone mass and identify the association between scoliosis and osteopenia in patients with adolescent idiopathic scoliosis (AIS).Methods: Demographic information, Cobb angle, and Hounsfield unit (HU) of the neutral vertebra (NV) and apical vertebra (apex) of the major curve were collected retrospectively in 54 AIS patients. For 84 control subjects, HU values were measured at T12 and L5. Propensity score matching was performed to balance the interference of age and BMI.Results: In the AIS group, the concave and convex lateral HU of the NV and the convex lateral HU of the apex were negatively correlated with the Cobb angle. The AIS patients had lower bilateral HU. The mean HU and the apex-convex HU were also lower in the AIS group, while the apex-concave HU was slightly higher. After matching, the apex-convex HU of the AIS group remained lower, while the apex-concave HU was higher.Conclusion: Patients with AIS exhibit osteopenia, particularly on the convex side. The severity of scoliosis was found to be directly proportional to the severity of bone loss and the degree of bilateral osteopenia asymmetry. Appropriate intervention for bone loss may be able to curb the progression of scoliosis.Keywords: adolescent idiopathic scoliosis, osteopenia, osteoporosis, Hounsfield unit, propensity score matching

BACKGROUND AND CONTEXT:  In patients with adolescent idiopathic scoliosis (AIS) of main thoracic and lumbar spine regions, combined anterior thoracic vertebral body tethering and posterior lumbar spine tethering (ATVBT/PLST) is a novel non-fusion treatment option for growth modulation and conservation of motion. METHODS:  Fourteen patients with AIS who underwent ATVBT/PLST with at least 2-year follow-up were included. Primary outcomes included quality of life as assessed by SRS-22 instruments, radiographic analysis, and revision operations. We secondarily reported perioperative metrics and post-operative opiate morphine equivalents (OME). Clinical success was defined as patients who achieved skeletal maturity with ≤ 30° curve magnitude of both their main thoracic and thoracolumbar/lumbar curves and who did not undergo posterior spine instrumentation and fusion (PSIF). RESULTS: Patients had a mean age of 11.6 years (range 10-14 years), majority were girls (92%), and mean follow-up was 3.0 years (range 2-4.8 years). All patients were skeletally immature with a Risser ≤ 2. Included curves were Lenke 1C, 3C, or 6C. Mean preoperative curve magnitudes were 53° ± 8° (range 45°-65°) main thoracic and 49° ± 9° (range 40°-62°) thoracolumbar/lumbar curves. At most recent follow-up, patients had a mean main thoracic curve of 29° ± 8° (range 15°-40°) and a mean thoracolumbar/lumbar curve of 20° ± 15° (range 4°-35°). 50% required a revision operation. Cable breakage occurred in 43%, which did not always require revision. One patient progressed to thoracic fusion, but no patient underwent lumbar fusion. Patients had a mean SRS-22 outcome score of 4.2 ± 0.4. CONCLUSIONS: ATVBT/PLST is a potential alternative to spine fusion for select immature patients with AIS at a minimum 2-year follow-up. ATVBT/PLST potentially offers motion conservation at the cost of a higher revision rate. Further study and reporting of results are necessary to refine indications and techniques, which in turn will improve outcomes of this procedure. LEVEL OF EVIDENCE: Level IV-Case series without comparative group.

STUDY DESIGN: Retrospective Comparative Study, Level III. OBJECTIVE: In patients with scoliosis >90°, cranio-femoral traction (CFT) has been shown to obtain comparable curve correction with decreased operative time and blood loss. Routine intraoperative CFT use in the treatment of AIS

Abstract Introduction Adolescent idiopathic scoliosis (AIS), a prevalent condition among teenagers, is often accompanied by osteopenia. However, the impact of brace treatment on bone density in AIS patients remains a matter of debate. The Vertebral bone quality (VBQ) score, derived from MRI signal intensity, has been shown to correlate with bone mineral density (BMD). Yet, no studies to date have drawn comparisons between VBQ scores in preoperative AIS patients who had brace treatment history and those who have not received brace treatment. Objective This study aims to elucidate the influence of brace treatment on bone density in AIS patients using VBQ score. Methods A retrospective analysis was conducted on 243 AIS patients, each with Cobb angles ranging from 50–70°, who had undergone preoperative MRI scans. The patients were segregated into two cohorts: those who received brace treatment (n = 174) and those who did not (n = 69). Through propensity score matching, a total of 53 matched pairs were selected for further analysis. VBQ scores were extracted from T1-weighted MRI scans. Results Post-matching, no significant baseline discrepancies were observed between the two groups. Interestingly, brace-treated patients exhibited lower average VBQ scores than their non-brace-treated counterparts (2.43 ± 0.11 vs. 2.55 ± 0.12, p

Abstract Background A number of studies have yielded disparate findings regarding the relationship between implant density and curve correction in adolescent idiopathic scoliosis (AIS) surgery. This study compared the efficacy and safety of low-density (LD) versus high-density (HD) pedicular screw implants in the correction of deformity in AIS regarding clinical, radiological, and quality of life outcomes. Methods This study was a single-blind, parallel, randomized trial that enrolled 20 adolescent patients with idiopathic scoliosis scheduled for posterior spinal fusion surgery with all pedicle screw constructs. Patients were randomized into two groups of 10 patients each. The LD group included patients in whom the number of screws per fused spinal level had a density of 1.5 or less, while the HD group had a density greater than 1.5. The primary outcomes were the radiological findings of curve correction. The secondary outcomes included the correlation between implant density and curve correction, the amount of blood loss, operation time, number of screws, fusion level, hospital stay duration, and quality of life assessed by the Scoliosis Research Society 22r questionnaire. Results Radiologically, the postoperative main curves Cobb angles and their changes were comparable between both approaches without statistical correlation with the implant density (p˃0.05). The LD approach significantly shortened the operative time (p=0.015), number of screws (p=0.011), implant density (p