Trunk imbalance in adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is the most common spine deformity in adolescent patients. Although structural deformity may affect spinal biomechanics of patients with AIS, little is known regarding various period prevalence proportions of back pain and chronic back pain and factors associated with back pain in such patients. (1) What are the period prevalence rates of back pain among teenagers with AIS? (2) Is back pain in patients with AIS associated with curve severity? A total of 987 patients with AIS who were treated without surgery were recruited from a single center's scoliosis clinic. Between December 2016 and July 2017, this center treated 1116 patients with suspected AIS. During that time, patients were offered surgery when their Cobb angle was at least 50° and had evidence of curve progression between two visits, and most of the patients who were offered surgery underwent it; other patients with AIS were managed nonsurgically with regular observation, brace prescription, posture training, and reassurance. To be included in this prospective, cross-sectional study, a patient needed to be aged between 10 and 18 years with a Cobb angle > 10°. No followup data were required. A total of 1097 patients with AIS were managed nonsurgically (98.3% of the group seen during the period in question). After obtaining parental consent, patients provided data related to their demographics; physical activity levels; lifetime, 12-month, 30-day, 7-day, and current thoracic pain and low back pain (LBP); chronic back pain (thoracic pain/LBP); brace use; and treatments for scoliosis/back pain. Pain was rated on a 10-point numeric rating scale for pain. The Insomnia Severity Index, Epworth Sleepiness Scale, and Depression Anxiety Stress Scales were also assessed. These features and radiologic study parameters between patients with and without back pain were also compared. Factors associated with current and 12-month back pain as well as chronic back pain were analyzed by multivariate analyses. Depending on the types of period prevalence, the prevalence of thoracic pain ranged from 6% (55 of 987) within 12 months to 14% (139 of 987) within 7 days, whereas that of LBP ranged from 6% (54 of 987) to 29% (289 of 987). Specifically, chronic thoracic pain or LBP had the lowest prevalence. Compared with the no pain group, patients with current back pain had more severe insomnia (odds ratio [OR], 1.80; p = 0.02; 95% confidence interval [CI], 1.10-2.93) and daytime sleepiness (OR, 2.41; p < 0.001, 95% CI, 1.43-4.07). Those with chronic back pain had the same problems along with moderate depression (OR, 2.49; p = 0.03; 95% CI, 1.08-5.71). Older age (OR range, 1.17-1.42; all p values ≤ 0.030) and Cobb angle > 40° (OR range, 2.38-3.74; all p values ≤ 0.015), daytime sleepiness (OR range, 2.39-2.41; all p values ≤ 0.011), and insomnia (OR range, 1.76-2.31; all p values ≤ 0.001) were associated with episodic and/or chronic back pain. Females were more likely to experience back pain in the last 12 months than males. Moderate depression (OR, 3.29; 1.45-7.47; p = 0.004) and wearing a brace (OR, 3.00; 1.47-6.15; p = 0.003) were independently associated with chronic back pain. Biopsychosocial factors are associated with the presence and severity of back pain in the AIS population. Our results highlight the importance of considering back pain screening/management for patients with AIS with their psychosocial profile in addition to curve magnitude monitoring. In particular, sleep quality should be routinely assessed. Longitudinal changes and effects of psychotherapy should be determined in future studies. Level II, prognostic study.

Review of a prospective database registry of surgical patients with adolescent idiopathic scoliosis (AIS). The purpose of this study was to examine the prevalence of postoperative pain and its impact on patient-reported postoperative outcomes using the Scoliosis Research Society (SRS)-22 outcomes questionnaire. Although reportedly rare, postoperative pain can be a devastating situation for the patient with AIS. Most recent studies examining outcomes in AIS surgical treatment use the SRS Pain domain score to assess pain in this population. A prospectively enrolled multicenter database was queried. Patients with minimum 2-year follow-up and 2-year SRS scores were included. Postoperative pain after the acute phase of recovery when reported by the patient to the treating surgeon/clinical team in follow-up is recorded as a complication in the database. Patients included in this series were grouped as either reporting pain or not to the surgeon/clinical team postoperatively. Pre- and postoperative SRS scores were then compared between these 2 groups using analysis of variance (P < 0.05). Five hundred and eighty-four patients meeting the inclusion criteria were identified. Sixty-one (11%) reported pain at sometime between 2 weeks and 2 years postoperatively. Thirteen were within the 6-month postoperative period. Of the remaining 48 reporting pain between 6 and 24 months postoperatively, 41 (7% of the total cohort) had no obvious cause for their pain. More than half of these patients (26/41) were referred for further treatment (physical therapy, referral to pain specialist, further imaging). These 41 patients had significantly decreased 2-year SRS scores in the domains of Pain, Self-image, Mental health, and Total score (P < 0.05). The patients with postoperative pain were found to have significantly lower preoperative Pain domain scores (P < 0.001), indicative of greater pain preoperatively, yet there were no other domains effected preoperatively. For this group the pre- to postoperative SRS pain scores did not show significant change (P > 0.05). Unexplained pain after the 6-month postoperative period occurred in 7% of the cohort. The results indicate that patients reporting pain to their surgeons/clinical team postoperatively have lower pain scores on a subjective outcome instrument thus further validating the SRS-22 outcome tool. This reported pain seems to be associated with decreases in other SRS-22 domains. Interestingly, these patients also have lower preoperative pain scores than those without postoperative pain. Study into causes of pain in AIS and whether preoperative education and expectations targeted at this population would positively impact outcomes is warranted, especially because on average patients after AIS surgery have less pain. 3.

The Scoliosis Research Society-30 (SRS-30) is a questionnaire originally developed from the SRS-22r questionnaire and is used to evaluate adolescent idiopathic scoliosis (AIS). It comprised questions on five domains: function, pain, self-image, mental health, and satisfaction, with seven additional questions related to postoperative aspects. In addition to the original English version, translations in multiple languages have been effectively applied. Herein, we evaluated the internal consistency and external validity of the Japanese version of the SRS-30 for AIS patients. Among the 30 questions in SRS-30, the eight additional questions from SRS-22r were translated and back-translated to create a Japanese version of the SRS-30. This translated questionnaire was then used to survey patients with AIS who underwent corrective fusion surgery one year postoperatively. The internal consistency of the responses was evaluated using the Cronbach α coefficient. Additionally, the Spearman correlation analyses were conducted to assess the correlation between the scores obtained from the SRS-30 Japanese version and SRS-22r and the Oswestry Disability Index (ODI) for the overall scale and the five domains. A total of 81 cases (eight males and 73 females; mean age at surgery 14.4 years) were enrolled. The mean preoperative Cobb angle was 51.0°. The Cronbach α coefficient for the overall SRS-30 was 0.861, indicating high internal consistency, while the coefficients for each domain were as follows: function/activity, 0.697; pain, 0.405; self-image/appearance, 0.776; mental health, 0.845; and satisfaction, 0.559. The SRS-30 total score significantly correlated with the SRS-22r total (r=0.945, P<0.001) and the ODI (r=-0.511, P<0.001). The SRS-30 domains highly correlated with the corresponding SRS-22r domains, with correlations ranging from r=0.826 to 0.901 (all P<0.001). The Japanese version of the SRS-30 demonstrated good internal and external validity. The SRS-30 can be used as an assessment tool for health-related quality of life in AIS patients.

National variations in back pain: Ecological fallacy or cultural differences?

To determine the value of scoliosis surgery, it is necessary to evaluate outcomes in domains that matter to patients. Since randomized trials on adolescent idiopathic scoliosis (AIS) are scarce, prospective cohort studies with comparable outcome measures are important. To enhance comparison, a core set of patient-related outcome measures is available. The aim of this study was to evaluate the outcomes of AIS fusion surgery at two-year follow-up using the core outcomes set. AIS patients were systematically enrolled in an institutional registry. In all, 144 AIS patients aged ≤ 25 years undergoing primary surgery (median age 15 years (interquartile range 14 to 17) were included. Patient-reported (condition-specific and health-related quality of life (QoL); functional status; back and leg pain intensity) and clinician-reported outcomes (complications, revision surgery) were recorded. Changes in patient-reported outcome measures (PROMs) were analyzed using Friedman's analysis of variance. Clinical relevancy was determined using minimally important changes (Scoliosis Research Society (SRS)-22r), cut-off values for relevant effect on functioning (pain scores) and a patient-acceptable symptom state (PASS; Oswestry Disability Index). At baseline, 65 out of 144 patients (45%) reported numerical rating scale (NRS) back pain scores > 5. All PROMs significantly improved at two-year follow-up. Mean improvements in SRS-22r function (+ 1.2 (SD 0.6)), pain (+ 0.6 (SD 0.8)), and self-image (+ 1.1 (SD 0.7)) domain scores, and the SRS-22r total score (+ 0.5 (SD 0.5)), were clinically relevant. At two-year follow-up, 14 out of 144 patients (10%) reported NRS back pain > 5. Surgical site infections did not occur. Only one patient (0.7%) underwent revision surgery. Relevant improvement in functioning, condition-specific and health-related QoL, self-image, and a relevant decrease in pain is shown at two-year follow-up after fusion surgery for AIS, with few adverse events. Contrary to the general perception that AIS is a largely asymptomatic condition, nearly half of patients report significant preoperative back pain, which reduced to 10% at two-year follow-up. Cite this article: Bone Joint J2022;104-B(2):265-273.

BackgroundAdolescent Idiopathic Scoliosis (AIS) is a common spinal deformity affecting 1%–3% of adolescents aged 10–18, characterized by a lateral curvature with a Cobb angle ≥10°. Current treatments, including bracing and surgery, have limitations in patient compliance and invasiveness, highlighting the need for effective non-surgical alternatives.MethodsThis retrospective cohort study included five prepubescent patients (age 10–14 years, Tanner Stage 1–2) with moderate AIS (Cobb angle 20°–40°). The intervention combined Schroth exercises with core exercises, performed 3–4 times daily over six months. Cobb angles were measured from standing full-spine radiographs at baseline and six months, while quality of life was assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire.ResultsThe mean Cobb angle significantly reduced from 24.12° ± 4.80° at baseline to 12.68° ± 8.11° post-intervention (p = 0.012). Quality of life improved across all SRS-22 domains, with statistically significant gains in pain (p < 0.001), function (p = 0.011), mental health (p < 0.001), and self-image (p < 0.001). These findings suggest that the combined intervention effectively addresses spinal alignment and muscle strength, leading to improved clinical outcomes.ConclusionThis preliminary study demonstrates that combining Schroth exercises with core exercises is a promising non-surgical intervention for prepubescent AIS patients, significantly reducing Cobb angles and improving quality of life. Future research should include larger cohorts and longer follow-up periods to validate these findings and explore the long-term benefits of this combined approach.

BackgroundStudies have shown a positive correlation between higher physical activity (PA) and health benefits. However, device-based assessment of PA and sedentary time (ST) in people with adolescent idiopathic scoliosis (AIS) has not been deeply investigated.ObjectiveAnalysis and comparison of weekend and weekdays PA and ST using multiple accelerometers in people with AIS with different curvature severity compared to healthy controls.Methods24 participants with AIS divided into 2 groups of 12 with Cobb angles < 40° and > 40°, along with 12 age and BMI matched healthy controls. Daily PA and ST during four consecutive days were measured using four tri-axial accelerometers. Clinical functional assessment was performed using the scoliosis research society (SRS-22) questionnaire.ResultsThe combined weekend and weekdays average daily step count was found to be 22% and 29% lower in the AIS groups with Cobb angle < 40° and > 40°, respectively, compared to the controls. The average ST was also reported to be 5% and 7% higher in the AIS groups with Cobb angle < 40° and > 40°, respectively, compared to the controls. The reported differences were significant in the AIS group with higher Cobb angle (p≤0.05). No significant differences in PA or ST were reported between the AIS groups based on curvature severity.ConclusionsDecreased PA and increased ST observed in patients with AIS may have long term health implications and may play a role in the disease process. The device-based assessment of PA to understand potential benefits in clinical practice is recommended.

Introduction Surgical outcomes for adult patients with residual adolescent idiopathic scoliosis (AdIS) with a major thoracic curve are expected to be inferior to those of AIS but have not been well reported. This study aimed to evaluate surgical, radiographical, and clinical results in adult patients with AdIS and to characterize these patients by comparing their results with those of patients with adolescent idiopathic scoliosis (AIS). Methods Thirty-five patients with AdIS, who were diagnosed with AIS Lenke type 1 or 2 before the age of 19 years and underwent surgery after the age of 20 years, were included in the study. As a control group, 84 patients with AIS Lenke type 1 or 2 who underwent surgery before the age of 19 were included. Both groups were matched on the basis of the preoperative main thoracic (MT) and proximal thoracic (PT) Cobb angles, causing 30 patients to be selected in each group. Results The AdIS group exhibited a greater preoperative bending Cobb angle of the MT and PT curves (MT: 35.1° vs. 31.3°, PT: 17.8° vs. 13.8°) and a lower MT curve flexibility index than in the AIS group (36.6% vs. 42.2%). Postoperatively, the AdIS group had a higher number of fused intervertebral segments than did the AIS group (8.2 vs. 7.4), but the correction rate was comparable in the 2 groups. Moreover, the intraoperative time was longer and blood loss was larger in the AdIS group. In the Scoliosis Research Society (SRS)-22 score, self-image and mental health domains were significantly lower preoperatively in the AdIS group. Postoperative improvement of self-image domain was significantly greater in the AdIS group (Δ self-image: 1.6 vs. 0.9), and postoperative satisfaction was similar in the 2 groups. Conclusions Surgical invasiveness was increased in AdIS, and preoperative SRS-22 scores were lower in self-image and mental health domains than in AIS. However, postoperative SRS-22 scores were comparable, and postoperative self-image improvement was significantly greater in AdIS than in AIS.

The purpose of this study was to evaluate the relationship between the correction rate in Cobb angle and the improvement in quality of life profile in terms of Scoliosis Research Society (SRS)-22 values. Between January 2007 and December 2013, posterior instrumentation and fusion was performed to 30 patients with adolescent idiopathic scoliosis (AIS). Patients were grouped according to their improvement rate in Cobb angles after surgery. Patients with an improvement rate of > 80% were grouped as Group A; those with an improvement rate of > 60% and ≤ 80% as Group B and those with an improvement rate of ≤ 60% were grouped as Group C. The SRS-22 questionnaire of these three groups was calculated and their relationship with the improvement in Cobb angle was evaluated. No statistical difference was found among the three groups in terms of pain, appearance, function, spirit, satisfaction, and SRS-22 values (all p > 0.05). The results of this study demonstrate that the degree of correction rate does not correlate with the degree of improvement in the SRS-22 questionnaire in patients with AIS that underwent posterior fusion and instrumentation.

The aim of this study was to evaluate the clinical outcomes and the coronal correction rate of the main and accompanying curves of adolescent idiopathic scoliosis (AIS) corrected with pedicle screws inserted consecutively or intermittently. The prospectively collected data of 60 patients (8 men and 52 women; mean age: 14.6±2.5 years) who underwent corrective surgery for AIS between January 2010 and December 2015 were reviewed retrospectively. Two groups were constituted according to the pedicle screw construct type: consecutive pedicle screw construct (CPSC) and intermittent pedicle screw construct (IPSC) groups. The preoperative, early postoperative, and 24-month follow-up radiographs and the Scoliosis Research Society-22 (SRS-22) scores were reevaluated. The Cobb angle of the main and accompanying curves, the correction rate, and the flexibility of the curves were calculated. The mean preoperative Cobb angles were 57.03° and 57.46°, the mean postoperative Cobb angles were 14.93° and 14.4°, and the mean correction rates were 76.22% and 75.31% in IPSC and CPSC groups, respectively (p>0.05). The preoperative and postoperative accompanying curve magnitudes and correction rates were similar (p>0.05). These radiographic outcomes were also consistent with the SRS-22 scores. Both the pedicle screw constructs had satisfactory outcomes following the surgery, which were confirmed by both the SRS-22 scores and radiographs taken perioperatively and at follow-ups. The IPSC and CPSC groups did not demonstrate a significant change in the correction rate of the main and minor or major accompanying structural and nonstructural curves, and also in the SRS-22 scores. Level III, Retrospective comparative study.

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

To evaluate the effects of motor and cognitive rehabilitation on disability in adults with idiopathic scoliosis at lower risk of progression. 130 adults with idiopathic scoliosis (main curve <35°) were randomly assigned to a 20-week rehabilitation programme consisting of active self-correction, task-oriented exercises and cognitive-behavioural therapy (experimental group, 65 subjects, mean age of 51.6, females 48) or general physiotherapy consisting of active and passive mobilizations, stretching, and strengthening exercises of the spinal muscles (control group, 65 subjects, mean age of 51.7, females 46). Before, at the end, and 12months after treatment, each participant completed the Oswestry disability index (ODI) (primary outcome), the Tampa scale for kinesiophobia, the pain catastrophizing scale, a pain numerical rating scale, and the Scoliosis Research Society-22 Patient Questionnaire. Radiological (Cobb angle) and clinical deformity (angle of trunk rotation) changes were also investigated. A linear mixed model for repeated measures was used for each outcome. Significant effects of time, group, and time by group interaction were found for all outcome measures (P<0.001). After training, the primary outcome showed a clinically significant between-group change (12% points), which was preserved at follow-up. At follow-up, the radiological deformities showed a significant, although not clinically meaningful, between-group difference of 4° in favour of the experimental group. The experimental programme was superior to general physiotherapy in reducing disability of adults with idiopathic scoliosis. Motor and cognitive rehabilitation also led to improvements in dysfunctional thoughts, pain, and quality of life. Changes were maintained for at least 1year.

Mailed survey to random sample of a specific population. To examine the lifetime and point prevalence of low back pain among alpine ski instructors. The lifetime prevalence for back pain is up to 60% among some athletes. Published literature documents back pain among athletes participating in many sports. However, the prevalence of low back pain among alpine ski instructors has not been established. Surveys were mailed to 500 randomly selected members of the Professional Ski Instructors of America. The lifetime and point prevalence were determined by respondents' report regarding history of low back pain and current back pain. Two hundred four (75% of the 272 respondents) reported a history of low back pain. Eighty-five of those who responded (31%) reported current back pain. Over 9% of respondents missed 10 or more days of work because of back pain. The lifetime prevalence of back pain among respondents was similar to the general population. The respondents reported more lifetime prevalence of back pain than athletes of many other sports. The high prevalence of back pain among ski instructors may increase cost and decrease revenue for the employer. Prevention training in this population may decrease the prevalence of back pain and lessen costs to the employer and the alpine ski instructor.

BackgroundThis is a retrospective database review with the objective to review adolescent idiopathic scoliosis (AIS) surgery in terms of radiographic and patient-reported surgical outcome, assessing the relationship with shoulder balance. MethodsDatabase search identified 97 AIS patients who underwent single-stage corrective fusion between 2011 and 2017, and had one year follow-up.The average age at surgery was 15.0 (10.9 -20.7 2.1) years.Preoperative and one-year radiographic analysis included Cobb angles, flexibility and correction indices.The curves were classified according to Lenke as 43 type 1, 14 type 2, 11 type 3, 12 type 4, 12 type 5 and five type 6.Shoulder balance was assessed by T1 tilt angle, clavicle angle and shoulder height.Pre-and postoperative Scoliosis Research Society (SRS)-22 patient-reported outcome measures (PROMs) were assessed in relation to the radiographic results. ResultsIn Lenke 1-4, the preoperative Cobb angle was 64.4 (26-99 15.69), with a flexibility index of 28% corrected to 22.8 (6-62 11.4).Lenke 5-6 thoracolumbar (TL) was corrected from 56.8 (30-88 143), with a flexibility index of 46% to 12.7 (0-34 7.9).Overall SRS-22 postoperative satisfaction was high at 9.6 (6-10 0.9), with improvement in self-image and mental health domains.While preoperative T1 tilt angle was associated, clavicle angle and shoulder height showed no difference in SRS-22 score. ConclusionSurgery improved SRS-22 PROMs overall, as well as self-image and mental health domains.Radiographic shoulder imbalance did not negatively affect the PROM.

Objective To investigate the risk factors of degenerative scoliosis patients with osteoporotic vertebral compression fracture. Methods The data of 150 cases of degenerative scoliosis were retrospectively reviewed from October 2007 to October 2015. According to the occurrence of vertebral compressive fractures, the 150 patients were divided into the experiment group(fracture) and control group(non-fracture). Visual analogue scale(VAS) was used to assess the back pain, and the bone mineral density were measured in patients by using dual-energy X-ray absorptiometry, Cobb angle was measured to evaluate the severity of scoliosis. The occurrence of osteopontin in scoliosis were observed and analyzed. Logistic analysis was used to investigate the risk factors of vertebral compression fractures. Results ①In experiment group, there were T11 vertebral compression fractures in 4 cases, T12 vertebral compression fractures in 13 cases, L1 vertebral compression fractures in 16 cases, and both T12 and L1 vertebral fracture in 5 cases. ②The gender composition of the two groups had no significant difference(χ2=0.253, P=0.615). Compared with the control group, the average age of the experiment group was lower(t=4.392, P<0.01), VAS score was higher(t=14.350, P<0.01), more severe osteoporosis(t=13.296, P<0.01), a higher incidence of osteopontin(χ2=11.824, P=0.001). The Cobb angle of the two groups had no significant difference(t=1.749, P=0.082). After analysis of Logistic regression, trauma history(OR=1.57, 95% CI: 1.09-2.11), bone bridge formation(OR=3.46, 95% CI: 2.10-5.38) and bone osteoporosis(OR=2.48, 95% CI: 1.58-4.36) will increase the chances of patients with fractures. Conclusions Osteoporotic vertebral compression fracture usually occur in thoraco-lumbar region in patients with degenerative scoliosis, and its risk factor are trauma, history, osteoporosis and bone bridge formation. Key words: Osteoporotic fractures; Vertebral compression frature; Degenerative scoliosis; Risk factors