Idiopathic scoliosis

To determine whether implant density impact three-dimensional deformity correction in posterior spinal fusion (PSF) without Ponte osteotomies (POs) for patients with Lenke 1 and 2 adolescent idiopathic scoliosis (AIS). Overview of Literature: Currently, the optimal pedicle screw (PS) density for flexible moderate-sized thoracic AIS curve correction is still controversial. There are limited data regarding the impact of implant density on three-dimensional correction in PSF without the use of PO for thoracic AIS surgery. Methods: A database of patients with AIS with Lenke 1 and 2 curves treated with PSF without PO and instrumented with PSs and ≥2-year follow-up was reviewed. The preoperative, immediate, and final follow-up postoperative radiographs were analyzed. The correlation between PS density and the following factors were determined: major curve correction (MCC), correction index (CI; MCC/ curve flexibility), kyphosis angle change, and rib index (RI) correction. Then, patients were divided into low-density (LD) and highdensity (HD) groups according to mean PS density for the entire cohort (1.5 PS per level). Demographics and radiographic and clinical outcomes were compared between groups. Results: The study included 99 patients with Lenke 1 and 23 patients with Lenke 2 AIS. The average MCC was 67.2%. There was no correlation between screw density and these parameters: MCC (r=0.10, p=0.26), CI (r=0.16, p=0.07), change in T2-T12 kyphosis angle (r=−0.13, p=0.14), and RI correction (r=−0.09, p=0.37). Demographic and preoperative radiographic parameters were similar between the LD and HD groups. At the latest follow-up, there were no differences between the two groups in regard to MCC, CI, change in T2-T12 kyphosis angle, RI correction, and Scoliosis Research Society-30 scores (all p>0.05). Conclusions: This study revealed no significant correlation between screw density and curve correction in any planes. HD construct may not provide better deformity correction in patients with flexible and moderate thoracic AIS undergoing PSF without PO.

Abstract
The thesis aims at organizing knowledge about the concept of idiopathic scoliosis and presenting the basis of the Schroth method, used for conservative treatment of scoliosis. The first chapter presents the general definition of scoliosis and their division. In the following part, idiopathic scoliosis, its diagnostics and SOSORT guidelines have been discussed. The second chapter focuses on the original Lehnert Schroth method, on the main assumptions of the system and on explaining what is rotating breath. The third chapter discusses the further evolution of the method enriched with a new view on scoliosis by Dr. Weiss and presents an extended classification of scoliosis. The fourth chapter is devoted to the effectiveness of therapy. All the work has been enriched with photographs to best present what scoliosis is, how to diagnose it and how to perform specific exercises. In the end have been presented conclusions that flow from it.

Streszczenie
Praca dyplomowa ma na celu uporządkowanie wiedzy dotyczącej pojęcia skoliozy idiopatycznej oraz przedstawienie podstaw metody Schroth, służącej do zachowawczego leczenia skolioz. W rozdziale pierwszym została przedstawiona ogólna definicja skolioz oraz ich podział. W dalszej części została omówiona skolioza idiopatyczna, jej diagnostyka oraz wytyczne SOSORT. Rozdział drugi skupia się na oryginalnej metodzie Lehnert-Schroth, na głównych założeniach systemu oraz na wyjaśnieniu czym jest obrotowy oddech. W rozdziale trzecim omówiono dalszą ewolucję metody wzbogaconą o nowe spojrzenie na skoliozy przez dr Weiss oraz przedstawiono rozszerzoną klasyfikację skolioz. Rozdział czwarty jest poświęcony efektywności terapii. Cała praca została wzbogacona o fotografie by jak najlepiej przedstawić czym jest skolioza, jak ją diagnozować oraz w jaki sposób przeprowadzić specyficzne ćwiczenia. W zakończeniu zostały zaprezentowane wnioski, które wypływają z pracy.

Introduction: Scoliosis is a three-dimensional deformative abnormality of the spine, defined by the Cobb's angle of spine curvature in the coronal plane, and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane. Based on the age of presentation, scoliosis is further categorized as infantile, juvenile or adolescent idiopathic. Adolescent idiopathic scoliosis (AIS) has the highest prevalence of the three categories. This type of scoliosis is present at age ten and lasts till the end of growth. Its prevalence is dependent on the curvature of the spine and gender of the patient. Objective: The purpose of this review is to evaluate the role of physiotherapy in reducing curve progression and pain, postponing or avoiding invasive treatment and improve the quality of life in adolescents with AIS. Methodology: The study is a Systematic Review, meta-analytic type, consisting of 5 studies (RCT) of the last ten years, which focus on the i...

Purpose The aim of this study was to assess the psychometric properties of a youth version of the EQ-5D five-level questionnaire (5LY) and its three-level version (3LY) in a sample of Chinese paediatric patients. Methods A consecutive sample of idiopathic scoliosis patients were recruited from a referral outpatient scoliosis center at Hong Kong, China in October 2017 and completed the two versions of EQ-5D-Y. Redistribution properties in each dimension of EQ-5D-Y were analyzed between 5LY and 3LY by logistics regressions. Absolute reduction and relative reduction in ceiling effects from the 3LY to the 5LY were calculated. Test-retest reliability was assessed by examining the Gwet's agreement coefficient (Gwet's AC) for five individual dimension responses over the 2-week period. Results A total of 129 idiopathic scoliosis patients completed the two versions of EQ-5D-Y at baseline assessment, among which 70 patients completed the test-retest interview in 2-3 weeks after baseline assessment. For redistribution properties , the proportion of inconsistency was low in all the dimensions, ranging from 0.0% ("Usual activities") to 3.9% ("Pain/ discomfort"). Ceiling effects were reduced in four dimensions. "Usual activities" dimension showed significant reduction (absolute and relative reductions: 3.9% and 4.3%; p = 0.025) and the "worried/sad/unhappy" dimension showed the largest significant reduction in ceiling effects (absolute and relative reductions: 7.8% and 9.8%; p = 0.012). The 3LY and 5LY showed very good agreement (> 80%) of individual dimension responses between two assessments, except for the "worried/ sad/unhappy" dimension in 3LY. Conclusion Through this head-to-head comparison, the 5LY had significant improvements in ceiling effects in two dimensions when compared to 3LY but other measurement properties of 3LY and 5LY performed similar in the idiopathic scoliosis patient group. Keywords EQ-5D-5L · EQ-5D-Y · Children · Youth · Psychometric properties · Idiopathic scoliosis JEL Classification I10 · J13 Key findings • This is the very first psychometric evidence of 5LY, and head-to-head comparison of the 3LY and 5LY worldwide .

Objective Bracing along with exercising is the most effective protocol in patients with idiopathic scoliosis
which have Cobb angles of 25 to 45 degrees. However, since the psychological aspects of scoliosis treatment
may affect the quality of life, and the exact time for adjusting the pads of Milwaukee brace is unknown;
Therefore the aim of this study was evaluating the effect of exercising in a group, with adjusting
the brace in shorter intervals, in compare to routine protocol, in the treatment of idiopathic scoliosis.
Materials & Methods Thirty-four patients with idiopathic scoliosis which had Cobb angles of 50 to 15 degrees
were included in this study and were divided into experimental and control groups. The patients of
two groups participated in an eleven-week treatment program, differ between the two groups. Quality
of life scores of both groups were evaluated before and after intervention using SRS-22 questionnaire,
as well as scoliosis angles before and after the intervention according to the primary and secondary
radiographic X-rays.
Results Statistical analysis was performed using Paired T-Test in each group, and Independent T-Test between
the two groups before and after treatment. The severity of scoliosis curvature and satisfaction
domain of the experimental group was reduced significantly in compared with the control group, after
intervention (P=0.04). Moreover in the case of the quality of life in patients with Cobb angles less than
30 degrees, compared with patients with Cobb angles greater than 31 degrees, in the domains of selfimage,
satisfaction, and total score, the difference was significant (P<0.05).
Conclusion Adjusting the brace at shorter intervals along with exercising as a group, during the eleven
weeks of treatment, has increased satisfaction and reduced the scoliosis Cobb angles of patients.

Background The Quality of Life Profile for Spine Deformities (QLPSD) is a self-reporting questionnaire designed for studying patients with spinal deformities. Purpose The aim of the present study was to systematically translate the QLPSD into German (G-QLPSD) and to test its reliability and validity. Special emphasis was intended to be given to patients with different Cobb angles and ages. Methods The QLPSD was systematically translated into German and was responded to in a web-based online survey by patients with idiopathic scoliosis and by healthy control individuals in order to carry out a matched-pair analysis. Participants aged 14 years and older were included. All participants answered a battery of validated questionnaires (SRS 22-r, PHQ-9, PANAS, FKS, WHO-5, BFI-S, PTQ). Reliability testing included Cronbach's alpha and test-retest reliability (retest 8 weeks after initial testing). Factorial, convergent, divergent, concurrent, and discriminant validity were calculated. Results A total of 255 scoliosis patients (age 30.0 ± 16.7 years, Cobb angle 43.5 ± 20.9°) and 189 matched healthy control individuals were finally included. Cronbach's alpha for the G-QLPSD total score was 0.93 and the test-retest reliability was 0.84. The G-QLPSD total score correlated with the SRS 22-r total score (r =-0.86). All concurrently applied scores showed strong correlations with the G-QLPSD (e.g., depression score PHQ-9: r = 0.70). The matched-pair analysis of 189 pairs showed strong discriminant validity (Cohen's d = 0.78). Patients with more severe Cobb angles (≥40°) and those ≥ 18 years of age had significantly poorer results than patients with minor curves and younger patients. Conclusion The G-QLPSD proved to be a highly reliable and valid instrument that can be recommended for clinical use in scoliosis patients.

SYSTEMATIC REVIEW • Cytokines may play an important role in the male reproductive system, and alterations in their structure and function may increase the risk of male infertility. • Interleukin-1-beta may affect sperm function by influencing oxidative stress. • The C3953T polymorphism in interleukin-1-beta may be a genetic risk factor for male infertility. According to the World Health Organization, infertility means that a couple will not have children after 12 months of unprotected sex. Half of all cases of infertility are due to male factors. Environmental and genetic factors play a role in idiopathic infertility in men. Genetic polymorphisms in cytokine family genes may be an important risk factor for male infertility. This study aimed to investigate the association of C3953T polymorphism in the interleukin-1-beta gene with male infertility through a meta-analysis approach. For this study, an electronic search was conducted in reputable databases such as PubMed, Google Scholar, and Science Direct. Finally, three eligible studies were included in our meta-analysis. The results of the meta-analysis showed that C3953T polymorphism was associated with male infertility in allelic model (OR= 1.2143, 95% CI= 1.0057; 1.4662, p= 0.0433) and homozygous codominant model (OR= 3.0292, 95% CI= 1.5681; 5.8519, p= 0.00097). Another study also showed that there was no publication bias in our study and a sensitivity analysis showed that the exclusion of one study could not have a significant effect on the pooled ORs. Based on these results, the C3953T polymorphism may be a genetic risk factor for idiopathic infertility in men. However, due to the limited number of studies in this meta-analysis, further studies with higher sample sizes and different races are needed to obtain more accurate results.

Background Successful brace treatment entails good control of scoliosis with avoidance of surgery. However, achieving curve regression may be an even better radiological result than prevention of curve progression for patients with adolescent idiopathic scoliosis. Vertebral remodeling may occur with well-fitted braces. Better in-brace curve correction may influence the likelihood of vertebral remodeling and the chance of curve regression. Only a few reports have evaluated curve regression with brace treatment, and the factors associated with these events are unknown. Questions/purposes (1) What changes in curvature are observed with brace treatment for adolescent idiopathic scoliosis? (2) What factors are associated with curve im-provement? (3) What factors are associated with curve de-terioration? (4) Is curve regression associated with improvements in patient-reported objective outcome scores? Methods Between September 2008 and December 2013, 666 patients with adolescent idiopathic scoliosis underwent underarm brace treatment and were followed until skeletal maturity at 18 years old. Among these patients, 80 were excluded because of early discontinuation of brace treatment (n = 66) and loss to follow-up (n = 14). Hence, 586 patients were included in this study, with a mean brace-wear duration of 3.8 6 1.5 years and post-weaning follow-up duration of 2.0 6 1.1 years. The mean age at baseline was 12.6 6 1.2 years. Most patients were female (87%, 507 of 586) and up to 53% (267 of 507) of females were post-menarche. Bracing outcomes were based on changes in the Cobb angle measured out of brace. These included curve regression, as indicated by at least a 5°reduction in the Cobb angle, curve progression, as indicated by at least a 5°increase in the Cobb angle, and unchanged, as indicated by a change in the Cobb angle of less than 5°. We studied the pre-brace and supine Cobb angles, curve flexibility (pre-brace Cobb angle-su-pine Cobb angle / pre-brace Cobb angle x 100%), correction rate (pre-brace Cobb angle-in-brace Cobb angle / pre-brace Cobb angle x 100%), location of apical vertebrae, apical ratio (convex vertebral height/concave vertebral height), change in the major curve Cobb angle, and apical ratio post-bracing. The refined 22-item Scoliosis Research Society questionnaire was used for patient-reported outcomes and Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Background Surgery for adolescent idiopathic scoliosis (AIS) is only complete after achieving fusion to maintain the correction obtained intraoperatively. The instrumented or fused segments can be referred to as the ‘‘fusion mass’’. In patients with AIS, the ideal fusion mass strategy has been established based on fulcrum-bending radiographs for main thoracic curves. Ideally, the fusion mass should achieve parallel endplates of the upper and lower instrumented vertebra and correct any ‘‘shift’’ for truncal balance. Distal adding-on is an important element to consider in AIS surgery. This phenomenon represents a progressive increase in the number of vertebrae included distally in the primary curvature and it should be avoided as it is associated with unsatisfactory cosmesis and an increased risk of revision surgery. However, it remains
unknown whether any fusion mass shift, or shift in the fusion mass or instrumented segments, affects global spinal balance and distal adding-on after curve correction surgery in patients with AIS.
Questions/Purposes (1) To investigate the relationship among postoperative fusion mass shift, global balance, and distal adding-on phenomenon in patients with AIS; and (2) to identify a cutoff value of fusion mass shift that will lead to distal adding-on.
Methods This was a retrospective study of patients with AIS from a single institution. Between 2006 and 2011 we performed 69 selective thoracic fusions for patients with main thoracic AIS. All patients were evaluated preoperatively and at 2 years postoperatively. The Cobb angle
between the cranial and caudal endplates of the fusion mass and the coronal shift between them, which was defined as ‘‘fusion mass shift’’, were measured. Patients with a fusion mass Cobb angle greater than 20 were excluded to specifically determine the effect of fusion mass shift on distal adding-on phenomenon. Fusion mass shift was empirically set as 20 mm for analysis. Therefore, of the 69 patients who underwent selective thoracic fusion, only 52 with a fusion mass Cobb angle of 20 or less were recruited for study. We defined patients with a fusion mass shift of 20 mm or less as the balanced group and those with a
fusion mass shift greater than 20 mm as the unbalanced group. A receiver operating characteristic (ROC) curve was used to determine the cutoff point of fusion mass shift for adding-on.
Results Of the 52 patients studied, fusion mass shift (20 mm) was noted in 11 (21%), and six of those patients had distal adding-on at final followup. Although global spinal balance did not differ significantly between patients with or without fusion mass shift, the occurrence of
adding-on phenomenon was significantly higher in the unbalanced group (55% (six of 11 patients), odds ratio [OR], 8.6; 95% CI, 2–39; p \ 0.002) than the balanced group (12% [five of 41 patients]). Based on the ROC
curve analysis, a fusion mass shift more than 18 mm was observed as the cutoff point for distal adding-on phenomenon (area under the curve, 0.70; 95% CI, 0.5–0.9; likelihood ratio, 5.0; sensitivity, 0.64; specificity, 0.73; positive predictive value, 39% [seven of 18 patients]; negative predictive value, 88% [30 of 34 patients]; OR, 4.8; 95% CI, 1–20; p = 0.02).
Conclusions Our study illustrates the substantial utility of the fulcrum-bending radiograph in determining fusion levels that can avoid fusion mass shift; thereby, underlining its importance in designing personalized surgical strategies for patients with scoliosis. Preoperatively, determining fusion levels by fulcrum-bending radiographs to avoid
residual fusion mass shift is imperative. Intraoperatively, any fusion mass shift should be corrected to avoid distal adding-on, reoperation, and elevated healthcare costs.

Surgery for adolescent idiopathic scoliosis (AIS) is only complete after achieving fusion to maintain the correction obtained intraoperatively. The instrumented or fused segments can be referred to as the &quot;fusion mass&quot;. In patients with AIS, the ideal fusion mass strategy has been established based on fulcrum-bending radiographs for main thoracic curves. Ideally, the fusion mass should achieve parallel endplates of the upper and lower instrumented vertebra and correct any &quot;shift&quot; for truncal balance. Distal adding-on is an important element to consider in AIS surgery. This phenomenon represents a progressive increase in the number of vertebrae included distally in the primary curvature and it should be avoided as it is associated with unsatisfactory cosmesis and an increased risk of revision surgery. However, it remains unknown whether any fusion mass shift, or shift in the fusion mass or instrumented segments, affects global spinal balance and distal adding-on a...

Study Design. Prospective cross-sectional study. Objective. To determine the health-related quality of life (HRQoL) of adolescent idiopathic scoliosis (AIS) patients undergoing bracing, previously braced and observation only. Summary of Background Data. HRQoL is an important treatment outcome measure for AIS. A poor HRQoL may also negatively influence the success of bracing by reducing the likelihood of good brace compliance. Yet, the HRQoL thresholds for patients undergoing observation only, brace treatment or previous brace treatment is not well understood. Methods. Chinese AIS patients with refined Scoliosis Research Society 22-item (SRS-22r) Questionnaire and 5-level EQ-5D (EQ-5D-5L) Questionnaire scores were consecutively recruited for this cross-sectional study. Patients were grouped based on their treatment modality (observation only, bracing, previously braced, and postoperatively). Coronal and sagittal Cobb angles, degree of apical vertebral rotation, and curve type were studied. Spearman correlation test, independent t test, and one-way analysis of variance (ANOVA) with Tukey Post-hoc test were performed for statistical analysis. Results. A total of 652 AIS patients with mean age of 14.8 AE 1.9 years and mean Cobb angle of 18.68 AE 10.08 was studied. The respective mean SRS-22r total scores for bracing, observation, and previously braced groups were 4.20, 4.54, and 4.42, and mean EQ-5D-5L scores were 0.87, 0.95, and 0.92. The total and domain scores were correlated with coronal Cobb angles (P < 0.001) while only EQ-5D-5L correlated with sagittal Cobb angles (P < 0.001). Curves greater than 408 had worse HRQoL (P < 0.001). Currently braced patients had significantly worse HRQoL than those under observation, as indicated by lower EQ-5D-5L (0.08) and SRS-22r (0.35) scores (P < 0.001 to P < 0.05). Previously braced patients had better HRQoL than currently braced patients, with 0.05 higher EQ-5D-5L score (P < 0.001), and 0.23 higher SRS-22r score (P < 0.001). However, currently braced patients were more satisfied with treatment (1.94 difference; P < 0.001) than previously braced. There were no gross differences between patients previously braced and undergoing observation only. Conclusion. The negative impact of bracing on HRQoL is only transient as previously braced patients have superior HRQoL. It appears as though the EQ-5D-5L scores are more sensitive to changes in the sagittal profile as compared with SRS-22r. Our study highlights the differences in HRQoL between patients only being observed, undergoing bracing or previous brace treatment and the importance of monitoring HRQoL throughout follow-up. Further longitudinal studies may help determine the timing and threshold of HRQoL changes during the entire duration of bracing as well as after brace weaning.

Abstract
Introduction: Scoliosis is a three-dimensional deformative abnormality of the spine, defined by the Cobb's angle of spine curvature in the coronal plane, and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane. Based on the age of presentation, scoliosis is further categorized as infantile, juvenile or adolescent idiopathic. Adolescent idiopathic scoliosis (AIS) has the highest prevalence of the three categories. This type of scoliosis is present at age ten and lasts till the end of growth. Its prevalence is dependent on the curvature of the spine and gender of the patient. Objective: The purpose of this review is to evaluate the role of physiotherapy in reducing curve progression and pain, postponing or avoiding invasive treatment and improve the quality of life in adolescents with AIS. Methodology: The study is a Systematic Review, meta-analytic type, consisting of 5 studies (RCT) of the last ten years, which focus on the impact of physiotherapy in AIS. Studies include 210 patients evaluated and treated by physiotherapist, divided into 2 groups: experimental and control group. The measurement and rehabilitation includes Cobb angle, pain and quality of life. Data was extracted from medical websites and scientific journals. The evaluation was realized with the PEDro scale, which shows the validity of each study. Results: The literature used in the study claimed that physiotherapist in AIS reduces pain and Cobb angle and improve QoL (p<0.05). The 5 studies had an average PEDro score of 5.6/10. Conclusions: Evidence suggests that physiotherapy is good at reducing the Cobb angle, pain and improving the quality of life in patients with AIS. Scientific research on this topic is limited, so it is suggested to increase research, especially now that AIS incidence is higher.

The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines&#39; version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process...

Background: Non-surgical treatments for adult idiopathic scoliosis is sometimes prescribed for patients as an alternative to surgical interventions, but their effectiveness is uncertain. Objective: To evaluate the effectiveness of the Schroth method, SEAS, and TCM on reducing Cobb angle in adult idiopathic scoliosis. Study Design: Systematic review and meta-analysis. Methods: Database indexing services were used to search for applicable studies. Studies are eligible if their subjects are adults, used Schroth, SEAS, or TCM, and reported pre- and post-treatment Cobb angles. Meta-analysis was performed to determine effectiveness and compare the methods. Results: With support from select, low-quality articles with unclear to high risk of bias, Schroth, SEAS, and TCM are effective in reducing Cobb angle for adult patients with idiopathic scoliosis. Conclusion: Alternate, non-surgical methods for treating adult idiopathic may be effective in reducing Cobb angle. However, further high-qual...

Aims
The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes.
Patients and Methods
This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic
parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable
logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores.
Results
Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores.
Conclusion
Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal
parameter changes do not appear to be associated with worse quality of life.

Background: VDR may be considered as a candidate gene potentially related to Idiopathic Scoliosis susceptibility and natural history. Transcriptional profile of VDR mRNA isoforms might be changed in the structural tissues of the scoliotic spine and potentially influence the expression of VDR responsive genes. The purpose of the study was to determine differences in mRNA abundance of VDR isoforms in bone, cartilage and paravertebral muscles between tissues from curve concavity and convexity, between JIS and AIS and to identify VDR responsive genes differentiating Juvenile and Adolescent Idiopathic Scoliosis in paravertebral muscles. Methods: In a group of 29 patients with JIS and AIS, specimens of bone, cartilage, paravertebral muscles were harvested at the both sides of the curve apex together with peripheral blood samples. Extracted total RNA served as a matrix for VDRs and VDRl mRNA quantification by QRT PCR. Subsequent microarray analysis of paravertebral muscular tissue samples was performed with HG U133A chips (Affymetrix). Quantitative data were compared by a nonparametric Mann Whitney U test. Microarray results were analyzed with GeneSpring 11GX application. Matrix plot of normalized log-intensities visualized the degree of differentiation between muscular tissue transcriptomes of JIS and AIS group. Fold Change Analysis with cutoff of Fold Change ≥2 identified differentially expressed VDR responsive genes in paravertebral muscles of JIS and AIS.

Most researchers agree that idiopathic scoliosis (IS) is a multifactorial disease influenced by complex genetic and environmental factors. The onset of the spinal deformity that determines the natural course of the disease, usually occurs in the juvenile or adolescent period. Transforming growth factors í µí»½ (TGF-í µí»½s) and their receptors, TGFBRs, may be considered as candidate genes related to IS susceptibility and natural history. This study explores the transcriptional profile of TGF-í µí»½s, TGFBRs, and TGF-í µí»½ responsive genes in the paravertebral muscles of patients with juvenile and adolescent idiopathic scoliosis (JIS and AIS, resp.). Muscle specimens were harvested intraoperatively and grouped according to the side of the curve and the age of scoliosis onset. The results of microarray and qRT-PCR analysis confirmed significantly higher transcript abundances of TGF-í µí»½2, TGF-í µí»½3, and TGFBR2 in samples from the curve concavity of AIS patients, suggesting a difference in TGF-í µí»½ signaling in the pathogenesis of juvenile and adolescent curves. Analysis of TGF-í µí»½ responsive genes in the transcriptomes of patients with AIS suggested overrepresentation of the genes localized in the extracellular region of curve concavity: LTBP3, LTBP4, ITGB4, and ITGB5. This finding suggests the extracellular region of paravertebral muscles as an interesting target for future molecular research into AIS pathogenesis.

Objective. To examine general mental health in adult males and females, who in adolescence participated in a scoliosis-specific therapeutic exercise program or were under observation due to diagnosis of scoliosis.Design. Registry-based, cross-sectional study with retrospective data collection.Methods. Sixty-eight subjects (43 women) aged 30.10 (25–39) years, with mild or moderate scoliosis (11–36° Cobb angle), and 76 (38 women) nonscoliotic subjects, aged 30.11 (24–38) years, participated. The time period since the end of the exercise or observation regimes was 16.5 (12-26) years. Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ-28) scores were analyzed with theχ2andUtests. Multiple regression analyses for confounders were also performed.Results. Intergroup differences of demographic characteristics were nonsignificant. Scoliosis, gender, participation in the exercise program, employment, and marital status were associated with BDI scores. The presence of scolio...

Study DesignProspective study.PurposeTo determine the risk of clinically significant curve progression in adolescent idiopathic scoliosis (AIS) based on the initial Cobb angle and to test the utility of the distal radius and ulna (DRU) classification in predicting these outcomes.Overview of LiteratureDetermining the remaining growth potential in AIS patients is necessary for predicting prognosis and initiating treatment. Limiting the maturity Cobb angle to &lt;40° and &lt;50° reduces the risk of adulthood progression and need for surgery, respectively. The risk of curve progression is the greatest with skeletally immature patients and thus warrants close monitoring or early intervention. Many parameters exist for measuring the skeletal maturity status in AIS patients, but the DRU classification has been shown to be superior in predicting peak growth and growth cessation. However, its predictive capabilities for curve progression are unknown.MethodsTotally, 513 AIS patients who prese...

Correspondence should be sent to J. P. Y. Cheung; email: cheungjp@ hku. hk The aim of this study was to assess whether supine flexibility predicts the likelihood of curve progression in patients with adolescent idiopathic scoliosis (AIS) undergoing brace treatment. Methods This was a retrospective analysis of patients with AIS prescribed with an underarm brace between September 2008 to April 2013 and followed up until 18 years of age or required surgery. Patients with structural proximal curves that preclude underarm bracing, those who were lost to follow-up, and those who had poor compliance to bracing (<16 hours a day) were excluded. The major curve Cobb angle, curve type, and location were measured on the pre-brace standing posteroanterior (PA) radiograph, supine whole spine radiograph, initial in-brace standing PA radiograph, and the post-brace weaning standing PA radio-graph. Validation of the previous in-brace Cobb angle regression model was performed. The outcome of curve progression post-bracing was tested using a logistic regression model. The supine flexibility cutoff for curve progression was analyzed with receiver operating characteristic curve. Results A total of 586 patients with mean age of 12.6 years (SD 1.2) remained for analysis after exclusion. The baseline Cobb angle was similar for thoracic major curves (31.6° (SD 3.8°)) and lumbar major curves (30.3° (SD 3.7°)). Curve progression was more common in the thoracic curves than lumbar curves with mean final Cobb angles of 40.5° (SD 12.5°) and 31.8° (SD 9.8°) respectively. This dataset matched the prediction model for in-brace Cobb angle with less mean absolute error in thoracic curves (0.61) as compared to lumbar curves (1.04). Reduced age and Risser stage, thoracic curves, increased pre-brace Cobb angle, and reduced correction and flexibility rates predicted increased likelihood of curve progression. Flexibility rate of more than 28% has likelihood of preventing curve progression with bracing. Conclusion Supine radiographs provide satisfactory prediction for in-brace correction and post-bracing curve magnitude. The flexibility of the curve is a guide to determine the likelihood for brace success. Cite this article: Bone Joint J 2020;102-B(2):254-260.

Patients with adolescent idiopathic scoliosis (AIS) more frequently suffer dysfunctions of dento-skeletal complex. To our knowledge, no study has ever evaluated the temporomandibular joint disorders (TMD) of AIS patients at least 23 years after the completion of Milwaukee brace treatment. We aimed to provide a complex assessment of TMD and AIS patients treated with a Milwaukee brace, in a minimum 23-year follow-up, using radiological, clinical, and socio-demographical data, and to adapt the TMD Disability Index Questionnaire (TMDQ) and Fonseca’s questionnaire (FQ) to Polish conditions. In total, 42 healthy females and 30 AIS patients with a minimum of 23 years after a completed Milwaukee brace treatment were asked to complete the Polish version of (TMDQ-PL) and (FQ-PL). AIS patients present higher TMD levels than healthy controls. Significant differences exist between TMDQ-PL and FQ-PL (both in total scores and particular sub-sections), and AIS patients. Clinical and radiological fa...

Purpose: The aim of this study is to evaluate the walked distance and physiological responses during incremental shuttle walk test in patients with different degrees of adolescent idiopathic scoliosis (AIS). Methods: We evaluated 20 healthy teenagers and 46 patients with AIS; they were divided into 2 groups: AIS &gt; 45° and AIS  45° presented significant reduced incremental shuttle walked distance compared with the AIS 

Study Design: Prospective study. Purpose: To determine the risk of clinically significant curve progression in adolescent idiopathic scoliosis (AIS) based on the initial Cobb angle and to test the utility of the distal radius and ulna (DRU) classification in predicting these outcomes. Overview of Literature: Determining the remaining growth potential in AIS patients is necessary for predicting prognosis and initiating treatment. Limiting the maturity Cobb angle to <40° and <50° reduces the risk of adulthood progression and need for surgery, respectively. The risk of curve progression is the greatest with skeletally immature patients and thus warrants close monitoring or early intervention. Many parameters exist for measuring the skeletal maturity status in AIS patients, but the DRU classification has been shown to be superior in predicting peak growth and growth cessation. However, its predictive capabilities for curve progression are unknown. Methods: Totally, 513 AIS patients who presented with Risser 0-3 were followed until either skeletal maturity or the need for surgery , with a minimum 2-year follow-up period. Outcomes of 40° and 50° were used for probability analysis based on the cutoffs of adulthood progression risk and surgical threshold, respectively. Results: At the R6/U5 grade, most curves (probability of ≥48.1%-55.5%) beyond a Cobb angle of 25° progressed to the 40° threshold. For curves of ≥35°, there was a high risk of unfavorable outcomes, regardless of skeletal maturity. Most patients with the R9 grade did not progress, regardless of the initial curve magnitude (probability of 0% to reach the 50° threshold for an initial Cobb angle of ≥35°). Conclusions: This large-scale study illustrates the utility of the DRU classification for predicting curve progression and how it may effectively guide the timing of surgery. Bracing may be indicated for skeletally immature patients at an initial Cobb angle of 25°, and those with a scoliosis ≥35° are at an increased risk of an unfavorable outcome, despite being near skeletal maturity.

Radiographic Cobb’s angle is the gold standard for evaluation of spinal curvature, however, X-ray is ionising. In contrast, ultrasound is non-ionising and inexpensive. However, no study has reported the reliability and accuracy of ultrasound on sagittal curvature analysis. Ultrasound and X-ray scanning were conducted on 16 sets of spine phantoms with different deformities. Intra-rater and inter-rater reliability, correlations, mean absolute differences (MAD) and linear regression of ultrasound spinous process angles (USSPA), X-ray spinous process angles (XSPA) and X-ray Cobb’s angles (XCA) together with the intra-operator reliability of USSPA were investigated. In addition, USSPA and XCA of five AIS subjects were obtained using the ultrasound system. In the phantom study, excellent intra-rater and inter-rater reproducibility for the three angles and excellent intra-operator reproducibility for USSPA were demonstrated. Good to moderate or better correlations were obtained among the angles. All three angles indicated positive linear relationships with MAD ≤ 6.0°. The results of the preliminary study demonstrated a high intra-reliability for the ultrasound measurements. The measured difference between the USSPA and XCA methods was 6.3° ± 5.4°. The results showed that ultrasound is feasible for measuring sagittal curvature and has the potential for monitoring the curve progression and evaluating sagittal spinal profiles.