Design and Application of a New Artificial Intelligence Screening Program for Scoliosis

Objective — Intelligent Scoliosis screening Application (ISSAPP) is an intelligent scoliosis screening application based on back photos, which is used to determine the effectiveness and reliability of the new tool and reduce the cost of screening by comparing it with traditional physical examination. Method — To design and upgrade the measurement procedures for back photographs during physical examination, including the measurement of bilateral shoulder apex line and horizon plus angle, and the measurement of the angle between the thoracic apex line and horizon during Adams' spinal flexion experiment so as to determine the validity and reliability of measurement program tools. Results — The first and second versions of the designed AI measurement program were more sensitive than the traditional physical examination, Adams spinal flexion test, and lateral flexion instrument. The majority of patients who were tested positive using the measurement procedure tool met the requirements for diagnosis of scoliosis. Conclusions — This new AI based measurement and screening tool can be used for early detection of shoulder and thoracic malformation caused by scoliosis, which is a simple, convenient and sensitive early screening tool. Based on this development idea, an upgraded version can be further developed for early screening of scoliosis.

The Prevalence of Scoliosis Screening Positive and its Influencing Factors: A School based Cross-sectional Study in Zhejiang Province, China

Background: Early detection of scoliosis is of great significance to patients with scoliosis and the whole society. This paper aims to learn the prevalence of scoliosis screening positive among students in primary and secondary schools, and to explore the influencing factors. Methods: In 2019, a stratified cluster sampling technique was employed in this school based cross-sectional study. Sampling covers all prefecture level cities in Zhejiang Province. Based on the whole class, at least 80 students in each grade of primary school, junior high school and senior high school were selected. Physical examination and scoliosis screening were performed in the school-based investigation. Distribution of demographic characteristics and nutritional status of children and adolescents with scoliosis screening positive were explored. Results: A total of 45547 students were screened. The overall prevalence of children and adolescents with scoliosis screening positive were 3.9%. Higher prevalence of scoliosis screening positive was found in students living in urban area (4.1%), female students (4.1%), students with low weight (5.3%) (p < 0.05), and the prevalence increased with age (p < 0.05). In logistic analysis, we found age (OR=1.145), gender (OR=1.118) and low weight (OR=1.480) were the influencing factors for prevalence of scoliosis screening positive (p < 0.05). Conclusions: There were no disparities between living areas, but there was significant difference between genders, among different ages, and among different nutritional status of children and adolescents with or without scoliosis screening positive. In multi analysis, age, gender, and low weight were the influencing factors for prevalence of scoliosis screening positive. Age and gender specific scoliosis screening strategy and nutritional public health policies for children and adolescent are need.

Using ultrasound for screening scoliosis to reduce unnecessary radiographic radiation – a prospective diagnostic accuracy study on 442 schoolchildren

Scoliosis screening is important for timely initiation of brace treatment to mitigate curve progression in skeletally immature children. Scoliosis screening programs frequently include the protocol of referring children screened positive with Scoliometer and Moiré Topography for confirmatory standard radiography. Despite being highly sensitive (88%) for detecting those who require specialist referral, the screening program was found to have more than 50% false positive rate that leads to unnecessary radiation exposure. Radiation-free ultrasound has been reported to be reliable for quantitative assessment of scoliosis curves. The aim of this prospective diagnostic accuracy study was to determine the accuracy of ultrasound in determining the referral status for children initially screened positive for scoliosis. 442 schoolchildren with a mean Cobb angle of 14.0 ± 6.6° were recruited. Using x-ray as the gold standard, the sensitivity and specificity of ultrasound in predicting the correct referral status were 92.3% and 51.6% respectively. ROC curve analysis revealed an area under curve of 0.735 for ultrasound alone and 0.832 for ultrasound plus scoliometer measurement. The finding provided strong evidences on the accuracy of ultrasound in determining the referral status that could result in more than 50% reduction of unnecessary radiation exposure for children undergoing scoliosis screening.

Idiopathic scoliosis and associated factors among school children: a school-based screening in Ethiopia

Background Early detection of scoliosis is a preface to prevent progression. In resource-constrained countries like Ethiopia, there is a need for a cost-effective reliable solution for screening. The surprising fact is that there is neither idiopathic scoliosis screening nor reporting of data from Ethiopia. This study aimed to identify the magnitude, associated factors of scoliosis among school children by using non-invasive and less expensive scoliometer Smartphone app and Adams forward bending test. Methods A school-based cross-sectional survey was carried out from March to June 2019 at seven primary schools. Children were screened by using physical examination (Adams forward bend test) and scoligauge iPhone app. Univariate and multivariable binary logistic regression model analysis was used to identify factors associated with idiopathic scoliosis. Results A total of 1905 children aged between 5 and 16 years were screened, 3.3 % (95 % CI 2.5–4.1) of them were found positive using the scoligauge HD and among them only 1.8 % were identified positive for Adam’s forward bend test. The associated factors of idiopathic scoliosis identified by multivariate analysis were; spinal pain (AOR 4.1, 95 % CI 2.42, 6.89), student sitting on stool: (AOR, 7.03; 95 % CI, 1.52, 32.5), sitting on the bench with a backrest (AOR 4.12; 95 %CI, 1.12, 15.14) and sitting on the bench without backrest: (AOR 4.56; 95 % CI 1.20, 17.34). Conclusions The magnitude of idiopathic scoliosis was relatively low in study setup. More attention is needed towards sitting furniture designs and for children reporting spinal pain.There is a reasonable level of recommendation to advocate that large school-based scoliosis screening was able to detect scoliosis among school children.

Adolescent idiopathic scoliosis screening: Could a school-based assessment protocol be useful for an early diagnosis?

BACKGROUND: Adolescent idiopathic scoliosis screening still needs a considerable implementation, particularly throughout a school-based assessment protocol. OBJECTIVE: This study aims to evaluate the effectiveness of clinical examinations currently in use for the diagnosis of adolescent idiopathic scoliosis, through a survey carried out in secondary schools to standardize a screening protocol that could be generalized. METHODS: In their classrooms, the adolescents underwent an idiopathic scoliosis screening through three examinations: Adam’s test, axial trunk rotation (ATR) and plumb line. In case of single positivity to one of the three examinations, a column X-ray examination was recommended. RESULTS: The sensitivity and diagnostic specificity of Adam’s test or ATR were 56.3% and 92.7%, respectively. The positivity to at least one between ATR or plumb line showed that sensitivity was higher than specificity: 91.3% versus 80.8%; the positivity to at least one between Adams’s test or plumb line showed a sensitivity of 95.2% and a specificity of 81.5%. Finally, the positivity to all three examinations showed an increase in specificity (99.7%). CONCLUSIONS: Taken together, our findings show that this school-based screening protocol had a very high specificity in early diagnosis of adolescent idiopathic scoliosis.

Annual Observation of Changes in the Angle of Trunk Rotation. Trunk Asymmetry Predictors. A Study from a Scoliosis Screening in School Adolescents

Adolescent forms of idiopathic scoliosis are commonly encountered deformities of the thoracic and lumbar spine. They affect a significant number of adolescents, yet their cause is still unknown. The presented research is a cross-sectional analysis of 3933 volunteers (2131 girls and 1802 boys). The participants were primary school students aged 9 to 13 years old. This study determined a relationship between predictors such as: body mass, body height and body mass index (BMI) (independent variables) and angle of trunk rotation (ATR) value (dependent variable). Moreover, a stepwise multiple regression with backward selection was conducted to determine to what extent the dependent variable is explained by body mass, body height and BMI. In the group of 11,12,13-year-old girls, the analyzed results of multiple stepwise regression were statistically significant. Among the all studied predictors, it has been shown that body mass in the 11-year-old girls and body height in 12- and 13-year-old girls are major correlates of a 1-year ATR increase in proximal and main thoracic spine levels.