Orthosis-wearing compliance is crucial for achieving positive treatment outcomes in patients with adolescent idiopathic scoliosis (AIS), for whom 23 h of daily wear is typically prescribed. However, self-reported compliance is subjective and often based on patients’ memory, leading to inaccuracies. While portable electronic devices have been developed to objectively monitor compliance, relying solely on temperature or force data can be insufficient. This study introduced a novel method that integrated both force and temperature data to estimate orthosis-wearing compliance. Twelve patients (eight females and four males) diagnosed with moderate AIS were included. Each patient was prescribed a thoracic-lumbar-sacral orthosis equipped with an integrated force and temperature sensor system. After one month of orthotic treatment, self-reported wear time averaged 17.8 ± 6.2 h/day, while the sensor indicated an average wear time of 13.3 ± 5.0 h/day. Most patients overestimated their compliance. Nighttime was the most common period for orthosis wear (6.1 h/day), whereas compliance during school hours (2.8 h/day) and after-school hours (3.7 h/day) was lower. The integration of force and temperature sensors provides a more comprehensive understanding of orthosis compliance. Future studies with larger samples and longer monitoring periods are needed to investigate the correlation between compliance and treatment outcomes.

Background: Orthotic treatment is commonly used as a non-surgical intervention for managing moderate adolescent idiopathic scoliosis (AIS). Although prior studies have evaluated various factors influencing health-related quality of life (HRQoL) in the patients with AIS, the association between trunk appearance perception and HRQoL, including potential gender differences, remains insufficiently defined. This study investigated gender differences in trunk appearance perception and its relationship with QoL among the patients with moderate AIS undergoing orthotic treatment. Methods: Patients with moderate AIS undergoing orthotic treatment were included, and HRQoL evaluations were conducted before treatment, as well as one and seven months after the initiation of orthotic treatment. The evaluation tools included the Trunk Appearance Perception Scale (TAPS), Scoliosis Research Society-22r (SRS-22r), and Brace Questionnaire (BrQ). The study time points were selected to capture baseline conditions, initial adaptation, and longer-term treatment effects. Results: A total of 34 females and 11 males participated in the study. No significant gender differences were observed in global HRQoL, with both groups consistently reporting low self-image and self-esteem. In females, increasing age was negatively correlated with TAPS scores, whereas in males, it showed a positive correlation. For females, higher compliance was associated with higher bodily pain scores on the BrQ (ρ = 0.417), indicating reduced pain levels. In contrast, among males, greater compliance was associated with poor trunk appearance perception after seven months (ρ = −0.619). While TAPS was unrelated to SRS-22r and BrQ in females, a more favorable trunk appearance in males was strongly related to better function and self-image scores on the SRS-22r after seven months (ρ = 0.614 and 0.703, respectively). Conclusion: Trunk appearance perception and overall HRQoL were similar between females and males in this study. However, the score related to self-image was lower than other HRQoL domains.

Objectives: Clinical ultrasound provides a non-invasive method to assess spinal curvature in adolescent idiopathic scoliosis (AIS). However, the reliability and validity of ultrasound assessment may be affected by body mass index (BMI). This study investigated the impact of BMI on the reliability and validity of ultrasound assessments in AIS. Design: 165 participants with suspected AIS were recruited for both ultrasound and radiographic assessments. Lateral spinal curvature was measured on ultrasound imaging using the spinous process method and on X-ray using the Cobb method. The same operator performed two ultrasound scans for each participant, and two independent raters measured the images (Rater 1: 1 ^st and 2 ^nd scans; Rater 2: 1 ^st scan only). Intra-operator and inter-rater reliabilities were assessed using intraclass correlation coefficients (ICCs), and validity was assessed by correlating ultrasound angles with Cobb angles using Pearson’s r. Participants were categorized by BMI tertiles and BMI-for-age percentiles for subgroup analyses. Results: The second BMI tertile (16.2–18.5 kg/m ² ) exhibited the highest reliability: ICC (2,1)=0.83 (95% CI: 0.73–0.90) intra-operator and 0.88 (95% CI: 0.76–0.94) inter-rater. By BMI-for-age classification, the normal-weight group demonstrated the highest reliability (ICC = 0.78 and 0.84) and the lowest standard error of measurement (2.6° and 2.3°). Validity was strongest in the 18.1–24.4 kg/m ² BMI group (r = 0.85), compared with 12.3–15.8 kg/m ² (r = 0.58) and 16.0–17.7 kg/m ² (r = 0.61). Conclusions: The reliability of ultrasound assessments of spinal curvature was highest in adolescents in the second BMI tertile and in the normal-weight group, while underweight and overweight groups showed lower reliability. Correlation with Cobb angles was strongest in the 18.1–24.4 kg/m² BMI group (r = 0.85), suggesting ultrasound performs best when soft-tissue conditions are neither minimal nor excessive. These findings suggest that BMI should be considered when interpreting ultrasound measurements and when designing screening protocols for AIS.

Purpose: To investigate the influence of in-orthosis correction on treatment outcomes of adolescent idiopathic scoliosis (AIS) with double-curve, and to explore baseline radiographic features associated with achieving high in-orthosis correction. Methods: This retrospective study analyzed 101 skeletally immature patients with double-curve AIS treated with customized thoracic-lumbar-sacral orthosis (TLSO). Radiographic measurements from pre-orthosis standing and supine, first in-orthosis, and final out-of-orthosis follow-up visits were analyzed. Initial in-orthosis correction rates for the thoracic and thoracolumbar/lumbar (TL/L) curves were compared. Patients were dichotomized into high (≥ 38.3%) and low (< 38.3%) thoracic correction groups. An exploratory multivariable analysis was performed to identify baseline radiographic features associated with thoracic correction outcomes. Results: Thoracic curves had significantly lower initial in-orthosis correction than TL/L curves (29.3% vs. 38.6%, p < 0.001). High initial thoracic correction was strongly associated with final treatment success for the thoracic curve ( p = 0.009), whereas TL/L curve correction was not ( p = 0.250). Thoracic curve progression accounted for 90.9% of treatment failures. Patients who achieved high thoracic correction had nearly eight times the odds of achieving high TL/L correction (OR = 7.89, 95% CI: 2.97–20.90). Five radiographic factors were found to be associated with high correction: greater pre-orthosis lumbar lordosis, higher thoracic and TL/L supine flexibility, lesser thoracic apical sagittal wedging, and a smaller increase in rib-vertebral angle difference (RVAD) from standing to supine. The model showed good discriminatory capacity within the cohort (AUC = 0.862). Conclusion: In AIS with double-curve, inadequate in-orthosis thoracic correction is strongly associated with treatment failure. A set of baseline radiographic features including favorable sagittal alignment, high flexibility, and rib cage stability are associated with successful thoracic correction, generating hypotheses regarding potential biomechanical factors for this limitation which can also serve as a foundation for future research.

Purpose: Although optical (OPI) and ultrasonic imaging (USI) have each been independently investigated as non-invasive alternatives to radiography (Xray) in scoliosis assessment, no study has yet directly compared their clinical performance. This study aimed to evaluate the clinical agreement and validity of OPI and USI, using Xray as the reference standard. Methods: Radiographic Cobb angle served as the gold standard for clinical evaluation of two non-invasive methods. The OPI-angle was derived from spine models fitted to digitised surface data based on structured-light, while USI-angle was measured from images acquired using an ultrasonic system. All scans were performed in the same upright posture. For analysis, 14 participants with suspected scoliosis completed all three assessments (Xray, OPI, USI) for direct three-way comparison. Additionally, 29 participants underwent Xray and OPI, and 25 underwent Xray and USI, enabling respective pairwise comparisons with the radiographic Cobb angle. The correlation, agreement, and measurement error were evaluated, with subgroup analyses based on spinal region, curve severity, and apical vertebral rotation (AVR) level. Results: Both non-invasive methods showed strong correlations with the radiographic Cobb angle (OPI: r = 0.873, 95% CI: 0.734–0.938; USI: r = 0.902, 95% CI: 0.791–0.953), with mean absolute differences (MADs) of 4.3° and 4.2°, respectively. The correlation between OPI- and USI-angles was r = 0.795 (95% CI: 0.590–0.898). Subgroup analyses revealed stronger correlations in the thoracic compared to the lumbar region for both methods. USI-angle showed a smaller MAD in mild than in moderate curves (4.3° vs. 7.1°). Optimal performance for both methods was observed at 5–10° AVR (OPI: MAD = 3.9°, r = 0.846; USI: MAD = 5.2°, r = 0.835). Conclusions: Both OPI and USI demonstrated strong agreement with radiographic measurements in scoliosis assessment, supporting their potential as useful non-invasive tools for clinical screening and monitoring applications. Additional validation with larger sample sizes, different severities, and various body mass index levels is required to further improve their clinical efficacy and applicability.