Scoliosis

IntroductionSynthesised data on the global prevalence of scoliosis in children and adolescents and its associated risk factors remain scarce. This systematic review aimed to estimate the global prevalence of scoliosis in children and adolescents and identify associated risk factors in children and adolescents.MethodsWe conducted a systematic review and meta-analysis, searching nine electronic databases for observational population-based studies on scoliosis in children and adolescents published until June 02, 2024, without language or geographical restrictions. We estimated the global prevalence using the DerSimonian-Laird random-effects model with Free-Tukey double arcsine transformation and stratified prevalence through prespecified subgroup analyses. Fixed-effects models were used for consistent risk factors across studies, while random-effects models were applied for factors with high heterogeneity.ResultsWe initially identified 12,339 records, of which 239 studies comprising 46,565,512 participants were included. The estimated global prevalence of scoliosis in children and adolescents was 1.65% (95% CI 1.38-1.94), varying from 0.05% in Ecuador to 16.67% in Romania. We found higher prevalence in European (2.88%) and Americas (2.54%) than other regions (Eastern Mediterranean 1.22%, South-East Asia 1.35%, Western Pacific 1.35%, and African 1.46%). The higher prevalence was in high-latitude regions (2.96% vs mid-latitude 1.62% vs low-latitude 1.73%). The prevalence in girls was nearly double that in boys (1.76% vs 0.87%), with a steady increase observed from ages 7 to 16 years, peaking at 12-14 years for girls and 15-16 years for boys. The prevalence in adolescents (10-18 years) was nearly four times higher than that in children (6-9 years) (1.13% vs 0.26%). Idiopathic scoliosis in children and adolescents constituted the majority of cases, predominantly presenting as mild scoliosis (Cobb angle 10°-19°, 86.65%) with the single thoracolumbar curve being the most common subtype (36.67%). Additionally, the prevalence may increase since 2020 year (3.02%). Scoliosis in children and adolescents was significantly associated with sex (girls, odds ratio 2.16, 95% CI 2.01-2.33), family history (1.92, 95% CI 1.47-2.50), sedentary behavior (≥ 11 h, 1.64, 95% CI 1.20-2.25), poor sitting posture (3.48, 95% CI 2.85-4.24), short outdoor time (ConclusionsScoliosis in children and adolescents remains highly prevalent globally. Our findings can help to guide epidemiological characteristics and development of tailored preventive and therapeutic strategies, ultimately enhancing primary prevention and controlling disease progression.Trial registrationCRD42024584704.

PurposeAdolescent idiopathic scoliosis (AIS) is a complex three-dimensional (3D) spinal deformity, with transverse plane rotational components increasingly targeted by modern surgical techniques. Yet, clinical evaluation remains predominantly based on 2D radiographic parameters, including the widely used Lenke classification. In response, the 3D Classification Task Force of the Scoliosis Research Society (SRS) developed a comprehensive, clinically relevant classification system that remains intuitive, reproducible, and readily applicable by spine surgeons. This manuscript introduces the proposed SRS-Lenke-Aubin 3D classification and evaluates its ability to provide a structured and clinically meaningful 3D characterization of spinal deformities in AIS.MethodsTo maintain continuity with standard clinical practices, the system builds upon the established Lenke classification and introduces two complementary 3D descriptors: the orientation of the regional plane of deformation (ORPD) and the apical vertebral rotation (AVR). These indices capture transverse plane deformities at the regional and local levels, respectively. Each was independently assessed for the proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TL/L) regions using calibrated 3D reconstructions from biplanar radiographs. A population-representative cohort of 285 AIS surgical cases was used to evaluate the system. ORPD and AVR values were translated into categorical modifiers using predefined clinical thresholds.ResultsThe new SRS-Lenke-Aubin 3D AIS classification adds two transverse plane modifiers per spinal region-the ORPD and AVR-yielding a modular 3-tiered, 4-modifier system: Curve type (1-6), Lumbar spine modifier (A, B, C), Thoracic sagittal profile modifier (-, N, +), Transverse plane regional modifier (ORPD: 1-3) and Transverse plane local modifier (AVR: s, m, l). A broad range of ORPD × AVR combinations was observed across the cohort, reflecting the system's ability to capture transverse plane heterogeneity. Notably, similar coronal curve types often exhibited divergent transverse morphologies, underscoring the added value of these 3D descriptors in identifying clinically relevant variation.ConclusionsThe SRS-Lenke-Aubin 3D classification enriches the existing Lenke framework by incorporating practical transverse plane descriptors compatible with standard imaging workflows. This system offers a clinically meaningful step toward more complete 3D characterization of AIS, with potential applications in improving surgical planning, assessing outcomes, and supporting future integration with automated 3D tools.

BackgroundIdiopathic scoliosis is a three-dimensional spinal deformity that typically develops during childhood or adolescence but may affect individuals across the lifespan. Regular monitoring is often necessary to detect progression and assess treatment effectiveness. Radiography remains the clinical gold standard; however, repeated ionizing radiation exposure is associated with increased cancer risks, highlighting the need for reliable, non-invasive, and radiation-free assessment methods. This systematic review and meta-analysis evaluated the diagnostic accuracy and criterion validity of emerging radiation-free scoliosis monitoring techniques compared to radiographic standards.MethodsA comprehensive literature search across six databases (Cochrane, EMBASE, IEEE Xplore, PUBMED, Scopus, Web of Science) identified 56 eligible studies involving 4,774 patients diagnosed with idiopathic scoliosis (median number of patients per study: 38; range: 5 to 952, mean patient age: 15.2 years, female-to-male ratio: 3:1). Criterion validity was assessed by pooling Pearson correlation coefficients between radiographic and non-ionizing measurements. Measurement accuracy was assessed by pooling their mean absolute differences in Cobb angles. Additionally, sensitivity and specificity for detecting deformity progression were assessed. Statistical analyses employed multilevel linear mixed-effects models, introducing moderators to explain study heterogeneity.ResultsUltrasonography demonstrated the highest overall validity, consistently correlating strongly (r≈0.9) with radiographic Cobb angles. Surface topography also showed robust correlation (r > 0.8), although evidence remains insufficient for patients with higher body mass indices or more severe spinal curvatures for both methods. Magnetic resonance imaging exhibited a very strong correlation (r = 0.93) with radiographic measurements; however, correlation varied significantly depending on patient positioning. Upright MRI provided more consistent results compared to supine positioning.ConclusionsUltrasonography and surface topography represent promising radiation-free alternatives that could significantly reduce radiographic assessment frequency, minimizing radiation exposure, particularly in suitable patient groups. While MRI also demonstrates excellent validity, its broader clinical applicability remains constrained by substantial costs, limited availability, and extended examination durations. Although these non-ionizing modalities are not yet viable replacements for routine radiography, their demonstrated validity and accuracy supports their potential as complementary technologies, particularly for screening or supplementary monitoring of scoliosis.