Scoliosis Management through Apps and Software Tools.

Background: Scoliosis is curvature of the spine, often found in adolescents, which can impact on quality of life. Generally, scoliosis is diagnosed by measuring the Cobb angle, which represents the gold standard for scoliosis grade quantification. Commonly, scoliosis evaluation is conducted in person by medical professionals using traditional methods (i.e., involving a scoliometer and/or X-ray radiographs). In recent years, as has happened in various medicine disciplines, it is possible also in orthopedics to observe the spread of Information and Communications Technology (ICT) solutions (i.e., software-based approaches). As an example, smartphone applications (apps) and web-based applications may help the doctors in screening and monitoring scoliosis, thereby reducing the number of in-person visits. Objectives: This paper aims to provide an overview of the main features of the most popular scoliosis ICT tools, i.e., apps and web-based applications for scoliosis diagnosis, screening, and monitoring. Several apps are assessed and compared with the aim of providing a valid starting point for doctors and patients in their choice of software-based tools. Benefits for the patients may be: reducing the number of visits to the doctor, self-monitoring of scoliosis. Benefits for the doctors may be: monitoring the scoliosis progression over time, managing several patients in a remote way, mining the data of several patients for evaluating different therapeutic or exercise prescriptions. Materials and Methods: We first propose a methodology for the evaluation of scoliosis apps in which five macro-categories are considered: (i) technological aspects (e.g., available sensors, how angles are measured); (ii) the type of measurements (e.g., Cobb angle, angle of trunk rotation, axial vertebral rotation); (iii) availability (e.g., app store and eventual fee to pay); (iv) the functions offered to the user (e.g., posture monitoring, exercise prescription); (v) overall evaluation (e.g., pros and cons, usability). Then, six apps and one web-based application are described and evaluated using this methodology. Results: The results for assessment of scoliosis apps are shown in a tabular format for ease of understanding and intuitive comparison, which can help the doctors, specialists, and families in their choice of scoliosis apps. Conclusions: The use of ICT solutions for spinal curvature assessment and monitoring brings several advantages to both patients and orthopedics specialists. Six scoliosis apps and one web-based application are evaluated, and a guideline for their selection is provided.

COVID-19 pneumonia in kyphoscoliosis: The success stories.

Coronavirus disease (COVID-19) pandemic has led to millions of deaths worldwide. Old age, immunocompromised state and multiple comorbidities are described as risk factors. Kyphoscoliosis (KS) is the most common spine abnormality and a risk factor of respiratory failure. Management of pneumonia in a patient with severe kyphoscoliosis is challenging to the intensivist. We report successful management of two patients with severe kyphoscoliosis who developed severe COVID-19 pneumonia.

Genetic variants associated with the occurrence and progression of adolescent idiopathic scoliosis: a systematic review protocol.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a structural lateral spinal curvature of ≥ 10° with rotation. Approximately 2-3% of children in most populations are affected with AIS, and this condition is responsible for approximately $1.1 billion in surgical costs to the US healthcare system. Although a genetic factor for AIS has been demonstrated for decades, with multiple potentially contributory loci identified across populations, treatment options have remained limited to bracing and surgery. METHODS: The databases MEDLINE (via PubMed), Embase, Google Scholar, and Ovid MEDLINE will be searched and limited to articles in English. We will conduct title and abstract, full-text, and data extraction screening through Covidence, followed by data transfer to a custom REDCap database. Quality assessment will be confirmed by multiple reviewers. Studies containing variant-level data (i.e., GWAS, exome sequencing) for AIS subjects and controls will be considered. Outcomes of interest will include presence/absence of AIS, scoliosis curve severity, scoliosis curve progression, and presence/absence of nucleotide-level variants. Analyses will include odds ratios and relative risk assessments, and subgroup analysis (i.e., males vs. females, age groups) may be applied. Quality assessment tools will include GRADE and Q-Genie for genetic studies. DISCUSSION: In this systematic review, we seek to evaluate the quality of genetic evidence for AIS to better inform research efforts, to ultimately improve the quality of patient care and diagnosis. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration #CRD42021243253.

The impact of COVID-19 on idiopathic scoliosis referrals: cause for concern.

STUDY DESIGN: Retrospective comparative review. OBJECTIVE: The aim of this study was to determine the short-term impact of the COVID-19 pandemic on the demographic and clinical profile of new idiopathic scoliosis (IS) patients, with a particular focus on treatment and late referral. The COVID-19 pandemic has limited health-care services and public access and, as a result, the diagnosis and management of non-COVID-19 health conditions have been compromised. Delayed diagnosis of IS may limit conservative treatment options and subsequently, increase a patient's risk of requiring surgical intervention. METHODS: The volume of spine referrals received and new IS clinic visits were compared between March 15-October 15, 2019 and the same period in 2020. A chart and radiographic review detailed the patient profile at initial presentation. Descriptive statistics and comparative analyses examined the referral source, curve magnitude, skeletal maturity, and prescribed treatment. Late referrals were those with a curve magnitude ≥ 50°, or > 40° and Risser 2 or less. RESULTS: During the 2020 study period, the referral volume decreased 76% and clinic visits 55%. The 2019 cohort was similar in age (13.7 ± 2.1 years vs 13.3 ± 2.3 years, p = 0.08), Risser score distribution (p = 0.32), menarchal status (0.07), and curve magnitude (37.1° ± 3.8° vs 39.0° ± 16.0°, p = 0.22). During the pandemic, there was an increased proportion of referrals made by pediatricians (41 to 54%, p = 0.01). The proportion of brace prescriptions increased from 30 to 42% (p = 0.01). The proportion of surgical bookings and late referrals were increased but did not reach significance. CONCLUSION: Despite no significant increase in the magnitude of the curve at initial presentation or the proportion of late referrals, there was a marked decrease in referral volume, over the first 7 months of the COVID-19 pandemic. This suggests that the majority of expected new IS patients remain undiagnosed. A future increase in late referrals should be anticipated. LEVEL OF EVIDENCE: III.

From bed-side to web-side, Advanced-Telemedicine platform for Spinal Muscular Atrophy (preprint)

We aimed to assess feasibility, accuracy, satisfaction of an advanced-telemedicine (A-TM) platform designed for remote physical evaluation, especially focused on lung auscultation, in spinal muscular atrophy (SMA) patients. Children affected by type 1 and 2 SMA, typically present generalized weakness, scoliosis, chest deformities the leading cause of progressive respiratory insufficiency and recurrent hospitalization. Covid-19 stimulated efforts to adopt innovative digital health solutions especially when caring for people living with disabilities. Because of chest asymmetry and scoliosis, SMA patients are not always the ideal candidates for telemedicine tools that have proved to be useful in the general population. 23 children affected by SMA (15 type 1 and 8 type 2) with different degree of scoliosis and chest asymmetry. Prospective study: We localized optimal thoracic auscultatory landmarks with traditional stethoscope and lung ultrasound for each child. Carers were trained to record complete lung auscultation independently and share data with our physicians via A-TM platform. After the first remote exam, carers videorecorded their experience (satisfaction). Our physicians blindly rated the audio files shared via A-TM which were compared to traditional auscultation findings for each child. to assess. Overall feasibility and accuracy of carers-performed remote physical evaluation. Our study showed that remotely performed lung auscultation was possible in all type 1 and 2 SMA children but adaptations to find optimal landmarks were needed in cases with asymmetrical or rotated chest and trunk. A-TM tools may simplify access to care, reduce logistic/economic burden for families, improve communication, safety and disease management while limiting infection exposure.

The Scoliosis Research Society adult spinal deformity standard outcome set.

PURPOSE: Symptomatic adult spinal deformity (ASD) with an extremely variable presentation with pain, with and without neurogenic leg pain, and/or disturbed sagittal and coronal balance, causes a significant societal burden of disease. It is an important consequence of the aging adult population, generating a plethora of spine-related interventions with variable treatment efficacy and consistently high costs. Recent years have witnessed more than a threefold increase in the prevalence and treatment of ASD, and further increases over the coming decades are expected with the growing elderly population worldwide. The ability to monitor and assess clinical outcomes has not kept pace with these developments. This paper addresses the pressing need to provide a set of common outcome metrics for this growing group of patients with back pain and other disabilities due to an adult spinal deformity. METHODS: The standard outcome set was created by a panel with global representation, using a thorough modified Delphi procedure. The three-tiered outcome hierarchy (Porter) was used as a framework to capture full cycle of care. The standardized language of the International Classification of Functioning, Disability and Health (WHO-ICF) was used. RESULTS: Consensus was reached on a core set of 25 WHO-ICF outcome domains ('What to measure'); on the accompanying globally available clinician and patient reported measurement instruments and definitions ('How to measure'), and on the timing of the measurements ('When to measure'). The current work has brought to light domains not routinely reported in the spinal literature (such as pulmonary function, return to work, social participation), and domains for which no adequate instruments have yet been identified (such as how to clinically quantify in routine practice lumbar spinal stenosis, neurogenic claudication, radicular pain, and loss of lower extremity motor function). CONCLUSION: A standard outcome set was developed for patients undergoing treatment for adult spinal deformity using globally available outcome metrics. The current framework can be considered a reference for further work, and may provide a starting point for routine methodical and systematic monitoring of outcomes. Post-COVID e-health may accelerate the routine capture of these types of data.

Management of patients with magnetically controlled growth rods amidst the global COVID-19 pandemic.

INTRODUCTION: At the time of writing, we are all coping with the global COVID-19 pandemic. Amongst other things, this has had a significant impact on postponing virtually all routine clinic visits and elective surgeries. Concurrently, the Magnetic Expansion Control (MAGEC) rod has been issued with a number of field safety notices and UK regulator medical device alerts. METHODS: This document serves to provide an overview of the current situation regarding the use of MAGEC rods, primarily in the UK, and the impact that the pandemic has had on the management of patients with these rods. RESULTS AND CONCLUSION: The care of each patient must of course be determined on an individual basis; however, the experience of the authors is that a short delay in scheduled distractions and clinic visits will not adversely impact patient treatment. The authors caution against a gap in distractions of longer than 6 months and emphasise the importance of continued remote patient monitoring to identify those who may need to be seen more urgently.

COVID-19 and restrictive lung disease: A deadly combo to trip off the fine balance.

Coronavirus Disease (COVID-19) pandemic has so far led to innumerable deaths worldwide. The risk factors so far that have been most studied as poor prognostic factors are old age, individuals with multiple comorbidities and immunocompromised patients. Amongst the chronic lung diseases, most patients with COVID-19 reported so far had asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease. Herein, we discuss the significance of restrictive lung disease during the COVID-19 pandemic as a potential risk factor via an example of a patient with kyphoscoliosis who succumbed to death due to COVID-19 pneumonia.