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Advances in scoliosis treatment and monitoring have added options for patients and drawn children, adolescents, and their families more directly into care.

One innovation harnessing artificial intelligence (AI) began in a pilot program this month at Cedars-Sinai Guerin Children’s in Los Angeles, where clinicians are testing the Momentum Spine App that enables radiation-free assessment and provides digital models of the patient’s spine.

The smartphone app technology starts with parents taking videos of their children at home by walking around them three times in 45 seconds. The video automatically converts into a three-dimensional (3D) model, is analyzed by AI to determine the Cobb angle, or spinal curve measurement, and sent to the care team via a secure portal. 

“Getting to Los Angeles can take patients in the area 2-3 hours every 4-6 months,” David Skaggs, MD, codirector of Cedars-Sinai Spine, executive vice chair of the Department of Orthopaedics and director of Pediatric Orthopaedics at Cedars-Sinai Guerin Children’s, told Medscape Medical News. “This can cut down on that travel time and reduce the number of times a developing child gets radiation.” The app also offers enormous potential time and cost savings for people who come to their center from other states or countries, he added. 

The combination of 3D total body topography combined with AI is demonstrating high accuracy. A study last year published in Brain and Spine found that the technology “predicted the Cobb angle with an overall correlation of 0.92 and a mean average error of 6.4 degrees for curves below 50 degrees. The app screened for adolescent idiopathic scoliosis (AIS; 10 degrees level) with a sensitivity of 0.93, specificity of 0.87, and area under the curve (AUC) of 0.96. At 40 degrees, sensitivity drops to 0.62, while specificity remained high at 1.0 with AUC of 0.96.”

Other radiation-free monitoring tools include scoliometers, ultrasound, and moiré topography, but they have poor sensitivity and specificity.

The new technology can catch increasing curvature early and also helps monitor whether night bracing, for instance, is working, or whether day bracing is needed as well, Skaggs said. Sensors can also be fitted into the back braces to track brace-wearing compliance.

3 Million New Cases a Year

AIS is the most common form of scoliosis, accounting for 80% of diagnosed cases, and occurs in young people most often between ages 10 years and 18 years. About 3 million new cases are diagnosed in the United States each year and the signs typically are discovered by pediatricians at annual checkups or in school screenings. Though more than half of adolescents report back pain, only about 4 in 100 adolescents have scoliosis.

About 30% of patients with AIS have a family history of the condition and according to the American Academy of Orthopaedic Surgeons, idiopathic scoliosis occurs 10 times more often in girls than in boys over the age of 10 years.

The cause of most childhood scoliosis is not known, but it can occur in people with conditions such as cerebral palsy and muscular dystrophy. Most cases are mild, but some curvatures increase as children grow.

Cedars-Sinai’s is the first health system to use the 3D smartphone solution in its pediatric clinics, Skaggs said. 

But Jennifer Winell, MD, an attending pediatric orthopedic surgeon at Children’s Hospital of Philadelphia, Philadelphia, who specializes in nonsurgical treatments for scoliosis, told Medscape Medical News she is also interested in piloting the 3D technology at CHOP.

Treatment for scoliosis falls into three categories, she said. For most with a Cobb angle < 25 degrees — the largest group — observation is typically the best treatment and when the curve goes past 45 degrees, surgery is typically the best choice, she said. “It’s the in-between, the bracing situation that has changed the most,” she said.

3D Braces Lighter, More Effective

Three-dimensional braces are now widely used after decades of the same traditional braces, which offered only two-dimensional, side-to-side support. “I find them effective because the plastic material is thinner and more pliable,” Winell said. “Kids are more compliant with it because it’s more comfortable.” Three-dimensional braces address the coronal imbalance, looking at someone from behind, and the sagittal balance, looking from the side. 

Nighttime bracing for mild curves has also made a comeback, she said. Traditionally, the thought had been not to brace before a curve hit 25 degrees. “What we’re trying now is getting to a younger patient with a smaller curve — say a 9- or 10-year-old with maybe a 15- or 20-degree curve — and starting to offer the family a trial of nighttime bracing to see if that prevents them from needing full-time bracing,” she said.

Full-time bracing for 18-20 hours is traumatic emotionally for kids, so they often are eager to try the nighttime brace, Winell said. “That’s a newer thing and I think it’s pretty exciting.” Anecdotally, she’s seeing strong buy-in with kids and families, but data will determine whether it is able to reduce brace time later, she said.

Schroth Method for Therapy

In conjunction with bracing, she recommends a type of physiotherapy with scoliosis-specific exercises employing the Schroth method. “I have used this in my practice to help kids adapt to the three-dimensional bracing,” she said.

Though she said the exercises don’t reverse the curve of the spine, they “can improve the cosmetic appearance of your back.” 

That’s the goal Lauren Ferrante, PT, DPT, a Schroth-certified physical therapist, talks about with her patients at Memorial Hermann Sports Medicine & Rehabilitation in Houston.

The exercises are tailored to each patient depending on the severity of the spinal curve. One person’s hip or shoulder may be higher on one side or a ribcage may be farther forward on one side. Therapists may include bars, poles, belts, and wedges to help lengthen and strengthen the muscles around the spine with the goal of improving posture and symmetry and slowing the progression of the curve. Schroth may be used in conjunction with other physical therapy as well.

“We may use mirrors to help them visualize the back and how we’re trying to improve the posture,” Ferrante said. The exercises may also employ deep breathing on the concave side of the body to help regain symmetry.

She tells her patients that Schroth exercises are like brushing teeth, in that they need to be a lifelong habit, part of a patient’s daily routine: 10-15 minutes a day, at least 5 days a week, with occasional clinic check-ins to achieve the goals they set together.

Goals for the exercises will be different for children with scoliosis, she said. For some, the priority is relieving pain, for others, it’s improving posture or better performance in physical activities or sports.

Positive Data Emerging

She also trains parents of younger patients, especially, to help their child complete the exercises. While Schroth has been widely used in Europe, she said, it’s seen a spike in the United States in the past decade and more data on its effectiveness are emerging.

A 2024 randomized, controlled study in PLOS One, for instance, found that Schroth exercises added to standard observation or bracing reduced asymmetry in AIS.

A meta-analysis of 10 randomized controlled trials found an improved effect size in patients with idiopathic scoliosis when Schroth was employed, from almost moderate to large, for the Cobb angle, angle of trunk rotation, and quality of life.

“The brace will be the best thing to help them push the posture of the spine into neutral alignment and Schroth will help them build the strength to maintain that posture,” Ferrante said.

Skaggs, Winell, and Ferrante reported no relevant financial relationships.

Marcia Frellick is an independent healthcare journalist, based in Chicago. She regularly covers primary care and specialties including cardiology, infectious disease, dermatology and oncology.