School scoliosis screening (SSS) officially began in 1963 in Minnesota, USA, and the model of SSS subsequently spread all over the world. On the basis of comprehensive literature review regarding SSS published by 2018, 23 countries, including Japan have been performed SSS. However, 4 countries (the United Kingdom, Norway, Canada, Australia) abolished SSS at the present. The most popular test was the forward bending test followed by measurement of the angle of trunk rotation and Moiré topography. With regard to positions on SSS, there were 16 countries in positive, 4 countries in negative, and 3 countries in controversial positions. None of the countries except Japan enshrine SSS in law. It revealed that SSS was independently adopted and run by their own systems and techniques on the basis of the concepts of each country although the efficacy of SSS was still controversial. Recently, a review report regarding SSS has been published from Russia, that never had SSS so far. The present global direction of SSS is considered positive.

In 2016, the school medical examination for locomotive organ was started. The purpose is to lead to lifelong health promotion by early detection of diseases and abnormalities of the spine, ribcage, limbs, bones, and joints of children and students who are in the process of growth and development. Another purpose is to encourage people to take an interest in their locomotive organs by filling out the locomotive health questionnaire at home. With reference to the questionnaire, the school doctor conducts a medical examination for locomotive organ. If an abnormality is suspected, an orthopedic consultation is recommended.

Looking at the results of school medical examination for locomotive organ, the most common reason for recommending orthopedic consultation is suspicion of scoliosis. However school doctors are mainly internists and pediatricians who do not specialize in locomotive organ. There is a problem of undressing at the school medical examination. Accurate examination cannot be performed without undressing. It is necessary to consider reducing the burden on school doctors by introducing auxiliary inspection equipment such as moire.

It is also a problem that there are many children who do not receive a medical examination even if they are recommended to see a doctor.

It is necessary to devise a school medical examination for locomotive organ system.

Introduction: Although spinal fusion surgery is beneficial for treating neuromuscular scoliosis (NMS), a high rate of complications remains problematic, and surgical site infection (SSI) is one of the most common and undesirable complications. In this study, we aimed to investigate the risk factors for SSI in NMS surgery, given that several known risk factors, such as gastrotomy, tracheostomy, and low body weight, are frequently present in our clinical cases.

Methods: We retrospectively analyzed 129 cases of posterior spinal fusion surgery for NMS patients between March 2017 and March 2022. The median age at surgery was 14.3 years, and BMI was 14.2 kg/m². The preoperative main Cobb angle was 92 degrees, and the Spino-pelvic obliquity (SPO) was 22 degrees. Ninety-three patients had epilepsy, and 45 patients had gastrotomy. We compared preoperative and perioperative patient data between the SSI and non-SSI groups.

Results: Five cases developed SSI. In comparing the SSI and non-SSI groups, we found statistically significant differences in SPO, anesthesia induction time, pelvic fixation, and the use of the V-flap technique for SSI. We did not find a clear association between SSI and epilepsy, gastrotomy, tracheostomy, GMFCS, low BMI, severity of preoperative deformity, intraoperative blood loss, surgical time, intraoperative hypothermia, or correction rate of deformity.

Conclusion: Our study revealed that there is still an SSI risk in NMS patients requiring pelvic fixation. Furthermore, patients who require a prolonged induction of anesthesia are suggested to be at further risk for SSI. These findings may help to guide the selection of patients for surgery and perioperative management to minimize SSI.

Introduction: In Akita Prefecture, school screening using the Moiré topography have been conducted since 1984, and have been continued after the start of musculoskeletal screening. In this study, we compared the results of the scoliosis examination using the Moiré screening with those of the musculoskeletal screening using data provided by the Akita City Board of Education.

Methods: From 2017 to 2020, 1,442 patients with spinal column findings in musculoskeletal screening and 474 patients with Moiré screening findings underwent secondary examination.

Results: The positive predictive value for the Cobb angle of 10 degrees or more was 39% in the musculoskeletal screening, and 60% in the Moiré screening. The positive predictive value of scoliosis in junior high school students was 57% for the musculoskeletal screening, which was similar to that for the Moiré screening. 13% of the diagnosed cases were newly positive for the musculoskeletal screening and 87% were continuously positive, and most of the cases were diagnosed with scoliosis by the Moiré screening.

Conclusions: The results of this study have once again demonstrated the usefulness of Moiré screening in comparison with musculoskeletal screening. In order to promote the use of Moiré screening, it is necessary to improve the follow-up system after the screening. In addition, it is necessary to approach and cooperate with boards of education and medical associations for the development of medical checkups to resolve issues such as the protection of personal information in order to provide feedback on the results of medical checkups.

Introduction: Screening of scoliosis has been carried out as a part of school musculoskeletal screening since 2016. In Shiga prefecture, this screening is performed based on self-assessment questionnaire and physical examination without any devices by school doctors who do not specialize in orthopedics. The objective of this study is to evaluate the contribution of screening in early diagnosis of scoliosis.

Methods: We retrospectively investigated patients who visited our hospital because of suspected spinal deformity for the first time between 2017 and 2019. Patients who were referred to our hospital based on a screening program (Group S) were compared to the others (Group N). In this study, we included screening programs performed in pre-school children as well as in school-aged children and adolescents. Patients who had already been diagnosed as a disease which is known to be a risk for scoliosis were excluded. We investigated the age and Cobb angle at the first visit, diagnosis, and whether the visit was according to the screening program or not.

Results: 137 patients were identified. 110 of them were girls. 63 patients (46%) visited our hospital according to a screening program. The diagnosis was idiopathic scoliosis in 119 patients, congenital scoliosis in 6 patients and syndromic scoliosis in 6 patients. 6 patients did not have scoliosis. The mean age and the mean Cobb angle of the patients in Group S and N were 12.6 (±3.1) and 12.9 (±3.8) years, and 25.4 (±14.4) and 29.3 (±12.5) degrees, respectively. No difference was observed between Group S and N (p=0.99 and 0.27).

Conclusions: In Shiga, screening programs involved in almost half of the diagnosis of scoliosis. Our result did not support early diagnosis of scoliosis by screening programs. Self-assessment questionnaire and physical examination alone may be insufficient for early diagnosis of scoliosis.

Introduction: Brace treatment for adolescent idiopathic scoliosis (AIS) is usually indicated for patients with Risser sign grade 0-3, but not for above grade 4. However, we occasionally see patients whose curves progress even in patients with Risser sign grade 4. We examine Cobb angle progression and risk factors in Risser sign grade 4 cases of AIS.

Methods: From January 2016 to December 2020, 42 AIS patients with Risser sign grade 4 at the first visit to our clinic and were followed up for at least 1 year were included. Patient background, physical findings, and radiological measurements including the Cobb angles were evaluated. Patients were divided into progressive and non-progressive groups to compare their risk factors of scoliosis.

Results: Eight patients were in the progressive group and 34 were in the non-progressive group. In the progressive group, the Cobb angle increased by 7.1 degrees, from 28.7 to 35.8 degrees. The time since menarche was significantly shorter in the progressive group (9.7 months) than in the non-progressive group (24.2 months) (P=0.003). Growth in height was significantly greater in the progressive group (+2.9 cm) than in the non-progressive group (+1.8 cm) (P = 0.02). There were no differences in the other factors.

Conclusions: In this study, curves progressed in approximately 20% of patients with Risser sign grade 4. In cases with short time since menarche or potential for height growth, AIS patients with Risser sign grade 4 may need to take brace therapy.

Purpose: The aim of this study was to assess the relationships of residual low back pain with radiographic, patient characteristics, and patient-reported outcomes (PROs) following adult spinal deformity (ASD) surgery.

Materials and methods: A total of 63 patients with ASD who underwent long fusion (>5 levels) from the thoracic spine to the pelvis were included. The following clinical outcome measures were used: Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Oswestry Disability Index (ODI), and visual analog scale (VAS) for low back pain (LBP). Radiographic parameters included thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), and sagittal vertical axis (SVA). Residual low back pain was defined as the VAS for LBP ≥50 mm at final follow-up. Patient characteristics, radiographic parameters, and PROs were compared between the two groups. Multiple logistic regression analysis was used to identify risk factors associated with residual low back pain.

Results: Overall, the VAS for LBP was significantly improved from 71.4 mm to 36.6 mm postoperatively (P<0.001). The ODI was significantly improved from 52.5% to 35.2% postoperatively (P<0.001). The JOABPEQ were significantly improved except for mental health. Residual low back pain (VAS>50 mm) was found in 33%. There were no significant differences in patient characteristics, surgical characteristics, and radiographic parameters between the two groups. The preoperative VAS for LBP, ODI, and JOABPEQ were significantly worse in the residual LBP group than in the non-LBP group. No significant risk factor was found for residual low back pain.

Conclusion: The VAS for LBP was significantly improved postoperatively, but residual low back pain was found in 33% of cases.

Introduction: Adolescent idiopathic scoliosis (AIS) is associated with low bone mineral density. But the correlation between bone turnover markers and vertebral body wedging was unclear. The purpose of this study was to assess whether bone turnover markers were associated with increased vertebral body wedging and major thoracic curve angle.

Methods: A retrospective study was performed in 28 patients (mean age: 15yrs, all female) with AIS who underwent surgery at our hospital from 2015 to 2021. Measurements included bone turnover markers (BAP and NTx), vertebral morphology (vertebral coronal plane wedging: VCPW) and Cobb angle of major thoracic curve. The statistical analysis was assessed using Spearman's rank correlation coefficient and multiple regression analysis. A p value of less than 0.05 was considered to be significant.

Results: The averages of BAP and NTx were 40.5±7.8 μg/l and 36.3±4.2 nMBC. VCPW and Cobb angle were 8.1±0.6°and 59.5±3.0°. BAP didn't associate with VCPW (ρ=0.35), but positively correlated with Cobb angle (ρ=0.55). NTx was positively correlated to both VCPW and Cobb angle (ρ=0.46, ρ=0.62 respectively). VCPW was positively correlated to Cobb angle (ρ=0.46). Multiple regression analysis showed that the significant predictor of VCPW was NTx (p value=0.002).

Conclusions: NTx was significantly associated with vertebral body wedging and Cobb angle. Bone resorption in AIS girls seems to be related to the scoliotic curve severity.

Introduction: Regarding leg length difference (LLD), there are two concepts, one is functional leg length difference (FLLD) and the other is an anatomical leg length difference (ALLD). FLLD is defined as a difference of the right and left height of the apex of the femoral head. ALLD is defined as a difference of the right and left sum of the femoral and tibial length. The LLD is recognized as a cause of the adolescent idiopathic scoliosis (AIS). The purpose of this study was to evaluate relationship FLLD and ALLD in AIS patients.

Materials and Methods: We analyzed 215 AIS patients who presented to our hospital between January 1, 2007 and August 31, 2021. A difference of 10 mm or more was defined as having LLD. The relationships between FLLD and ALLD were analyzed using Student t test and regression analysis.

Results: The study group included 90.2% female, and the overall average age was 16.3 years. FLLD and ALLD was present in 4.6% and 6.0%, respectively. Among all cases, the maximum FLLD and ALLD was 14.0 mm and 18.2 mm, respectively. The mean value of FLLD and ALLD was 3.8 mm and 4.0 mm, respectively. There was no association between FLLD and ALLD (p=0.13), and a statistically significant correlation between FLLD and ALLD in all cases (r=0.882, p<0.01).

Conclusion: There was no significant difference between FLLD and ALLD the among AIS patients. Meanwhile, there was a statistically significant correlation between FLLD and ALLD. We might consider to take lower limbs Xp for those cases.

Introduction: Malignant hyperthermia (MH) is a muscle disorder with an autosomal dominant inheritance that presents mainly during general anesthesia. Patients with congenital myopathy, including central core disease, often have a risk of developing MH. Mutations in the ryanodine receptor (RYR1) gene are a major cause of congenital myopathy and MH.

Case Report: A female patient with an RYR1 mutation had early-onset scoliosis due to congenital myopathy. At 10 years old, her thoracic spinal curvature had progressed to 66° and her lumbar curvature to 79°. Repeating growth-friendly treatments such as growing rod surgery increases the patient's risk of developing MH during the growth period. The patient was twice placed in a Risser-Cotrel cast under total intravenous anesthesia (TIVA). Serial casting delayed surgical treatment for about 2 years. Finally, at 12 years old, she underwent scoliosis surgery using spinal instrumentation. Despite 3 episodes of TIVA, she has never suffered from MH. At 2 years postoperatively, her thoracic spinal curvature improved to 29° and lumbar curvature to 31° without a crankshaft phenomenon.

Conclusions: Scoliosis surgery for a patient with congenital myopathy was successfully managed using TIVA. Despite congenital myopathy in patients with an RYR1 mutation, intravenous anesthetics may not be as commonly associated with the onset of MH as thought.

Introduction: Diastematomyelia is a rare disease that is often asymptomatic. Patients rarely display clinical symptoms, however, spinal cord tension increases with growth causing progressive neurological symptoms. Surgical treatments include septal resection, spinal cord detachment and duraplasty, nevertheless, if the condition coincides with congenital scoliosis, these operations are often later followed by corrective fusion surgery in a two-stage manner. In the present case, corrective fixation was performed in a one-stage surgery with a resection limited to bony septum only. The case indicates that under careful monitoring, there are cases that can be corrected with minimal invasion.

Case report: An 11-year-old girl was referred to our hospital with a spinal abnormality after scoliosis school screening. Somatic findings showed no abnormalities in muscle strength or sensory ability, however, her Cobb angles at T1-T4-L1 were 19° and, 44°, a Lenke Type 1 deformity, with abnormal vertebral arch morphology at T11 to L1 and fused vertebrae at T9 to T10. The skeletal maturity was classified as Risser Grade 4 and thumb ossification composite index (TOCI) stage 7 and she was considered to be still in the growth period. In addition, CT/MRI examinations revealed a spinal cord split with a bony septum at T12. The patient was diagnosed with a congenital scoliosis with diastematomyelia and a one-stage surgery was performed. While monitoring under free-running MEG and MEP, the surgery first removed the bony septum that split the cord, and then using O-arm navigation, fused posterior spines for scoliosis treatment. The surgery was completed in 6 hours and 39 minutes with bleeding of 50 ml. After the operation, the Cobb angles at T1-T5-L2 were corrected to 10° and 8° with no postoperative complications.

Conclusions: The present case reports congenital scoliosis with type 1 diastematomyelia. The case suggests that under a careful monitoring, such scoliosis that are characterized by modest correction angle without neurological symptoms may be corrected in a one-stage surgery with minimal invasion, when the resection is limited solely to the bony septum.