Spinal deformity refers to a range of disorders that are defined by anomalous curvature of the spine and may be classified as scoliosis, lordosis, or kyphosis. Among these, scoliosis stands out as the most common type of spinal deformity in human beings, and it can be distinguished by abnormal lateral spine curvature accompanied by axial rotation. Accurate identification of spinal deformity is crucial for a person's diagnosis, and numerous assessment methods have been developed by researchers. Therefore, the present study aims to systematically review recent works on spinal deformity as-assessment for scoliosis diagnosis, utilizing image processing techniques. To gather relevant studies, a search strategy was conducted on three electronic databases (Scopus, ScienceDirect, and PubMed) between 2012 and 2022, using specific keywords and focusing on scoliosis cases. A total of 17 papers fully satisfied the established criteria and were extensively evaluated. Despite variations in methodological designs across the studies, all reviewed articles obtained quality ratings higher than satisfactory. Various diagnostic approaches have been employed, including artificial intelligence mechanisms, image processing, and scoliosis diagnosis systems. These approaches have the potential to save time and, more significantly, can reduce the incidence of human error. While all assessment methods have potential in scoliosis diagnosis, they possess several limitations that can be ameliorated in forthcoming studies. Therefore, the findings of this study may serve as guidelines for the development of a more accurate spinal deformity assessment method that can aid medical personnel in the real diagnosis of scoliosis.

Incobotulinumtoxin A and Yoga-like Isometric Exercise in Adolescent Idiopathic Lumbar Scoliosis – a randomized pilot study Abstract: Background: Approximately 90% of scoliosis is adolescent idiopathic (AIS). From its first appearance at 10-14 until age 18 it is most vulnerable to deterioration; young people are most susceptible to the condition worsening. An effective non-surgical means of remediation would be welcome. Design: Randomized control two-arm study, assessing the safety and efficacy of combining incobotulinum injections with yoga to reverse lumbar and thoracolumbar AIS. Methods: In a private clinic setting, non-pregnant healthy 12 – 18 year-olds were either taught a symmetrical “placebo” yoga pose (control sub-group 1), given the side plank (Vasisthasana) done thrice daily with placebo injection (control sub-group 2) or given the thrice-daily side-plank with botulinum injection (Intervention group 3). Injection: 33 IU of incobotulinum toxin type A (Xeomin) injected into concave-side lumbar paraspinals and quadratus lumborum at L2-3 and the psoas muscle at L3-4, or injected similarly with placebo. Randomization by Random.com. Objective: Assess whether muscular asymmetry treated with botulinum toxin injection and the side-plank are safe and effective in AIS.Results: Outcome: Twelve intervention and 12 placebo patients (Groups 1 + 2), 12 -18 years old completed the three-month study period. Mean daily side-plank time = 165 seconds. Mean initial lumbar curvature was 36.9 degrees (SD 14.36), (p<0.0001); mean curvature at 3 weeks was 29.5 degrees. (SD 14.23) (p<0.0001); mean curvature at 3 months was 26.0 degrees (SD 12.81) Onset vs 3-month value: p<0.0001. Two patients in Group 3 complained of shoulder pain, and 2 of wrist pain that resolved when the side-plank was done on the elbow. Conclusion: Muscle asymmetry appears relevant to AIS treatment. Incobotulinum injections combined with the side-plank done with the convex side downward may be safe and helpful in adolescent idiopathic lumbar scoliosis.

Background: Menarche as an important parameter in assessment of scoliosis progression in girls is proven to be dependent on geographical latitude. The aim of the study was to determine whether the age of menarche differs in scoliotic and non-scoliotic Balkan girls and the relation between menarche and laterality of scoliotic curves. Participants and methods: Retrospective study with three groups: scoliotic, non-scoliotic and control group. Patients data collection and analysis was approved by the Ethical committee of the Institute. Statistical analysis: Program SPSS 24 was used and included One-way ANOVA, Fisher’s and Chi-squared test to compare different groups. Statistical significance was defined as p&lt;0,05. Results: No statistically significant difference was found in age of menarche between the three groups (p=0,168). In scoliotic postmenarchal group, primary right curve was dominant in 54,80%, while in scoliotic premenarchal group primary left curve was dominant in 60,09% (p&lt;0,01). Conclusion: In Bosnia &amp; Herzegovina and Serbia Balkan girls, there was no significant difference in age of menarche between scoliotic and non-scoliotic girls. A significant difference was found in laterality of primary curve in premenarchal and postmenarchal scoliotic girls.

Background: Parkinsons’s disease is characterized by progressive worsening of gait, posture and balance with disability in daily life activities and to improvement in chronic musculoskeletal pain, often in neck pain associated with worsening of balance. The aim of the study is to investigate the correlation between scoliosis, balance and cervical pain in Parkinson’s disease. Methods: Cross-sectional, pilot study. A total of 16 Parkinson’s patients were enrolled in the study. The Pain Visual analogue scale and the short form McGill pain questionnaire measured neck cervical pain; static balance, Tinetti, Berg Balance and Short Physical Performance Battery scales(SPPB) were used to evaluate dynamic balance. Whole-spine standard X-ray assess spinal scoliosis with Cobb angles measurement .An observational statistical analysis was performed with the patients subdivided into a non-scoliosis (NS) group and a true scoliosis (TS) group based on whether they presented a Cobb’s angle below or ≥10°. Results: Frequency of neck pain in the NS group was 37% compared to 50% in the TS group. A non-statistically significant difference was found in terms of static, dynamic balance and cervical pain scores between NS and TS groups. Conclusions: Scoliosis, cervical pain and postural imbalance are significant yet often overlooked complaints in PD.

Incobotulinumtoxin A and Yoga-like Isometric Exercise in Adolescent Idiopathic Lumbar Scoliosis – a randomized pilot study Abstract: Background: Approximately 90% of scoliosis is adolescent idiopathic (AIS). From its first appearance at 10-14 until age 18 it is most vulnerable to deterioration; young people are most susceptible to the condition worsening. An effective non-surgical means of remediation would be welcome. Design: Randomized control two-arm study, assessing the safety and efficacy of combining incobotulinum injections with yoga to reverse lumbar and thoracolumbar AIS. Methods: In a private clinic setting, non-pregnant healthy 12 – 18 year-olds were either taught a symmetrical “placebo” yoga pose (control sub-group 1), given the side plank (Vasisthasana) done thrice daily with placebo injection (control sub-group 2) or given the thrice-daily side-plank with botulinum injection (Intervention group 3). Injection: 33 IU of incobotulinum toxin type A (Xeomin) injected into concave-side lumbar paraspinals and quadratus lumborum at L2-3 and the psoas muscle at L3-4, or injected similarly with placebo. Randomization by Random.com. Objective: Assess whether muscular asymmetry treated with botulinum toxin injection and the side-plank are safe and effective in AIS. Results: Outcome: Twelve intervention and 12 placebo patients (Groups 1 + 2), 12 -18 years old completed the three-month study period. Mean daily side-plank time = 165 seconds. Mean initial lumbar curvature was 36.9 degrees (SD 14.36), (p<0.0001); mean curvature at 3 weeks was 29.5 degrees. (SD 14.23) (p<0.0001); mean curvature at 3 months was 26.0 degrees (SD 12.81) Onset vs 3-month value: p<0.0001. Two patients in Group 3 complained of shoulder pain, and 2 of wrist pain that resolved when the side-plank was done on the elbow. Conclusion: Muscle asymmetry appears relevant to AIS treatment. Incobotulinum injections combined with the side-plank done with the convex side downward may be safe and helpful in adolescent idiopathic lumbar scoliosis.

Background: Adolescent Idiopathic Scoliosis (AIS) patients have been found to exhibit cortical asymmetry. This study aimed to examine the impact of conservative treatments on perceptual and cognitive asymmetry in the auditory system of AIS patients with thoracic major curve. Method: The study involved 30 AIS patients and 21 healthy subjects. The intervention group used a Cheneau brace and performed 18 Schroth Best Practice (SBP) exercise sessions. Auditory lateralization was assessed with a Dichotic Listening Paradigm (DLP) in both groups before and after the intervention. Results: The six-week intervention resulted in a significant increase in left ear responses in the force-left condition in the AIS (p<0.05). Left ear responses were lower in AIS at baseline (p<0.05). Sixth-week results were similar in all conditions (p>0.05). Conclusion: The results of this study demonstrated that SBP exercises and Cheneau brace treatment can improve perceptual and cognitive asymmetry in the auditory system in AIS patients with thoracic major curve. Scoliosis-associated changes in the spine and postural control may affect auditory perception by causing adaptations in sensory and motor networks. Future studies are needed to examine the connectivity in brain regions related to motor control and auditory processing after conservative treatment.

Idiopathic scoliosis (IS) is an unexplained dysplasia of the spine that can occur at any age, with idiopathic scoliosis making up the largest proportion of the total population worldwide, approximately 2-3%. Scoliosis is not just a cosmetic defect, but the development of the spinal deformity can lead to cardiovascular and respiratory lesions, often resulting in serious health problems. Treatment of the condition usually involves major surgery, which is both a physical and financial burden for patients. In order to clarify the aetiology of IS and provide a theoretical basis for new diagnostic and treatment methods IS, it is important to use different animal models for experiments. Zebrafish is an emerging model animal with a short reproductive cycle, minimal breeding expenses, and other beneficial traits including in vitro fertilisation, in vitro development, and embryo transparency. As a result, genetic alteration and observation are simpler than with traditional model animals. This study examines the history of animal models for IS research, focuses on the benefits and drawbacks of zebrafish as an IS model and the advances it provides to IS research, and anticipates zebrafish application prospects in IS research.

Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and pre or intraoperative traction would be effective for severe spinal deformity, but invasive. This study aimed to evaluate the outcomes of PSF only surgery for patients with severe NMS with Cobb angle &gt;100 °. Thirty NMS patients (13 boys and 17 girls; mean age 13.8 years) who underwent PSF only surgery for scoliosis with Cobb angle &gt;100 ° were included. We reviewed the lower instrumented vertebra (LIV), duration of surgery, blood loss, perioperative complications, preoperative clinical findings, and radiographic findings including Cobb angle and pelvic obliquity (PO) in the sitting position pre and postoperatively. The correction rate and correction loss of the Cobb angle and PO were also calculated. The mean duration of surgery was 338 min, intraoperative blood loss was 1,440 mL, preoperative %VC was 34.1%, FEV1.0 (%) was 91.5%, and EF was 66.1%. There were eight cases of perioperative complications. The Cobb angle and PO correction rates were 48.5% and 42.0%, respectively. We divided the patients into two groups: the L5 group, in which the LIV was L5, and the pelvis group, in which the LIV was the pelvis. The duration of surgery and PO correction rate in the pelvis group was significantly higher than that of the L5 group. Patients with severe NMS demonstrated severe preoperative restrictive ventilatory impairments. PSF only surgery for severe NMS showed satisfactory outcomes, although highly invasive. Instrumentation and fusion to the pelvis for severe scoliosis in patients with NMS showed good PO correction and low correction loss of Cobb angle and PO, but a longer duration of surgery.

The link between scoliotic deformity and bone metabolism in adolescent idiopathic scoliosis (AIS) has not been well researched. Moreover, the data concerning the cross-talk between fat tissue content/hormonal activity and bone markers in this group of patients are lacking. The objective of this study was to correlate the extent of scoliotic-curve severity with the bone turnover vs. leptin level and nutritional status in girls with AIS. The study encompassed 77 AIS girls, aged 14.7 ± 2.17 years. Scoliotic curve severity assessed by Cobb’s angle was categorized as mild (10-19o) moderate (20-39º) or severe (≥40º). Corrected height, weight, waist and hip circumferences were measured and body mass index (BMI), corrected height Z-score, BMI Z-score and waist/height ratio (WHtR) were calculated for the entire group. Body composition parameters: fat mass (FAT), fat-free mass (FFM) and predicted muscle mass (PMM) were determined using a bioelectrical impedance analyzer. Bone turnover markers (osteocalcin (OC) and amino terminal of collagen cross-links NTx) and leptin levels were assessed in serum. Multiple regression analysis showed that, OC, NTx (negatively with p<0.05) and leptin (positively with p<0.01) were significantly associated with curve severity in AIS girls. Moreover, Cobb’s angle was positively correlated with W/HtR (p<0.01)and FAT (p<0.05). One-way analysis of variance (ANOVA) revealed significant differences in leptin (p<0.05 vs. mild only), OC (p<0.05 vs. mild and moderate)) and W/HtR (p<0.01 and p<0.05 vs. mild and moderate respectively) between the three AIS severity subgroups. OC was significantly lower in the severe AIS subgroup, while leptin and W/HtR were significantly higher. Significant correlations between leptin and anthropometrical parameters as BMI z-score and W/HtR were shown. Leptin level correlated also significantly with BMI z score (p<0.001), W/HtR (p<0.0001) and body composition parameters (p<0.000001). Moreover, there was a significant negative correlation between NTx and leptin level (p<0.05). Bone metabolism in AIS girls seems to be altered and significantly related to the scoliotic curve severity. Leptin may be a crucial link in the cross-talk between bone turnover and body composition in this group of patients. Further studies concerning this topic are needed.

Study design: Creating and psychometric testing of a new QoL Questionnaire about Physiotherapeutic Specific Exercises of Scoliosis (Questionnaire of Physiotherapeutic Specific Exercises of Scoliosis -QPSSE). Purpose: The purpose of this study is to create a reliable and valid questionnaire for patients suffering mild and moderate adolescent idiopathic scoliosis (AIS) who have been treated with Physiotherapeutic Specific Exercises of Scoliosis (PSSE) in order to evaluate their quality of life. Materials and Methods: The developed questionnaire was based on a thorough literature review as well as on authors experience. It consists of 53 questions, of which 37 have a positive meaning, 15 have a negative meaning, and one is multiple choice question, additionally there are six “open” questions. Except for the multiple choice question, all other questions are answered on a Likert scale ranging from 1 to 5 scores. 5 represents a positive meaning or very much, whereas 1 stands for a negative meaning or not at all. Questions were developed by the authors who subsequently categorized the 53 questions into the following 8 domains: physical functioning, self-image, Physiotherapeutic Scoliosis-Specific Exercises (PSSEs), psychosocial functioning, cognitive functioning, compliance, motivation and pain. A pilot study was conducted so that we could calculate Cronbach’s Alpha based on the outcome. Due to the COVID-19 pandemic, the authors worked through the Zoom online platform to structure the questionnaire. Results: Pearson's correlation coefficient was used for all correlations evaluated. P values of less than 0.05 were considered to be significant. Internal consistency was evaluated with Cronbach's alpha. Although there were very few missing values, accounting for 0.78% of the total values of the questionnaire, expectation maximization likelihood algorithm was used to impute data. IBM® SPSS® Statistics Software v.25 was used for the analysis. Cronbach's alpha coefficients for the overall score was 0.84. Conclusion: This original QPSSE was found to be a reliable and valid tool for AIS treated conservatively with PSSE and for their clinicians.

Neuromonitoring of the efferent nerve impulses transmission in the spinal cord tracts during surgical scoliosis treatment makes it possible to assess whether the functional status is deteriorating, affecting the procedure's safety. Is there any relationship between pre- and intraoperative motor evoked potentials recordings and does idiopathic scoliosis (IS) surgical correction improve directly the spinal efferent transmission? This study aimed to compare the results of surface recorded electromyography (EMG), electroneurography (ENG, M and F-waves), and especially motor evoked potentials (MEP) from tibialis anterior (TA) muscle bilaterally in 353 girls with the right idiopathic scoliosis (types 1A-4C according to Lenke classification). It has not yet been documented whether the results of MEPs recordings induced by transcranial single magnetic stimulus (TMS, pre – and postoperatively) and trains of electrical stimuli (TES; intraoperatively in T0-before surgery, T1 – after pedicle screws implantation, T2 – after scoliosis curvature distraction and derotation following two rods implantation) can be compared for diagnostic verification of improvement of the spinal neural transmission. The study also attempted to determine whether the constant level of optimal anesthesia during the certain surgical steps of scoliosis treatment affects the parameters of MEPs recorded during neuromonitoring procedures. No neurological deficits have been observed postoperatively. Values of amplitudes but not latencies in MEPs recordings evoked with TMS in IS patients compared before and after surgery indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts postoperatively. Results of all neurophysiological studies in IS patients were significantly asymmetrical and recorded worse on the concave side, suggesting greater neurological motor deficits at p=0.04. This asymmetry had been significantly reduced following IS surgery. The surgeries in IS patients brought significant improvement (p=0.04) in parameters of amplitudes of sEMG recordings, however reflecting still the consequences of the neurogenic injury of TA muscle motor units. ENG studies results indicated the symptoms of the axonal type injury in peroneal motor fibers improved only on the concave side at p=0.04 in parallel with the significant improvement of F-waves parameters, which suggests that surgeries might result in the lumbar ventral roots decompression. There were not detected significant differences in amplitudes or latencies of MEPs induced with TMS or TES comparing the parameters recorded preoperatively (one day before surgery) and intraoperatively in T0. The amplitudes of TES evoked MEPs increased gradually at p=0.04 in the subsequent periods (T1 and T2) of observation. The significant reduction of MEPs latency at p=0.05 was observed only at the end of the IS surgery. Studies on the possible connections between the level of anesthesia fluctuations and the required TMS stimulus strength, as well as the MEPs amplitude changes measured in T0-T2 revealed lack of relationships. It is not likely that they could be the factors influencing the efferent transmission in spinal pathways beside the surgical procedures. Considering that MEPs amplitude parameter reflects the number of axons excited from the motor cortex and transmitting the efferent impulses via spinal descending tracts in the white matter, pre- (TMS evoked) and intraoperative (TES evoked) recordings are reliable for evaluating the patient’s neurological status before and during surgical scoliosis correction procedures. The results of this study indicate an agreement between preoperative and early-intraoperative evaluations with these both diagnostic methods. An increase of MEPs amplitude parameters recorded on both sides after scoliosis surgery proves immediate improvement of the total efferent spinal cord transmission. Considering comparative pre- and postoperative sEMG and ENG recordings it can be concluded that surgeries might directly result in the additional lumbar ventral roots decompression. Our results of the tests on the possible variability of the anesthesia level on the parameters of intraoperative recorded MEPs show no clear relationships. We can conclude that MEPs parameters changes are determined by the surgery procedures during neuromonitoring, not the anesthesia conditions if they are kept stable, which influences a decrease in the number of false-positive neuromonitoring warnings. Further studies on a larger population of patients with long-lasting observation postoperatively are required to confirm the presented conclusions on the direct influences of scoliosis surgery on improvement of the motor function in patients with IS.

Growth-preserving instrumentation techniques are utilized in early-onset scoliosis (EOS) cases requiring surgical intervention. Shilla technique corrects the deformity and may reduce the need for surgical treatment with its growth-directing effect. As with other techniques, various prob-lems can be encountered following the administration of the Shilla technique. The aim of this study was to examine the effect of complications encountered with Shilla treatment on correction and growth. Sixteen patients with a follow-up period of at least 1 year who received Shilla growth guidance for EOS were included in the study. No complications occurred in 50% cases and no unplanned surgery was required. Of the remaining 8 patients with postoperative im-plant-related complications (50%), 6 (37.5%) required unplanned surgery; this consequently caused implant failure in the proximal region in 5 cases (31.25%) and deep tissue infection around the implant in 1 case (6.25%). Deformity correction, spine length, and quality-of-life scores significantly improved in EOS through Shilla growth guidance. Although implant-related com-plications were observed and related unplanned surgeries were required with Shilla growth guidance in our patients, these complications did not have a significant negative effect on correc-tion and spine growth.

Lethal congenital contracture syndrome 11 (LCCS11) is a form of arthrogryposis multiplex congenita (AMC) which is associated with mutations in the gliomedin gene (GLDN) and has been known to be severely life-shortening, mainly due to respiratory insufficiency. Patients with this condition have been predominantly treated by pediatricians as they usually do not survive beyond childhood. In this case report we present a young adult who developed severe progressive respiratory insufficiency as a teenager due to diaphragmatic hypomotility and was diagnosed with LCCS11 following the finding of compound heterozygous pathogenic variants in GLDN. This case demonstrates the importance of screening for neuromuscular diseases in well-child visits and follow-ups of patients at risk for gross and fine motor function developmental delay. It also underscores the significance of including LCCS11 and other axonopathies in the differential diagnosis of juvenile onset of respiratory insufficiency, highlights that patients with this condition may present to adult practitioners and questions whether the nomenclature of this condition with various phenotypes should be reconsidered due to the stigmatizing term ‘lethal’.

Evaluation of the patients after the surgical correction of idiopathic scoliosis in long-term follow-up with the clinical neurophysiology methods has not been presented in detail. This study aimed to compare the results of the neurophysiological studies in 45 girls with scoliosis of Lenke 1-3 types performed pre- (T0), postoperatively (T1, one week after surgery), and 6 months after the surgery (T2). Parameters of surface electromyography during the attempt of maximal contraction (mcsEMG) and transcranially evoked motor evoked potentials (MEP) recorded from anterior tibial muscles, as well as the electroneurography (ENG) of peripheral transmission in the peroneal nerve motor fibers were compared. The results indicate that efferent neural conduction function both centrally and peripherally as well as TA muscle function improve immediately after surgical correction of scoliosis (at p=0.05) and further normalization appears after six months in long-term follow-up (at p=0.03). It has been found in sEMG recordings, that the TA muscle motor unit recruitment function after half a year from surgical treatment in IS patients is comparable to the normal condition. ENG recordings results indicated the gradual retreat of the motor fibers injury symptoms mainly of the axonal type in peroneal nerves, the surgeries improved also the lumbar ventral roots’ neural transmission to the functional status considered as normal. MEP amplitude parameters recorded after the surgical scoliosis correction in T1 indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts; in long-lasting T2 observation, they reached values comparable to those recorded in healthy volunteers bilaterally. Preoperatively (T0) the results of all neurophysiological study parameters in IS patients were asymmetrical at p=0.036-0.05 and recorded as worse on the concave side, suggesting the lateralization of neurological motor deficits. One week postoperatively (T1), this asymmetry was recorded as gradually reduced, showing almost no difference between the right and left sides six months later (T2). The presented algorithm of the diagnostic proceeding pre-, early post-, and long-lasting postoperatively using mcsEMG, MEP, and ENG neurophysiological examinations can be significant not only in making the final decision regarding surgical treatment and its personalization but also helps in precise ascertaining its effects as well as in predicting the final result of IS treatment.

Proximal Junctional Kyphosis (PJK) as one of the most discussed problems after corrective surgery in adolescent idiopathic scoliosis (AIS), is still not fully clarified and seems to be multifactorial. Biome-chanical and few clinical studies have shown the influence of destruction of posterior ligaments by re-section of spinous processes and some parameters concerning rod contouring as risk factors for PJK. To verify these results 192 patients with AIS and corrective surgery via posterior approach between 2009 and 2017 were included. Radiographic parameters were analyzed preoperatively (preOP), postoperatively (postOP), and with a mean follow up (FU) of 27 months. The participants were divided into two groups (PJK group and non-PJK group). The incidence of PJK was 15.6%. Contrary to the results of biomechanical studies, we could not find any significant influence of the spinous process resection. However, the PJK group had significantly larger preOP T4-T12 kyphosis (31.1°±13.93° vs. 23.3°±14.93°, p=.016). Furthermore, the PJK group showed a significantly larger rod contour angle (RCA) (8.0°±4.44° vs. 5.9°±3.28°, p=.003) and mismatch of postOP proximal junctional angle (PJA) and RCA (3.5°±5.72° vs. 0.9°±4.86°, p=.010) compared to the non-PJK group. An increase of the mismatch of postOP PJA and RCA (OR=1.14, p=.008) and a high RCA are risk factors for PJK and need to be focused on by surgeons.

The practical problem-solving of incidental unreliability of intraoperative neuromonitoring may be the simultaneous neurophysiological recording and the inspection of the surgical field through the camera (the "Real-time neuromonitoring" concept). This would allow the immediate warning of the surgeon on the possibility of the spinal structures insult during but not after the application of the standard procedures in scoliosis surgery (the “Interactive verbal surgeon-neurophysiologist neuromonitoring" concept). This study aimed to compare the advantages, utility, reliability, and time-consuming of both intraoperative neuromonitoring scenarios using non-invasive and innovative recordings from peroneal nerves (PER) versus tibialis anterior muscles (TA) with surface electrodes of motor evoked potentials (MEP) bilaterally as a result of transcranial magnetic (TMS) or electrical (TES) stimulations. Studies were performed in two similar groups ("Real-time neuromonitoring", N=60 and "Interactive verbal sur-geon-neurophysiologist neuromonitoring", N=60) of patients treated surgically because of mainly Lenke 2 type idiopathic scoliosis (IS) pre- (T0), intra- (T1 – before surgical procedures, T2 – after surgical procedures) and postoperatively (T3) as well as in healthy volunteers (N=60, Control). The cumulative parameters of MEP amplitudes and latencies recorded from PER compared to those recorded from TA in healthy volunteers were approximately 67% (1100µV) lower at p=0.007 and 10.6% shorter (3.1 ms) at p=0.04, respectively. A similar trend was also observed in patients from both groups at each follow-up stage. MEP recordings from TA and PER in patients of both groups differed similarly in T0-T3 compared to controls at p=0.008-0.04. MEP parameters in all patients induced by TMS (T0) and TES (T1) did not differ. The parameters of MEP amplitudes recorded from TA and PER intraoperatively in T1 and T2 differed at p=0.04-0.03, indicating the bilateral improvement of neural spinal conduction due to the surgical intervention. Parameters of TMS-induced MEP amplitudes in T3 further increased bilaterally compared to the tests recorded in T0 at p=0.03-0.02. In both groups of patients, an average 51,8 BIS level of anaesthesia minimally affects the variability of the MEP amplitude, especially in PER recordings when ap-plied TES strength was at 98.2 mA. The number of MEP parameter fluctuations, mainly the amplitudes decreasing, was strictly associated with the neurophysiologist's warnings due to transpedicular screws implantation, corrective rods implantation, distraction, derotation, and compression procedures, respectively; at p=0.04-0.03 more in patients from the “Interactive S-N neuromonitoring” group. The average duration of the surgery was significantly shorter (p=0.04) by about 1 hour in the "Real-time neuromonitoring" group. The number of two-way communications between the surgeon and neurophysiologist and vice versa in the "Real-time neuromonitoring" group was reduced by approximately half at p=0.008. The study's results prove the advantages of using the "Real-time neuromonitoring" procedure in increasing safety and non-invasiveness, shortening the time, and lowering the costs of surgical treatment of patients with pathological lateral curvature of the spine. The modifications of the MEP nerve conduction recording technology with surface electrodes from nerves presented in this study enable precise and reliable information on the patient's neurological condition at every stage of applied surgical procedures, even in conditions of slight fluctuations in the anaesthesia.

Background. Pose estimation based on deep learning has been expected to be a breakthrough method to increase the accuracy of clinical photographic evaluation and to decrease interobserver errors. The purpose is to quantify pose estimation from photography of patients with adolescent idiopathic scoliosis (AIS) using open-source software packages and determine correlations between parameters obtained by radiography and photography. Methods. We included 12 consecutive patients with AIS treated with spinal correction surgery. Photographs were taken preoperatively using a tripod-mounted camera (iPhone 13Pro) on an X-ray tube head. To assess photographic parameters obtained by photography, we defined 17 points to analyze posture and define parameters. Results. In the sagittal plane, there was a significant correlation between the radiographic trunk tilt angle and the photographic sagittal trunk tilt angle of the shoulder–hip and ear–hip. In the coronal plane, there was a significant correlation between the radiographic clavicle angle and the photographic shoulder height angle, and the radiographic C7–CSVL and the photographic coronal trunk tilt angle. Conclusions. Posture analysis by photography using popular mobile devices has clinical utility for improving and promoting the screening and early detection of AIS because it is simple, without patient exposure to X-ray radiation.

The aim of this report is to evaluate the segmental rib index (RI) from T1-T12 spinal level in mild and moderate idiopathic scoliosis (IS) curves of thoracic, thoracolumbar and lumbar type by gender. The relationship of segmental RI to the frontal plane radiological deformity presented as the Cobb angle and to the posterior truncal surface deformity presented as the scoliometric readings of Angle of Trunk Rotation (ATR) in these patients is also assessed. Any statistical significant rela-tionship of these parameters would be very important for biomechanical relations of the rib cage (RC) deformity presented as the rib hump deformity (RHD) and the deformity in the spine and it would thus provide valuable information about scoliogeny. The segmental rib index (RI) is presented in 83 boys and girls with mild and moderate IS. The measurements include the scoliometric readings for truncal asymmetry (TA), the Cobb angle assessment and the segmental RI from T1-T12. The statistical package SPSS 23 was used for statistical analysis. The TA is documented and the Cobb angle is presented by gender and curve type. The segmental RI of thoracic, thoracolumbar and lumbar curves are presented for the first time. The correlations of the segmental RI to surface deformity presented as the rib hump deformity (RHD) in all IS patients and particularly in thoracic curves, to Cobb angle by gender and age and the comparison of the segmental RI index of asymmetric but not scoliotic children to the scoliotic peers by curve (in thoracic, thoracolumbar, lumbar curves) in boys and girls are presented. The findings emphasize the significant protagonistic role of the thoracic asymmetry in relation to the spinal deformity mainly in girls for the thoracic and in boys for the thoracolumbar curves. The cut-off point of age of the examined scoliotics is 14 years, that is when the RI shows stronger correlation with the spinal deformity, namely when the thoracic deformity is decisively effective to the developing thoracic spinal deformity, in terms of Cobb angle. In summary, the results of this study provide aetiological implications for IS, as far as the role of thorax is con-cerned.