Open research questions in Scoliosis diagnosis and treatment

What the literature leaves open

• Evaluating model performance relative to established minimal clinically important differences (MCIDs) for all domains, - Investigating the clinical utility of MLMs in predicting HRQoL outcomes for AIS patients, - Developing MLMs that incorporate additional preoperative and intraoperative variables

  Using artificial intelligence to predict health-related quality of life for adolescent idiopathic scoliosis · 2026 · DOI

• long-term follow-up to assess curve stability and surgical conversion rates, - comparison of bracing with surgical correction in severe AIS, - investigation of factors influencing treatment outcomes

  Outcomes of high-compliance bracing in patients with severe adolescent idiopathic scoliosis declining operative intervention · 2026 · DOI

• The effectiveness of bracing for severe adolescent idiopathic scoliosis remains uncertain. There is a lack of evidence-based guidance for conservative management in patients with severe AIS who refuse surgery. The study aims to address this gap by evaluating the outcomes of high-compliance bracing.

  Outcomes of high-compliance bracing in patients with severe adolescent idiopathic scoliosis declining operative intervention · 2026 · DOI

• Inter-institutional color disparities and domain shifts. Shortcut learning associated with superficial color profiles. The need for domain-invariant feature representations to improve model robustness.

  Overcoming color domain shift in endoscopic spine surgery: robust instrument segmentation via aggressive photometric augmentation · 2026 · DOI

• Investigating the impact of other types of domain shifts on instrument segmentation, - Exploring the application of aggressive photometric augmentation to other medical imaging tasks, - Developing more robust and generalizable models for instrument segmentation in ESS

  Overcoming color domain shift in endoscopic spine surgery: robust instrument segmentation via aggressive photometric augmentation · 2026 · DOI

• One challenge is the limitation of posterior spinal fusion, including limited mobility and growth. Another challenge is the potential for postoperative complications, such as pseudoarthrosis and adjacent segment disease. The study also notes the challenge of comparing two-row vertebral body tethering to posterior spinal fusion.

  Sagittal alignment outcomes following two-row vertebral body tethering versus posterior spinal fusion in adolescent idiopathic scoliosis: a multicenter two-year study · 2026 · DOI

• School-based screening programs for adolescent idiopathic scoliosis (AIS) have been widely implemented as part of preventive health strategies; however, their effectiveness remains controversial in the literature due to concerns regarding low diagnostic accuracy, overdiagnosis, and unnecessary imaging.

  Diagnostic performance of school-based scoliometric screening for adolescent idiopathic scoliosis: a real-world retrospective study from a Turkish population · 2026 · DOI

• The molecular and genetic evidence is rarely ADS-specific, - Mechanosensitive pathways are drawn predominantly from studies of symmetric intervertebral disc degeneration or adolescent idiopathic scoliosis, - Extrapolating findings across diverse phenotypes remains an unproven assumption

  Pathogenic mechanisms of adult degenerative scoliosis · 2026 · DOI

• Further validation is needed to confirm the Three-Axis Reciprocal Coupling Pathogenic Model, - Research on the asymmetric degeneration of intervertebral discs, endplates, facet joints, and paraspinal muscles is needed

  Pathogenic mechanisms of adult degenerative scoliosis · 2026 · DOI

• The study was not designed as a formal equivalence trial, - The study did not demonstrate equivalence between the two devices, - The study had a limited sample size of 11,587 students

  Application of the electronic scoliometer in school-based scoliosis screening among elementary school students and analysis of factors associated with suspected scoliosis · 2026 · DOI

• The lack of data on scoliosis screening in elementary school students aged 6-12 years. The need for a comparison of the electronic scoliometer and manual scoliometer in a school-based setting.

  Application of the electronic scoliometer in school-based scoliosis screening among elementary school students and analysis of factors associated with suspected scoliosis · 2026 · DOI

• Future research should explore longer-term outcomes, particularly with respect to complications such as tether breakage and overcorrection, which often mani- fest after the 2-year mark.

  Sagittal alignment outcomes following two-row vertebral body tethering versus posterior spinal fusion in adolescent idiopathic scoliosis: a multicenter two-year study · 2026 · DOI

• further studies are needed to refine screening thresholds and improve diagnostic efficiency, - research on the effectiveness of school-based screening programs for adolescent idiopathic scoliosis is needed, - studies on the cost-effectiveness of scoliometric screening are required

  Diagnostic performance of school-based scoliometric screening for adolescent idiopathic scoliosis: a real-world retrospective study from a Turkish population · 2026 · DOI

• PURPOSE: Sagittal plane changes after isolated lumbar fusion for pediatric idiopathic scoliosis are under-reported in current literature.

  Thoracic compensation after pediatric lumbar spinal fusion: adaptations in the sagittal plane · 2026 · DOI

• Despite advances, the cellular and molecular mechanisms driving AIS remain poorly understood.

  Current insights into circulating biomarkers and their potential for predicting adolescent idiopathic scoliosis progression · 2026 · DOI

• The evidence was insufficient to determine additional effects on the quality of life, pain, respiratory function, posture, chest-wall or rib-cage mobility, pelvic alignment, balance, gait, long-term progression, surgery, adherence, harm, or treatment burden.

  Schroth exercises added to bracing for adolescent idiopathic scoliosis: a systematic review and meta-analysis · 2026 · DOI

• Schroth exercises are often adjunctively prescribed; however, their incremental value over bracing alone remains uncertain.

  Schroth exercises added to bracing for adolescent idiopathic scoliosis: a systematic review and meta-analysis · 2026 · DOI

• BACKGROUND Overcorrection of lumbar lordosis (LL) during deformity surgery can create iatrogenic hyperlordosis with negative sagittal balance, a rare but disabling complication with no standard treatment.

  Reverse pedicle subtraction osteotomy for iatrogenic hyperlordosis in a scoliosis patient: illustrative case · 2026 · DOI

• Further investigation into this multimodal non-surgical approach for children, parents, and healthcare providers and policymakers seeking an alternative to surgical intervention for AIS is warranted.

  A Non-Surgical Multimodal Approach to Severe Thoracic Adolescent Idiopathic Scoliosis Combining ScoliBrace and Scoliosis-Specific Rehabilitation Therapies: A Case Series · 2025 · DOI

• Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period.

  Telerehabilitation After Surgery in Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial · 2025 · DOI

• While previous studies have examined balance impairments in scoliosis, the extent to which proprioception errors contribute to postural instability remains unclear.

  Proprioceptive deficits and postural instability in adolescent idiopathic scoliosis: a comparative study of balance control and key predictors · 2025 · DOI

• Purpose: Adolescent Idiopathic Scoliosis (AIS) is a complex three-dimensional spinal deformity, and its etiology and progression mechanisms have not been fully elucidated.

  From a biomechanical perspective: pathogenesis, clinical manifestations and treatment strategies of adolescent idiopathic scoliosis · 2025 · DOI

• The examination of spinal and lower limb deficiencies in this age group represents a highly relevant and underexplored topic.

  Postural deficiencies prevalence and correlation with foot conditions, body composition, and coordination, in Romanian preadolescents children: descriptive observational study · 2025 · DOI

• Future research should focus on longitudinal studies to further validate these findings.

  The role of pelvic coronal parameters in determining sagittal balance: a prospective radiographic analysis of pelvic spinopelvic alignment in Chinese asymptomatic Han adolescents · 2025 · DOI

• While bracing and exercise therapies are standard conservative treatments, limited research has examined the feasibility of fully online, home-based combined exercise programs and the clinical trends observed during participation -especially in adolescents undergoing brace treatment.

  Feasibility and age-related trends of a home-based online exercise program in adolescents with idiopathic scoliosis · 2025 · DOI

Most-cited papers in Scoliosis diagnosis and treatment

• Adolescent idiopathic scoliosis · The Lancet · 2008 · 1,325 citations
• Accuracy of clear aligners: A retrospective study of patients who needed refinement · American Journal of Orthodontics and Dentofacial Orthopedics · 2018 · 211 citations
• Effect of spinal irradiation on growth. · Archives of Disease in Childhood · 1987 · 168 citations
• Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis · Injury · 2010 · 139 citations
• Use of Lactobacillus helveticus BGRA43 for manufacturing fermented milk products. · Food Technology and Biotechnology · 2013 · 131 citations
• Spine loading during asymmetric lifting using one versus two hands · Ergonomics · 1998 · 118 citations
• Prevalence and Risk Factors of Poor Posture in School Children in the Czech Republic · Journal of School Health · 2007 · 88 citations
• Idiopathic Scoliosis · Deutsches Ärzteblatt international · 2010 · 83 citations
• Scoliosis in Spinal Muscular Atrophy: Review of 63 Cases · Journal of Child Neurology · 1989 · 75 citations
• Reliability of Thoracic Spine Rotation Range-of-Motion Measurements in Healthy Adults · Journal of Athletic Training · 2012 · 70 citations

Most recent work

• Current insights into circulating biomarkers and their potential for predicting adolescent idiopathic scoliosis progression · Frontiers in Cell and Developmental Biology · 2026
• Feasibility of Minimally Invasive Scoliosis Surgery in Adolescent Idiopathic Scoliosis Exceeding 80° of Curve Magnitude · Neurospine · 2026
• Guidance for the referral of children and young people for consideration of neurosurgical interventions in the management of posture and tone (NIMPTs): a UK-wide consensus report · Archives of Disease in Childhood · 2026
• Patient-perceived recovery after posterior spinal fusion: evaluating minimum clinically important difference (MCID) in adolescents with idiopathic scoliosis · Spine Deformity · 2026
• Comment on “Sagittal misalignment patterns and pathomechanical hypothesis of adolescent idiopathic scoliosis: a radiographic analysis” · Spine Deformity · 2026
• Using artificial intelligence to predict health-related quality of life for adolescent idiopathic scoliosis · European Spine Journal · 2026
• Latent profile analysis of multidimensional muscle profiles versus traditional sarcopenia metrics for capturing sagittal malalignment in adult spinal deformity: a retrospective study · Asian Spine Journal · 2026
• School-based screening for scoliosis and foot biomechanical abnormalities: a study of prevalence, plantar pressure, and gait among adolescents in Haidian District, Beijing · Frontiers in Pediatrics · 2026
• Artificial intelligence for scoliosis surgical planning and postoperative prediction · npj Digital Medicine · 2026
• Deep learning-based precision phenotyping of spine curvature identifies novel genetic risk loci for scoliosis in the UK Biobank · npj Digital Medicine · 2026

Related topics in Medicine