Association between incorrect postures and curve magnitude of adolescent idiopathic scoliosis in china

Abstract Background Despite advancements in school scoliosis screening (SSS), there are still no effective indicators to estimate the severity of spinal curvature. We aim to investigate the association between incorrect postures and curve magnitude of adolescent idiopathic scoliosis (AIS) among Chinese adolescents. Methods In this SSS program, we examined the incorrect posture, Adam’s forward bending test (FBT) results, and angle of trunk rotation (ATR) in adolescents. Those with suspected scoliosis were referred for a standing anteroposterior whole-spine radiography as outpatients. The radiographic data of 426 students with lateral Cobb angles were collected from 2016 to 2022 and the associations were studied using logistic regression (LR) models and receiver operating characteristic (ROC) curves. Results Univariate LR revealed that female gender odds ratio (OR) = 2.92, 95% confidence interval (CI) 1.67–5.09, P < 0.001, age 16–19y (OR = 2.83, 95%CI 1.10–7.28, P = 0.031), right shoulder height (OR = 2.15, 95%CI 1.23–3.75, P = 0.007), right scapula tilt (OR = 2.03, 95%CI 1.18–3.50, P = 0.010), right rib hump (OR = 1.88, 95%CI 1.23–2.85, P = 0.003), right thoracic rotation ≥ 5° (OR = 2.14, 95%CI 1.43–3.20, P < 0.001), and left thoracolumbar kyphosis (OR = 3.79, 95%CI 1.06–13.56, P = 0.041) were all significantly associated with the severity of the curve magnitude. Multivariate LR showed that female gender adjusted OR (AOR) = 3.23, 95%CI 1.81–5.73, P < 0.001, those aged 16–19y (AOR = 5.08, 95%CI 1.86–13.91, P = 0.002), and with a right rib hump (AOR = 1.72, 95%CI 1.11–2.64, P = 0.015) presented with a higher risk of severe curve magnitude than men, those aged 7–12y, and without a rib hump, respectively. ROC curves further proved that sex, age, shoulder-height difference, scapula tilt, flat back, rib hump, angle of thoracic rotation were the risk predictors for curve magnitude. Conclusion Incorrect posture and ATR, especially the right rib hump, were significantly associated with the curve magnitude of AIS. Early screening for incorrect postures and ATR could be an effective and economical strategy to predict the severity of AIS through SSS in Chinese adolescents.