Huang Zifang, Xiaohong Wang, Zheng Lingling, Liu Fuyun, Hu Weiming, Yang Dongling, Qi Wenjuan, Xuan Xiaoling, Fei Zhijun, Yang Jingfan, Yang Junlin
Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Xinmiao Scoliosis Prevention Center, Guangzhou, Guangdong, China.
Spine (Phila Pa 1976). 2025 Sep 15. doi: 10.1097/BRS.0000000000005501.
Diagnostic accuracy study.
To evaluate the diagnostic performance of a combined screening method for adolescent idiopathic scoliosis (AIS), integrating scoliometer-based Angle of Trunk Rotation (ATR) measurement with physical examination findings, and to determine optimal screening thresholds.
The scoliometer and Adam's Forward Bending Test (FBT) are widely used in AIS screening, but the optimal ATR cutoff and the additive value of clinical signs remain debated. Accurate and efficient school-based screening is essential for early detection and timely intervention.
This study included 595 participants (458 with AIS and 137 without scoliosis). Screening involved visual inspection, Adam's Forward Bending Test (FBT), and Angle of Trunk Rotation (ATR) measurement. Diagnostic confirmation was performed using standing whole spine X-ray or spine ultrasound. Receiver operating characteristic (ROC) analysis and logistic regression were used to identify the best predictive combination of ATR thresholds and clinical signs.
Among the 595 participants, the mean Cobb angle was 21.0˚±8.1˚ for AIS patients and 4.0˚±4.0˚ for non-AIS individuals. An ATR cutoff of 5.5° yielded an AUC of 0.72, with a sensitivity of 73.1% and specificity of 70.8%. Combining ATR ≥5.5° with at least three clinical signs (head tilt, shoulder unlevel, waistline asymmetry, pelvic prominence) improved sensitivity to 84.1% (AUC=0.694). For clinical implementation, a simplified threshold of 5° with at least three clinical signs further increased sensitivity to 91.5%, with acceptable specificity (47.4%). Among patients with Cobb angles ≥20°, 10.3% had an ATR <6°, emphasizing the role of clinical signs in identifying severe cases. In sex-specific analyses, girls showed higher sensitivity (89.7%) at an ATR cutoff of 4.5°, compared to boy who had a cutoff of 5.5°, while boys exhibited sensitivity improved when clinical signs were added. A unified threshold of ATR ≥6° combined with four or more clinical signs achieved sensitivity above 90% for both sexes in detecting severe scoliosis, supporting its practical value for school-based screening.
Combining ATR with clinical signs substantially enhances AIS screening performance. A practical strategy of ATR ≥5° plus three clinical signs offers balanced sensitivity and specificity for general screening. For detecting severe scoliosis, ATR ≥6° plus four clinical signs is recommended. This structured protocol supports more accurate, sex- and severity-adapted school-based AIS screening.
诊断准确性研究。
评估一种青少年特发性脊柱侧凸（AIS）联合筛查方法的诊断性能，该方法将基于脊柱侧凸测量仪的躯干旋转角度（ATR）测量与体格检查结果相结合，并确定最佳筛查阈值。
脊柱侧凸测量仪和亚当前屈试验（FBT）广泛应用于AIS筛查，但最佳ATR临界值和临床体征的附加价值仍存在争议。准确有效的校内筛查对于早期发现和及时干预至关重要。
本研究纳入595名参与者（458例AIS患者和137例无脊柱侧凸者）。筛查包括视诊、亚当前屈试验（FBT）和躯干旋转角度（ATR）测量。使用站立位全脊柱X线或脊柱超声进行诊断确认。采用受试者操作特征（ROC）分析和逻辑回归来确定ATR阈值和临床体征的最佳预测组合。
在595名参与者中，AIS患者的平均Cobb角为21.0˚±8.1˚，非AIS个体为4.0˚±4.0˚。ATR临界值为5.5°时，曲线下面积（AUC）为0.72，灵敏度为73.1%，特异度为70.8%。将ATR≥5.5°与至少三个临床体征（头部倾斜、肩部不平、腰线不对称、骨盆突出）相结合，可将灵敏度提高到84.1%（AUC=0.694）。对于临床应用，简化为ATR≥5°且至少有三个临床体征可进一步将灵敏度提高到91.5%，特异度可接受（47.4%）。在Cobb角≥20°的患者中，10.3%的患者ATR<6°，强调了临床体征在识别严重病例中的作用。在按性别分析中，女孩在ATR临界值为4.5°时显示出较高的灵敏度（89.7%），而男孩的临界值为5.5°，当加入临床体征时男孩的灵敏度有所提高。ATR≥6°与四个或更多临床体征的统一临界值在检测严重脊柱侧凸时，男女灵敏度均高于90%，支持其在校内筛查中的实用价值。
将ATR与临床体征相结合可显著提高AIS筛查性能。ATR≥5°加三个临床体征的实用策略在一般筛查中提供了平衡的灵敏度和特异度。对于检测严重脊柱侧凸，建议采用ATR≥6°加四个临床体征。这种结构化方案支持更准确、根据性别和严重程度调整的校内AIS筛查。
