{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:35:09Z","timestamp":1791340509336,"version":"4.3.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Wyss-Campbell Center for Thoracic Insufficiency Syndrome"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>While the C-EOS system helps organize and classify Early Onset Scoliosis (EOS) pathology, it is not data-driven and does not help achieve consensus for surgical treatment. The current study aims to create an automated method to cluster EOS patients based on pre-operative clinical indices.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 1114 EOS patients were used for the study, with the following distribution by etiology: congenital (240), idiopathic (217), neuromuscular (417), syndromic (240). Pre-operative clinical indices used for clustering were age, major curve (Cobb) angle, kyphosis, number of levels involved in a major curve (Cobb angle) and kyphosis along with deformity index (defined as the ratio of major Cobb angle and kyphosis). Fuzzy C-means clustering was performed for each etiology individually, with one-way ANOVA performed to assess statistical significance (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The automated clustering method resulted in three clusters per etiology as the optimal number based on the highest average membership values. Statistical analyses showed that the clusters were significantly different for all the clinical indices within and between etiologies.\u00a0Link to the ACT-EOS web application: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/biomed.drexel.edu\/labs\/obl\/toolkits\/act-eos-application\">https:\/\/biomed.drexel.edu\/labs\/obl\/toolkits\/act-eos-application<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>An automated method to cluster EOS patients based on pre-operative clinical indices was developed identifying three unique, data-driven subgroups for each C-EOS etiology category. Adoption of such an automated clustering framework can help improve the standardization of clinical decision-making for EOS.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s43390-022-00634-1","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T11:02:36Z","timestamp":1674730956000},"page":"723-731","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Automated Clustering Technique (ACT) for Early Onset Scoliosis: A preliminary report"],"prefix":"10.1007","volume":"11","author":[{"given":"Girish","family":"Viraraghavan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Cahill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Vitale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan A.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Pediatric Spine Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7886-6184","authenticated-orcid":false,"given":"Sriram","family":"Balasubramanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,1,26]]},"reference":[{"issue":"3","key":"634_CR1","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1097\/BPO.0000000000000073","volume":"34","author":"D Skaggs","year":"2014","unstructured":"Skaggs D, Akbarnia B, Flynn J et al (2014) Chest wall and spine deformity study group; growing spine study group; pediatric orthopaedic society of North America; scoliosis research society growing spine study committee. A classification of growth friendly spine implants. J Pediatr Orthop 34(3):260\u2013274","journal-title":"J Pediatr Orthop"},{"issue":"2","key":"634_CR2","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.jspd.2015.01.003","volume":"3","author":"R El-Hawary","year":"2015","unstructured":"El-Hawary R, Akbarnia BA (2015) Early onset scoliosis - time for consensus. Spine Deform 3(2):105\u2013106","journal-title":"Spine Deform"},{"issue":"5","key":"634_CR3","doi-asserted-by":"publisher","first-page":"974","DOI":"10.2106\/00004623-197355050-00006","volume":"55","author":"EJ Riseborough","year":"1973","unstructured":"Riseborough EJ, Wynne-Davies R (1973) A genetic survey of idiopathic scoliosis in Boston, Massachusetts. JBJS 55(5):974\u2013982","journal-title":"JBJS"},{"issue":"1","key":"634_CR4","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-0709","volume":"137","author":"S Yang","year":"2016","unstructured":"Yang S, Andras LM, Redding GJ et al (2016) Early-onset scoliosis: a review of history, current treatment, and future directions. Pediatrics 137(1):e20150709","journal-title":"Pediatrics"},{"key":"634_CR5","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-540-85207-0","volume-title":"The growing spine: management of spinal disorders in young children","author":"BA Akbarnia","year":"2010","unstructured":"Akbarnia BA, Yazici M, Thompson GH (2010) The growing spine: management of spinal disorders in young children. Springer, Berlin, Heidelberg. https:\/\/doi.org\/10.1007\/978-3-540-85207-0"},{"issue":"3","key":"634_CR6","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1097\/BPO.0000000000000073","volume":"34","author":"DL Skaggs","year":"2014","unstructured":"Skaggs DL, Akbarnia BA, Flynn JM et al (2014) A classification of growth friendly spine implants. J Pediatr Orthop 34(3):260\u2013274","journal-title":"J Pediatr Orthop"},{"issue":"3","key":"634_CR7","doi-asserted-by":"publisher","first-page":"399","DOI":"10.2106\/00004623-200303000-00001","volume":"85","author":"RM Campbell Jr","year":"2003","unstructured":"Campbell RM Jr, Smith MD, Mayes TC et al (2003) The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. JBJS 85(3):399\u2013408","journal-title":"JBJS"},{"issue":"16","key":"634_CR8","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.2106\/JBJS.M.00253","volume":"96","author":"BA Williams","year":"2014","unstructured":"Williams BA, Matsumoto H, McCalla DJ et al (2014) Development and initial validation of the classification of early-onset scoliosis (C-EOS). J Bone Joint Surg Am 96(16):1359\u20131367","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"634_CR9","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s43390-019-00006-2","volume":"8","author":"C Dragsted","year":"2020","unstructured":"Dragsted C, Ohrt-Nissen S, Hallager DW et al (2020) Reproducibility of the classification of early onset scoliosis (C-EOS). Spine Deform 8(2):285\u2013293","journal-title":"Spine Deform"},{"issue":"10","key":"634_CR10","doi-asserted-by":"publisher","first-page":"e737","DOI":"10.1097\/BPO.0000000000001337","volume":"39","author":"C Russo","year":"2019","unstructured":"Russo C, Trupia E, Campbell M et al (2019) The association between the classification of early-onset scoliosis and smith complications after initiation of growth-friendly spine surgery: a preliminary study. J Pediatr Orthop 39(10):e737\u2013e741","journal-title":"J Pediatr Orthop"},{"issue":"8","key":"634_CR11","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.2106\/00004623-200108000-00006","volume":"83","author":"LG Lenke","year":"2001","unstructured":"Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. JBJS 83(8):1169\u20131181","journal-title":"JBJS"},{"issue":"4","key":"634_CR12","doi-asserted-by":"publisher","first-page":"290","DOI":"10.5435\/00124635-200207000-00007","volume":"10","author":"DS Garbuz","year":"2002","unstructured":"Garbuz DS, Masri BA, Esdaile J et al (2002) Classification systems in orthopaedics. JAAOS - J Am Acad Orthop Surg 10(4):290\u2013297","journal-title":"JAAOS - J Am Acad Orthop Surg"},{"issue":"5","key":"634_CR13","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1007\/s11999-010-1540-0","volume":"469","author":"MG Vitale","year":"2011","unstructured":"Vitale MG, Gomez JA, Matsumoto H et al (2011) Variability of expert opinion in treatment of early-onset scoliosis. Clin Orthop Relat Res 469(5):1317\u20131322","journal-title":"Clin Orthop Relat Res"},{"issue":"10","key":"634_CR14","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00805","volume":"95","author":"J Corona","year":"2013","unstructured":"Corona J, Miller DJ, Downs J et al (2013) Evaluating the extent of clinical uncertainty among treatment options for patients with early-onset scoliosis. JBJS 95(10):e67","journal-title":"JBJS"},{"issue":"7","key":"634_CR15","doi-asserted-by":"publisher","first-page":"e621","DOI":"10.1097\/BPO.0000000000001473","volume":"40","author":"MS Hughes","year":"2020","unstructured":"Hughes MS, Swarup I, Makarewich CA et al (2020) Expert consensus for early onset scoliosis surgery. J Pediatr Orthop 40(7):e621\u2013e628","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"634_CR16","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1097\/BPO.0b013e318279c501","volume":"33","author":"BA Williams","year":"2013","unstructured":"Williams BA, Asghar J, Matsumoto H et al (2013) More experienced surgeons less likely to fuse: a focus group review of 315 hypothetical EOS cases. J Pediatr Orthop 33(1):68\u201374","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"634_CR17","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/BRS.0b013e3181877bbb","volume":"34","author":"AP Sangole","year":"2009","unstructured":"Sangole AP, Aubin C-E, Labelle H et al (2009) Three-dimensional classification of thoracic scoliotic curves. Spine 34(1):91\u201399","journal-title":"Spine"},{"issue":"6","key":"634_CR18","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1097\/BRS.0b013e318190b914","volume":"34","author":"IA Stokes","year":"2009","unstructured":"Stokes IA, Sangole AP, Aubin C-E (2009) Classification of scoliosis deformity 3-D spinal shape by cluster analysis. Spine 34(6):584","journal-title":"Spine"},{"issue":"1","key":"634_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12984-015-0083-8","volume":"12","author":"S Donzelli","year":"2015","unstructured":"Donzelli S, Poma S, Balzarini L et al (2015) State of the art of current 3-D scoliosis classifications: a systematic review from a clinical perspective. J Neuroeng Rehabil 12(1):1\u201311","journal-title":"J Neuroeng Rehabil"},{"issue":"10","key":"634_CR20","doi-asserted-by":"publisher","first-page":"3104","DOI":"10.1007\/s00586-016-4426-3","volume":"25","author":"W Thong","year":"2016","unstructured":"Thong W, Parent S, Wu J et al (2016) Three-dimensional morphology study of surgical adolescent idiopathic scoliosis patient from encoded geometric models. Eur Spine J 25(10):3104\u20133113","journal-title":"Eur Spine J"},{"issue":"1","key":"634_CR21","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1007\/s00586-011-2004-2","volume":"21","author":"S Kadoury","year":"2012","unstructured":"Kadoury S, Labelle H (2012) Classification of three-dimensional thoracic deformities in adolescent idiopathic scoliosis from a multivariate analysis. Eur Spine J 21(1):40\u201349","journal-title":"Eur Spine J"},{"key":"634_CR22","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4757-0450-1","volume-title":"Pattern recognition with fuzzy objective function algorithms","author":"J Bezdek","year":"1981","unstructured":"Bezdek J (1981) Pattern recognition with fuzzy objective function algorithms. Plenum, New York"},{"issue":"3","key":"634_CR23","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s43390-020-00051-2","volume":"8","author":"J Shen","year":"2020","unstructured":"Shen J, Parent S, Wu J et al (2020) Towards a new 3D classification for adolescent idiopathic scoliosis. Spine Deform 8(3):387\u2013396","journal-title":"Spine Deform"},{"key":"634_CR24","unstructured":"Ball GH (1965) Isodata-An iterative method of multivariate analysis and pattern classification. Proc IFIPS Congr"}],"container-title":["Spine Deformity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-022-00634-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43390-022-00634-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-022-00634-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T17:43:54Z","timestamp":1682703834000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43390-022-00634-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,26]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["634"],"URL":"https:\/\/doi.org\/10.1007\/s43390-022-00634-1","relation":{},"ISSN":["2212-134X","2212-1358"],"issn-type":[{"value":"2212-134X","type":"print"},{"value":"2212-1358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,26]]},"assertion":[{"value":"25 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 December 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 January 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was given Ethical Approval by the Institutional Review Board\u00a0prior to the conduct of this study.\u00a0Informed consent and\/or a waiver of consent was obtained.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}