{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:40:27Z","timestamp":1792777227874,"version":"4.5.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The contribution of sagittal spinal alignment to sensorimotor function in adolescent idiopathic scoliosis (AIS) remains unclear. We examined whether thoracic kyphosis (TK) is associated with sensory integration and postural balance in patients with AIS, independent of coronal structural misalignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Forty-five AIS patients (Cobb angle\u2009\u2265\u200910\u00b0) were consecutively recruited from the outpatient rehabilitation clinic of a university-affiliated hospital (median age 11.0 years, IQR 10.0\u201313.0; 33 female). There was no selection criterion related to kyphosis. All participants were newly screened and had not yet initiated scoliosis-specific exercise, physiotherapy, or brace treatment. Participants completed the Sensory Organization Test (SOT) and full-spine radiography. Five sensory ratios and four postural control indices were derived from SOT condition-level equilibrium scores (ES). The C4\/C1 ratio reflects the ability to maintain postural stability when somatosensory input is disrupted by a sway-referenced support surface (C4) relative to a fixed surface (C1). Associations were examined with Spearman and partial Spearman correlations (adjusting for Cobb angle, age, and BMI) and tertile comparisons with false discovery rate (FDR) correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Forty-two patients had complete data for primary analyses (median Cobb angle 15.3\u00b0, IQR 11.2\u00b0\u201320.0\u00b0). Greater TK was associated with a higher C4\/C1 ratio (Spearman \u03c1\u2009=\u20090.416, p\u2009=\u20090.006), and this association remained significant after adjustment for Cobb angle, age, and BMI (partial Spearman \u03c1\u2009=\u20090.475, p\u2009=\u20090.002). Cobb angle was not associated with any sensory ratio (all p\u2009&gt;\u20090.1) but was positively associated with firm-surface equilibrium scores (C1: \u03c1\u2009=\u20090.525, p\u2009&lt;\u20090.001). The C4\/C1 ratio increased monotonically across TK tertiles (Low 0.701\u2009\u2192\u2009Mid 0.832\u2009\u2192\u2009High 0.861; Kruskal-Wallis H\u2009=\u20098.58, p\u2009=\u20090.014) and was associated with better postural control across all domains (composite ES: \u03c1\u2009=\u20090.453; variability: \u03c1\u2009= \u22120.410; adaptation: \u03c1\u2009=\u20090.433; all p\u2009&lt;\u20090.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>TK and Cobb angle showed differential associations with postural control: TK was associated with the C4\/C1 ratio, whereas Cobb angle was associated with firm-surface stability. The C4\/C1 ratio statistically carried the association between TK and postural control via an indirect-only pathway. These findings suggest that sagittal and coronal spinal parameters are differentially associated with postural control, which may inform future research on phenotype-specific assessment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0361226","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:21:45Z","timestamp":1792776105000},"page":"e0361226","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thoracic kyphosis is associated with somatosensory dependence and postural control in adolescent idiopathic scoliosis"],"prefix":"10.1371","volume":"21","author":[{"given":"Wenjun","family":"Jiang","sequence":"first","affiliation":[{"name":"Suzhou Vocational Health College","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningnan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Suzhou Research Center of Medical School, Suzhou Hospital","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Suzhou Research Center of Medical School, Suzhou Hospital","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Suzhou Research Center of Medical School, Suzhou Hospital","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3088-4308","authenticated-orcid":true,"given":"Sheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Suzhou Research Center of Medical School, Suzhou Hospital","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueliang","family":"Wu","sequence":"additional","affiliation":[{"name":"Suzhou Research Center of Medical School, Suzhou Hospital","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"issue":"8","key":"pone.0361226.ref001","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1302\/0301-620X.104B8.BJJ-2021-1638.R1","article-title":"Adolescent idiopathic scoliosis","author":"S Marya","year":"2022","journal-title":"The Bone & Joint Journal"},{"issue":"12","key":"pone.0361226.ref002","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1097\/BRS.0b013e318059321d","article-title":"Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis: how do these two curve types differ?","volume":"32","author":"VV Upasani","year":"2007","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"pone.0361226.ref003","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s00221-005-0246-0","article-title":"Sensory deprivation and balance control in idiopathic scoliosis adolescent","volume":"170","author":"M Simoneau","year":"2006","journal-title":"Exp Brain Res"},{"issue":"3","key":"pone.0361226.ref004","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1152\/jn.2002.88.3.1097","article-title":"Sensorimotor integration in human postural control","volume":"88","author":"RJ Peterka","year":"2002","journal-title":"J Neurophysiol"},{"key":"pone.0361226.ref005","doi-asserted-by":"crossref","first-page":"1054346","DOI":"10.3389\/fneur.2022.1054346","article-title":"Evolution of postural control assessment: From dynamic posturography to virtual reality","volume":"13","author":"EA Keshner","year":"2023","journal-title":"Front Neurol"},{"issue":"2","key":"pone.0361226.ref006","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/S0733-8619(18)30359-1","article-title":"Dynamic posturography in the diagnosis and management of dizziness and balance disorders","volume":"8","author":"LM Nashner","year":"1990","journal-title":"Neurol Clin"},{"issue":"2","key":"pone.0361226.ref007","doi-asserted-by":"crossref","DOI":"10.1097\/BPO.0000000000002300","article-title":"Is the Integration Problem in the Sensoriomotor System the Cause of Adolescent Idiopathic Scoliosis?","volume":"43","author":"A Payas","year":"2023","journal-title":"J Pediatr Orthop"},{"issue":"5","key":"pone.0361226.ref008","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1523\/JNEUROSCI.02-05-00536.1982","article-title":"Adaptation to altered support and visual conditions during stance: patients with vestibular deficits","volume":"2","author":"LM Nashner","year":"1982","journal-title":"J Neurosci"},{"issue":"7","key":"pone.0361226.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0070205","article-title":"Pelvic morphology, body posture and standing balance characteristics of adolescent able-bodied and idiopathic scoliosis girls","volume":"8","author":"GA Stylianides","year":"2013","journal-title":"PLoS One"},{"key":"pone.0361226.ref010","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.clinbiomech.2017.11.011","article-title":"Are we simplifying balance evaluation in adolescent idiopathic scoliosis?","volume":"51","author":"S Pasha","year":"2018","journal-title":"Clin Biomech (Bristol)"},{"key":"pone.0361226.ref011","article-title":"The postural stability control and gait pattern of idiopathic scoliosis adolescents","volume":"13","author":"P-Q Chen","year":"1998","journal-title":"Clin Biomech (Bristol)"},{"key":"pone.0361226.ref012","doi-asserted-by":"crossref","first-page":"979816","DOI":"10.3389\/fped.2022.979816","article-title":"Trunk balance, head posture and plantar pressure in adolescent idiopathic scoliosis","volume":"10","author":"J-X Wen","year":"2022","journal-title":"Front Pediatr"},{"issue":"1","key":"pone.0361226.ref013","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00586-010-1554-z","article-title":"Horizontal body and trunk center of mass offset and standing balance in scoliotic girls","volume":"20","author":"G Dalleau","year":"2011","journal-title":"Eur Spine J"},{"issue":"2","key":"pone.0361226.ref014","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/BPO.0b013e3181651bdc","article-title":"Postural characteristics of adolescents with idiopathic scoliosis","volume":"28","author":"KF Zabjek","year":"2008","journal-title":"J Pediatr Orthop"},{"key":"pone.0361226.ref015","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13013-017-0145-8","article-title":"2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth","volume":"13","author":"S Negrini","year":"2018","journal-title":"Scoliosis Spinal Disord"},{"issue":"13","key":"pone.0361226.ref016","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1097\/01.BRS.0000067118.60199.D1","article-title":"Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type","volume":"28","author":"J-M Mac-Thiong","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"issue":"12","key":"pone.0361226.ref017","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0b013e3182444402","article-title":"Comparison of sagittal spinopelvic alignment in Chinese adolescents with and without idiopathic thoracic scoliosis","volume":"37","author":"Q Yong","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"pone.0361226.ref018","volume-title":"Revised Glossary of Terms","author":"Scoliosis Research Society, SRS Terminology Committee and Working Group on Spinal Classification","year":"2000"},{"issue":"39","key":"pone.0361226.ref019","first-page":"3647","article-title":"Qingshaonian tefasing jizhu cewan kangfu zhenliao zhinan (2024 ban) [Rehabilitation diagnosis and treatment guideline for adolescent idiopathic scoliosis (2024 edition)]","volume":"104","author":"Chinese Society of Physical Medicine and Rehabilitation, Chinese Medical Association","year":"2024","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"pone.0361226.ref020","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/1748-7161-9-7","article-title":"In favour of the definition \u201cadolescents with idiopathic scoliosis\u201d: juvenile and adolescent idiopathic scoliosis braced after ten years of age, do not show different end results. SOSORT award winner 2014","volume":"9","author":"S Donzelli","year":"2014","journal-title":"Scoliosis"},{"issue":"6","key":"pone.0361226.ref021","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1093\/ptj\/73.6.346","article-title":"A study of the clinical test of sensory interaction and balance","volume":"73","author":"H Cohen","year":"1993","journal-title":"Phys Ther"},{"key":"pone.0361226.ref022","volume-title":"Practical Nonparametric Statistics","author":"WJ Conover","year":"1999","edition":"3"},{"issue":"6","key":"pone.0361226.ref023","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations","volume":"51","author":"RM Baron","year":"1986","journal-title":"J Pers Soc Psychol"},{"issue":"1","key":"pone.0361226.ref024","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Y Benjamini","year":"1995","journal-title":"J R Stat Soc Ser B"},{"issue":"14","key":"pone.0361226.ref025","article-title":"Balance control in adolescents with idiopathic scoliosis and disturbed somatosensory function","volume":"31","author":"X Guo","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"issue":"13","key":"pone.0361226.ref026","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0b013e3181ff5837","article-title":"Postural instability in early-stage idiopathic scoliosis in adolescent girls","volume":"36","author":"T Haumont","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"pone.0361226.ref027","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1086\/651257","article-title":"Reconsidering Baron and Kenny: Myths and Truths about Mediation Analysis","volume":"37","author":"X Zhao","year":"2010","journal-title":"J Consum Res"},{"issue":"5","key":"pone.0361226.ref028","first-page":"357","article-title":"Factors Affecting Dynamic Postural Control Ability in Adolescent Idiopathic Scoliosis","volume":"78","author":"R Yamawaki","year":"2024","journal-title":"Acta Med Okayama"},{"issue":"5","key":"pone.0361226.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0303086","article-title":"Neurophysiological, balance and motion evidence in adolescent idiopathic scoliosis: A systematic review","volume":"19","author":"M Paramento","year":"2024","journal-title":"PLoS One"},{"key":"pone.0361226.ref030","doi-asserted-by":"crossref","first-page":"136366","DOI":"10.1016\/j.neulet.2021.136366","article-title":"Proprioceptive postural control strategies differ among non-injured athletes","volume":"769","author":"B Picot","year":"2022","journal-title":"Neurosci Lett"},{"issue":"4","key":"pone.0361226.ref031","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.3390\/ijerph19042028","article-title":"The Effects of Proprioceptive Training on Balance, Strength, Agility and Dribbling in Adolescent Male Soccer Players","volume":"19","author":"DV Gidu","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0361226.ref032","first-page":"23","article-title":"A 10-Week Program of Combined Hippotherapy and Scroth\u2019s Exercises Improves Balance and Postural Asymmetries in Adolescence Idiopathic Scoliosis: A Randomized Controlled Study","volume":"9","author":"AA Abdel-Aziem","year":"2021","journal-title":"Children (Basel)"},{"key":"pone.0361226.ref033","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/978-3-031-31986-0_45","article-title":"The Effect of Schroth Method on Postural Control and Balance in Patients with Adolescent Idiopathic Scoliosis: A Literature Review","volume":"1425","author":"A Kastrinis","year":"2023","journal-title":"Adv Exp Med Biol"},{"key":"pone.0361226.ref034","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4103\/1110-161X.181876","article-title":"Somatosensory evoked potentials and dynamic postural assessment in adolescent idiopathic scoliosis","volume":"43","author":"D El Mikkawy","year":"2016","journal-title":"Egypt Rheumatol Rehabil"},{"issue":"18","key":"pone.0361226.ref035","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1097\/01.brs.0000179086.30449.96","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"SD Glassman","year":"2005","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0361226","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:21:53Z","timestamp":1792776113000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0361226"}},"subtitle":[],"editor":[{"given":"Seyed Hamed","family":"Mousavi","sequence":"first","affiliation":[{"name":"University of Tehran","place":["IRAN, ISLAMIC REPUBLIC OF"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,23]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0361226","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,23]]}}}