{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:52:47Z","timestamp":1782363167360,"version":"3.54.5"},"reference-count":63,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>The aim of this report is to review the literature dealing with the postoperative correction of rib hump (RH) after spinal operations for adolescent idiopathic scoliosis (AIS) and its aetiological implications of hump postoperative fate for IS. Recommendations related to RH deformity for the follow-up of younger asymmetric but not scoliotic children are provided, and the concept that clinical monitoring of the chest deformity is more important than merely an initially negative radiographic examination (curve less than 10\u00b0) is underlined. Additionally, guidelines are provided based on the segments T1\u2013T12 rib index (RI) in the existing lateral preoperative radiographs for the optimal selection of the rib level for a successfully costoplasty. This review is based on the collected articles that used either the RI method, derived from the double rib contour sign (DRCS) at the lateral spinal radiographs, or alternative methods for the assessment of the RH deformity and presented the results of the operative treatment of the scoliotic spine on RH. A total of 19 relevant articles published from 1976 to 2022 were found in PubMed. Findings: All the above articles show that not only is the hump incompletely corrected, but it recurs and worsens during the follow-up and even more intensively in skeletally immature operated scoliosis children. Conclusions and Future Directions: Surgery straightens the spine, yet the RH is corrected approximately only as much as the spinal derotation. The only way to correct the RH more is with costoplasty, which, however, is not performed in most cases for many reasons. The key reason for this phenomenon is the fact that the RH deformity (RHD) is mainly due to the asymmetric development of the ribs and much less so due to the rotation of the vertebrae in the thoracic spine. Surgery on the spine cannot limit the asymmetry of the ribs or stop the mechanism that causes their asymmetrical growth. The results presented in all the reviewed articles support the important protagonistic role of RHD on scoliogenesis, which precedes the subsequent formed spinal deformity.<\/jats:p>","DOI":"10.3390\/children10101697","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T08:08:33Z","timestamp":1697530113000},"page":"1697","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3018-5168","authenticated-orcid":false,"given":"Theodoros B.","family":"Grivas","sequence":"first","affiliation":[{"name":"Department of Orthopedics & Traumatology, \u201cTzaneio\u201d General Hospital of Piraeus, 18536 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2428-5250","authenticated-orcid":false,"given":"Elias","family":"Vasiliadis","sequence":"additional","affiliation":[{"name":"3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 16541 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Vynichakis","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Gen. Hospital of Argolida\u2014N.M. Argos, 21231 Argos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Chandrinos","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Gen. Hospital of Argolida\u2014N.M. Argos, 21231 Argos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Athanasopoulos","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Peristeri Medical Group, 12132 Peristeri, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paschalis","family":"Christodoulides","sequence":"additional","affiliation":[{"name":"Department of Radiology, General Hospital of Paphos, Paphos 8026, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"key":"ref_1","unstructured":"SOSORT Educational Committee (2014). SOSORT 2014\u20144th Educational Courses, SOSORT."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"702","DOI":"10.2106\/00004623-198163050-00003","article-title":"Idiopathic scoliosis","volume":"63","author":"Weinstein","year":"1981","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1748-7161-1-9","article-title":"Association between adolescent idiopathic scoliosis prevalence and age at menarche in different geographic latitudes","volume":"1","author":"Grivas","year":"2006","journal-title":"Scoliosis"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.1097\/BPO.0b013e3181f73c12","article-title":"Top theories for the etiopathogenesis of adolescent idiopathic scoliosis","volume":"31","author":"Wang","year":"2011","journal-title":"J. Pediatr. Orthoped."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1748-7161-8-4","article-title":"Whither the etiopathogenesis (and scoliogeny) of adolescent idiopathic scoliosis? Incorporating presentations on scoliogeny at the 2012 IRSSD and SRS meetings","volume":"8","author":"Burwell","year":"2013","journal-title":"Scoliosis"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.2106\/00004623-200008000-00014","article-title":"Etiology of idiopathic scoliosis: Current trends in research","volume":"82","author":"Lowe","year":"2000","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1111\/j.1651-2227.1989.tb11137.x","article-title":"Trunk asymmetry and scoliosis. Anthropometric measurements in prepubertal school children","volume":"78","author":"Nissinen","year":"1989","journal-title":"Acta Paediatr Scand."},{"key":"ref_8","first-page":"84","article-title":"School screening as a research tool in epidemiology, natural history and aetiology of idiopathic scoliosis","volume":"135","author":"Grivas","year":"2008","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1748-7161-8-17","article-title":"Screening for adolescent idiopathic scoliosis: An information statement by the scoliosis research society international task force","volume":"8","author":"Labelle","year":"2013","journal-title":"Scoliosis"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"E1259","DOI":"10.1097\/BRS.0b013e318205e413","article-title":"Evaluation of the three dimensional deformities in scoliosis surgery with computed tomography: Efficacy and relationship with clinical outcomes","volume":"36","author":"Hong","year":"2011","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1007\/s00586-005-0977-4","article-title":"Primary thoracolpasty and pedicle screw instrumentation in thoracic idiopathic scoliosis","volume":"14","author":"Min","year":"2005","journal-title":"Eur. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1097\/00007632-199309000-00005","article-title":"Are there indications for partial rib resection in patients with adolescent idiopathic scoliosis treated with Cotrel-Dubousset instrumentation?","volume":"18","author":"Harvey","year":"1993","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/00003086-200206000-00018","article-title":"Pulmonary function after thoracolpasty in adolescent idiopathic scoliosis","volume":"399","author":"Chen","year":"2002","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_14","first-page":"27","article-title":"Scoliosis: Experimental and clinical studies","volume":"191","author":"Sevastik","year":"1984","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/00007632-198606000-00001","article-title":"The thermal emission from the skin and the vascularity of the breasts in normal and scoliotic girls","volume":"11","author":"Normelli","year":"1986","journal-title":"Spine"},{"key":"ref_16","first-page":"282","article-title":"Experimental scoliosis in growing rabbits by operations on the rib cage","volume":"136","author":"Sevastik","year":"1987","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1097\/00007632-198809000-00016","article-title":"Induction of scoliosis in the growing rabbit by unilateral rib-growth stimulation","volume":"13","author":"Agadir","year":"1988","journal-title":"Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/00007632-198609000-00016","article-title":"The symmetry of the breasts in normal and scoliotic girls","volume":"11","author":"Normelli","year":"1986","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1097\/00007632-199008010-00015","article-title":"Effects of rib elongation on the spine: I. Distortion of the vertebral alignment in the rabbit","volume":"15","author":"Sevastik","year":"1990","journal-title":"Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1097\/00007632-199008010-00016","article-title":"Effects of rib elongation on the spine: II. Correction of scoliosis in the rabbit","volume":"15","author":"Sevastik","year":"1990","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1002\/jor.1100080218","article-title":"Vascular Changes in the Chest Wall After Unilateral Resection of the Intercostal Nerves in the Growing Rabbit","volume":"8","author":"Agadir","year":"1990","journal-title":"J. Orthop. Res."},{"key":"ref_22","first-page":"218","article-title":"In vitro opto-electronic analysis of 3-D segmental vertebral movements during gradual rib lengthening in the pig","volume":"61","author":"Sevastik","year":"1995","journal-title":"Acta Orthop. Belg."},{"key":"ref_23","first-page":"345","article-title":"Simulations of rib cage surgery for the management of scoliotic deformities","volume":"88","author":"Aubin","year":"2002","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_24","first-page":"20","article-title":"Dysfunction of the autonomic nerve system (ANS) in the aetiopathogenesis of adolescent idiopathic scoliosis","volume":"88","author":"Sevastik","year":"2002","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1007\/s00586-002-0489-4","article-title":"A new concept for the etiopathogenesis of the thoracospinal deformity of idiopathic scoliosis: Summary of an electronic focus group debate of the IBSE","volume":"12","author":"Sevastik","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_26","first-page":"552","article-title":"Right convex thoracic female adolescent scoliosis in the light of the thoracospinal concept","volume":"123","author":"Sevastik","year":"2006","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1748-7161-2-11","article-title":"The effect of growth on the correlation between the spinal and rib cage deformity: Implications on idiopathic scoliosis pathogenesis","volume":"2","author":"Grivas","year":"2007","journal-title":"Scoliosis"},{"key":"ref_28","first-page":"38","article-title":"The Double Rib Contour Sign (DRCS) in lateral spinal radiographs: Aetiologic implications for scoliosis","volume":"88","author":"Grivas","year":"2002","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1302\/0301-620X.65B3.6841390","article-title":"The effect of the adolescent growth spurt on early posterior spinal fusion in infantile and juvenile idiopathic scoliosis","volume":"65","author":"Hefti","year":"1983","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1302\/0301-620X.58B1.1270497","article-title":"The rib hump in idiopathic scoliosis. Measurement, analysis and response to treatment","volume":"58","author":"Thulbourne","year":"1976","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1097\/00007632-198109000-00011","article-title":"Effect of the Harrington compression system on the correction of the rib hump in spinal instrumentation for idiopathic scoliosis","volume":"6","author":"Gaines","year":"1981","journal-title":"Spine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1302\/0301-620X.69B2.3818745","article-title":"The rib deformity in adolescent idiopathic scoliosis. A prospective study to evaluate changes after Harrington distraction and posterior fusion","volume":"69","author":"Weatherley","year":"1987","journal-title":"J. Bone Jt. Surg Br."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s005860000196","article-title":"Preoperative and early postoperative three-dimensional changes of the rib cage after posterior instrumentation in adolescent idiopathic scoliosis","volume":"10","author":"Delorme","year":"2000","journal-title":"Eur. Spine J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1097\/00007632-200108150-00009","article-title":"Changes in surface and radiographic deformity after Universal Spine System for right thoracic adolescent idiopathic scoliosis: Is rib-hump reassertion a mechanical problem of the thoracic cage rather than an effect of relative anterior spinal overgrowth?","volume":"26","author":"Pratt","year":"2001","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1007\/s00586-012-2625-0","article-title":"Five-year clinical and radiographic outcomes using pedicle screw only constructs in the treatment of adolescent idiopathic scoliosis","volume":"22","author":"Hwang","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1007\/s00586-011-1702-0","article-title":"Does lateral vertebral translation correspond to Cobb angle and relate in the same way to axial vertebral rotation and rib hump index? A radiographic analysis on idiopathic scoliosis","volume":"20","author":"Easwar","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/BSD.0b013e3182745f51","article-title":"Assessment of rib hump deformity correction in adolescent idiopathic scoliosis with or without costoplasty using the double rib contour sign","volume":"28","author":"Lykissas","year":"2015","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1097\/BRS.0b013e31829a6d37","article-title":"En bloc vertebral column derotation provides spinal derotation but no additional effect on thoracic rib hump correction as compared with no derotation in adolescents undergoing surgery for idiopathic scoliosis with total pedicle screw instrumentation","volume":"38","author":"Mattila","year":"2013","journal-title":"Spine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1186\/1748-7161-10-S2-S10","article-title":"Rib hump deformity assessment using the rib index in adolescent idiopathic scoliotics treated with full screw or hybrid constructs: Aetiological implications","volume":"10","author":"Soultanis","year":"2015","journal-title":"Scoliosis"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1097\/BPO.0000000000001389","article-title":"Long-term Results of Spine Stapling for AIS to Skeletal Maturity and Beyond","volume":"40","author":"Haber","year":"2020","journal-title":"J. Pediatr. Orthop."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1007\/s43390-021-00350-2","article-title":"Clinical, radiological and HRQoL outcomes after selective thoracic fusion with minimum 15-year follow-up","volume":"9","author":"Hamzaoglu","year":"2021","journal-title":"Spine Deform."},{"key":"ref_42","unstructured":"Igoumenou, V.G., Megaloikonomos, P.D., Tsiavos, K., Georgopoulos, G., Liontos, M., Mavrogenis, A.F., Grivas, T.B., Soultanis, K., and Papagelopoulos, P.J. (2016, January 25\u201328). Postoperative rib hump deformity correction in patients with adolescent idiopathic scoliosis. Comparison of a three generations spinal fusion systems. Proceedings of the Combined Meeting of the International Research Society of Spinal Deformities and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment, Banff, AB, Canada."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1615\/JLongTermEffMedImplants.2021039387","article-title":"Rib Hump Deformity Correction in Patients with Adolescent Idiopathic Scoliosis: A Comparison of Three Spinal Fusion Systems","volume":"31","author":"Igoumenou","year":"2021","journal-title":"J. Long Term Eff. Med. Implant."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13013-014-0020-9","article-title":"Rib index","volume":"9","author":"Grivas","year":"2014","journal-title":"Scoliosis"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"375","DOI":"10.31616\/asj.2020.0398","article-title":"Does Implant Density Impact Three-Dimensional Deformity Correction in Adolescent Idiopathic Scoliosis with Lenke 1 and 2 Curves Treated by Posterior Spinal Fusion without Ponte Osteotomies?","volume":"16","author":"Lertudomphonwanit","year":"2022","journal-title":"Asian Spine J."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Tsirikos, A.I., and McMillan, T.E. (2022). All Pedicle Screw versus Hybrid Hook\u2013Screw Instrumentation in the Treatment of Thoracic Adolescent Idiopathic Scoliosis (AIS): A Prospective Comparative Cohort Study. Healthcare, 10.","DOI":"10.3390\/healthcare10081455"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/s00586-011-1808-4","article-title":"Right adolescent idiopathic thoracic curve (Lenke 1 A and B): Does cost of instrumentation and implant density improve radiographic and cosmetic parameters?","volume":"20","author":"Yang","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.spinee.2012.05.029","article-title":"Low-density versus high-density thoracic pedicle screw constructs in adolescent idiopathic scoliosis: Do more screws lead to a better outcome?","volume":"13","author":"Bharucha","year":"2013","journal-title":"Spine J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3095","DOI":"10.1007\/s00586-016-4400-0","article-title":"Thoracic sagittal plane variations between patients with thoracic adolescent idiopathic scoliosis and healthy adolescents","volume":"25","author":"Pizones","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Grivas, T.B., Vynichakis, G., Chandrinos, M., Mazioti, C., Papagianni, D., Mamzeri, A., and Mihas, C. (2021). Morphology, Development and Deformation of the Spine in Mild and Moderate Scoliosis: Are Changes in the Spine Primary or Secondary?. J. Clin. Med., 10.","DOI":"10.3390\/jcm10245901"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/00007632-199204000-00009","article-title":"School screening for scoliosis: Methodologic considerations. Part 1: External measurements","volume":"17","author":"Pruijs","year":"1992","journal-title":"Spine"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/BF00303416","article-title":"School screening for scoliosis: The value of quantitative measurement","volume":"4","author":"Pruijs","year":"1995","journal-title":"Eur. Spine J."},{"key":"ref_53","first-page":"1993","article-title":"Trunk Asymmetry, Posture, Growth, and Risk of Scoliosis. A Three-Year Follow-Up of Finnish Prepubertal School Children","volume":"18","author":"Nissinen","year":"1995","journal-title":"Spine"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/01241398-198408000-00012","article-title":"Development of trunk asymmetries and structural scoliosis in prepubertal school children in Malmo: Follow up study of children 10\u201314 years of age","volume":"4","author":"Willner","year":"1984","journal-title":"J. Pediatr. Orthop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/BF00460117","article-title":"Moir\u00e9 topography-A method for school screening of scoliosis","volume":"95","author":"Willner","year":"1979","journal-title":"Arch. Orthrop. Traumat. Surg."},{"key":"ref_56","unstructured":"Drerup, B., Frobin, W., and Hierholzer, E. (1983). Moir\u00e9 Fringe Topography, Gustav Fischer."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1302\/0301-620X.75B6.8245076","article-title":"Costoplasty in adolescent idiopathic scoliosis. Objective results in 55 patients","volume":"75","author":"Barrett","year":"1993","journal-title":"J. Bone Jt. Surg Br."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1097\/00007632-199404000-00020","article-title":"Internal thoracoplasties. A new procedure","volume":"19","author":"Shufflebarger","year":"1994","journal-title":"Spine"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"920","DOI":"10.2106\/00004623-198365070-00006","article-title":"Rib resection and spine fusion in correction of convex deformity in scoliosis","volume":"65","author":"Steel","year":"1983","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00586-002-0523-6","article-title":"Rib deformity in scoliosis","volume":"12","author":"Erkula","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Grivas, T.B., Jevtic, N., Ljubojevic, D., Pjanic, P., Golic, F., and Vasiliadis, E. (2023, September 10). Segmental Rib Index and Spinal Deformity: Aetiological Implications to Idiopathic Scoliosis. 2023. Me\u0111unarodni Kongres, se Odr\u017eava na Zlatiboru u Kongresnom Centru \u201cHotel Mona\u201d od 21\u201324 Septembra 2023, Godine Pod Nazivom: \u201cNove Perspektive u Razvoju Fizikalne i Rehabilitation Medicine\u201d. Available online: https:\/\/fizijatri.org\/.","DOI":"10.20944\/preprints202310.1678.v1"},{"key":"ref_62","unstructured":"(2023, September 10). 4th ScoSym, September 23\u201324, 2023, Istinye University Topkapi Campus, Convention Center, T\u00fcrkiye. Available online: https:\/\/scosym2023.org\/."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.21474\/IJAR01\/17344","article-title":"Thorax and the idiopathic Scoliosis","volume":"11","author":"Grivas","year":"2023","journal-title":"Int. J. Adv. Res."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/10\/1697\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:08:08Z","timestamp":1760130488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/10\/1697"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,17]]},"references-count":63,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["children10101697"],"URL":"https:\/\/doi.org\/10.3390\/children10101697","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,17]]}}}