{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:46:08Z","timestamp":1785854768700,"version":"3.56.0"},"reference-count":20,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives. Spinal misalignment in childhood and adolescence may be associated with altered sensory integration and body representation. The subjective visual vertical reflects visual, vestibular, and somatosensory integration, but its relationship with pediatric spinal misalignment remains uncertain. This study investigated the subjective visual vertical using two complementary paradigms. Methods. This exploratory, single-center, cross-sectional study included participants aged 7\u201317 years with clinically identified spinal misalignment. Participants underwent standardized physiatric assessment and subjective visual vertical testing using a luminous-line test and the Bucket Test. Spearman\u2019s rank correlations examined associations with clinical and radiographic variables, with false-discovery-rate control using the Benjamini\u2013Hochberg procedure. Radiographic analyses were restricted to participants with available imaging. Results. Fifty-seven participants were included (mean age 12.8 years, SD 2.25), and all completed both tests. Mean subjective visual vertical was 0.053\u00b0 (SD 0.953) with the luminous-line test and \u22120.561\u00b0 (SD 1.165) with the Bucket Test. Radiographs were available for 21 participants. No association remained significant after false-discovery-rate correction. Two luminous-line associations were nominally significant before correction: primary lumbar curve presence (\u03c1 = \u22120.278, p = 0.036) and secondary thoracolumbar curve presence (\u03c1 = \u22120.324, p = 0.015); both had q = 0.721. The tests were moderately correlated (\u03c1 = 0.493, p &lt; 0.001). Radiographic sensitivity and subgroup analyses showed no significant findings. Conclusions. Subjective visual vertical was not robustly associated with spinal misalignment characteristics in this modest, clinically heterogeneous cohort. Larger controlled studies with standardized imaging and adequately powered severity groups are required.<\/jats:p>","DOI":"10.3390\/diagnostics16152461","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:42:36Z","timestamp":1785850956000},"page":"2461","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Visual Vertical Perception Altered in Children and Adolescents with Spinal Misalignment? A Cross-Sectional Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-8276","authenticated-orcid":false,"given":"Alessandro","family":"Picelli","sequence":"first","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"},{"name":"Department of Neurosciences, University Hospital of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Turri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"},{"name":"Recovery and Functional Rehabilitation Unit, Marzana Hospital, 37142 Marzana, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Di Censo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Hospital of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Chignola","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Hospital of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Dell\u2019Orco","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Hospital of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2576-963X","authenticated-orcid":false,"given":"Ilaria","family":"Di Maria","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaspare","family":"Crimi","sequence":"additional","affiliation":[{"name":"Recovery and Functional Rehabilitation Unit, Marzana Hospital, 37142 Marzana, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5930-5974","authenticated-orcid":false,"given":"Mirko","family":"Filippetti","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7630-1887","authenticated-orcid":false,"given":"Nicola","family":"Smania","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"},{"name":"Department of Neurosciences, University Hospital of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4242-8497","authenticated-orcid":false,"given":"Valentina","family":"Varalta","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"},{"name":"Department of Neurosciences, University Hospital of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15030","DOI":"10.1038\/nrdp.2015.30","article-title":"Adolescent idiopathic scoliosis","volume":"1","author":"Cheng","year":"2015","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115563","DOI":"10.1016\/j.bone.2020.115563","article-title":"From genetics to epigenetics to unravel the etiology of adolescent idiopathic scoliosis","volume":"140","author":"Bas","year":"2020","journal-title":"Bone"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1080\/17483100801921311","article-title":"Neurophysiological basis of rehabilitation of adolescent idiopathic scoliosis","volume":"30","author":"Smania","year":"2008","journal-title":"Disabil. Rehabil."},{"key":"ref_4","first-page":"477","article-title":"Is self-image, in reference to the gravitational vertical, altered in adolescent idiopathic scoliosis? A multicenter, single-blind, case-control study","volume":"15","author":"Catanzariti","year":"2022","journal-title":"J. Pediatr. Rehabil. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Obrero-Gait\u00e1n, E., Molina, F., Del-Pino-Casado, R., Ib\u00e1\u00f1ez-Vera, A.J., Rodr\u00edguez-Almagro, D., and Lomas-Vega, R. (2020). Visual verticality perception in spinal diseases: A systematic review and meta-analysis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061725"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cort\u00e9s-P\u00e9rez, I., Salamanca-Montilla, L., G\u00e1miz-Berm\u00fadez, F., Obrero-Gait\u00e1n, E., Ib\u00e1\u00f1ez-Vera, A.J., and Lomas-Vega, R. (2023). Vestibular morphological alterations in adolescent idiopathic scoliosis: A systematic review of observational studies. Children, 10.","DOI":"10.3390\/children10010035"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3233\/VES-2011-0414","article-title":"Subjective visual vertical in patients with idiopatic scoliosis","volume":"21","year":"2011","journal-title":"J. Vestib. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3233\/VES-230005","article-title":"Subjective visual vertical and head position in patients with idiopathic scoliosis","volume":"33","author":"Illinger","year":"2023","journal-title":"J. Vestib. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.3233\/BMR-150602","article-title":"Do adolescents with idiopathic scoliosis have body schema disorders? A cross-sectional study","volume":"29","author":"Picelli","year":"2016","journal-title":"J. Back. Musculoskelet. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1161\/01.STR.0000155740.44599.48","article-title":"Subjective visual vertical in pitch and roll in right hemispheric stroke","volume":"36","author":"Saj","year":"2005","journal-title":"Stroke"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1212\/WNL.0b013e3181a55ecf","article-title":"A bucket of static vestibular function","volume":"72","author":"Zwergal","year":"2009","journal-title":"Neurology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1080\/00016489.2017.1410289","article-title":"Evaluation and interpretation of the Bucket Test in healthy individuals","volume":"138","year":"2018","journal-title":"Acta Otolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1044\/2018_AJA-17-0019","article-title":"Assessment of subjective visual vertical using the Bucket Test and the virtual subjective visual vertical system","volume":"27","author":"Michelson","year":"2018","journal-title":"Am. J. Audiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_15","first-page":"261","article-title":"Outline for the study of scoliosis","volume":"5","author":"Cobb","year":"1948","journal-title":"Instr. Course Lect."},{"key":"ref_16","first-page":"111","article-title":"The iliac apophysis: An invaluable sign in the management of scoliosis","volume":"11","author":"Risser","year":"1958","journal-title":"Clin. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.rehab.2016.02.004","article-title":"Visual verticality perception after stroke: A systematic review of methodological approaches and suggestions for standardization","volume":"60","author":"Piscicelli","year":"2017","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jspd.2018.05.004","article-title":"Do adolescents with idiopathic scoliosis have an erroneous perception of the gravitational vertical?","volume":"7","author":"Pradeau","year":"2019","journal-title":"Spine Deform."},{"key":"ref_19","first-page":"97","article-title":"Body image and body schema in adolescents with idiopathic scoliosis: A scoping review","volume":"8","author":"Bertuccelli","year":"2023","journal-title":"Adolesc. Res. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1007\/s00221-018-5256-9","article-title":"Verticality perception reveals a vestibular deficit in adolescents with idiopathic scoliosis","volume":"236","author":"Antoniadou","year":"2018","journal-title":"Exp. Brain Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2461\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:46:59Z","timestamp":1785851219000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2461"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":20,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16152461"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16152461","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}