{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:18:20Z","timestamp":1761808700716,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T00:00:00Z","timestamp":1734652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Orthopedics, Hvidovre Hospital, Hvidovre, Denmark"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Spinal flexibility radiographs are important in adolescent idiopathic scoliosis (AIS) for clinical decision-making. In this study, we introduce a new method, the \u2018quantitatively controlled standing fulcrum side-bending\u2019 test (CSFS test). This is a feasibility study; we aimed to quantify the applied force and track the temporospatial changes in the spine specifically by measuring the continuous change in the Cobb angle (in degrees) during lateral bending. Methods: In this cross-sectional study, we included patients with AIS. Using a low-dose cinematic fluoroscopic technique, we captured the lateral bending of the thoracolumbar vertebral spine while inducing quantified lateral force on the ribs by a force gauge in a three-point fixation setup of controlled lateral bending. Trial registration number: H-1703423. Results: Twenty-one patients with small-curve AIS were included as subjects. All subjects performed the CSFS test adequately. They had small curves with a mean Cobb angle of 12.0 (range: 0.0\u201326.0, SD: 7.1). The measured median stiffness was 3.66 N\/degrees (\u00b0) of the Cobb angle (range: 0.02\u201311.81) with a median coefficient of determination R2 of 0.58 (range: 0.002\u20130.92) by regression analyses. When analysed concerning the median-term clinical outcome of either progression\/regression or stationary curves, various Cobb angle measurements and the other experimental parameters, there were no significant relationships. Conclusions: The CSFS test is feasible to quantify the force applied and the temporospatial changes in the spine during lateral bending. The CSFS test has been utilised in basic research for mechanical characterisation of the scoliotic spine and has the potential of being implemented directly in patient-specific bracing to estimate the forces needed for brace correction and adjustment so as not to supersede the allowed skin pressure.<\/jats:p>","DOI":"10.3390\/jcm13247809","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T08:40:25Z","timestamp":1734684025000},"page":"7809","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Feasibility Study of a Controlled Standing Fulcrum Side-Bending Test in Adolescent Idiopathic Scoliosis"],"prefix":"10.3390","volume":"13","author":[{"given":"Christian","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Rigshospitalet, 2100 Osterbroo, Denmark"},{"name":"Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Koutras","sequence":"additional","affiliation":[{"name":"Department of Computer Science, Universidad Rey Juan Carlos, 28942 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamed","family":"Shayestehpour","sequence":"additional","affiliation":[{"name":"Department of Materials and Production, Aalborg University, 9220 Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benny","family":"Dahl","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3880-7622","authenticated-orcid":false,"given":"Miguel A.","family":"Otaduya","sequence":"additional","affiliation":[{"name":"Department of Computer Science, Universidad Rey Juan Carlos, 28942 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3257-5653","authenticated-orcid":false,"given":"John","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Department of Materials and Production, Aalborg University, 9220 Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E250","DOI":"10.1097\/BRS.0000000000002276","article-title":"Spinal Flexibility Assessment on the Patients With Adolescent Idiopathic Scoliosis: A Literature Review","volume":"43","author":"He","year":"2018","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1302\/0301-620X.104B4.BJJ-2021-1677.R1","article-title":"Curve Type, Flexibility, Correction, and Rotation Are Predictors of Curve Progression in Patients with Adolescent Idiopathic Scoliosis Undergoing Conservative Treatment: A Systematic Review","volume":"104-B","author":"Wong","year":"2022","journal-title":"Bone Joint J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1186\/s13018-023-04430-z","article-title":"Associations between Spinal Flexibility and Bracing Outcomes in Adolescent Idiopathic Scoliosis: A Literature Review","volume":"18","author":"Luo","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1302\/0301-620X.102B2.BJJ-2019-0916.R1","article-title":"Supine Flexibility Predicts Curve Progression for Patients with Adolescent Idiopathic Scoliosis Undergoing Underarm Bracing","volume":"102-B","author":"Cheung","year":"2020","journal-title":"Bone Joint J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1016\/j.spinee.2018.06.344","article-title":"Radiographic Methods to Estimate Surgical Outcomes Based on Spinal Flexibility Assessment in Patients Who Have Adolescent Idiopathic Scoliosis: A Systematic Review","volume":"18","author":"Khodaei","year":"2018","journal-title":"Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2619","DOI":"10.1007\/s00586-014-3386-8","article-title":"Axial Suspension Test to Assess Pre-Operative Spinal Flexibility in Patients with Adolescent Idiopathic Scoliosis","volume":"23","author":"Studer","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s00586-014-3623-1","article-title":"Patient-Specific Spinal Stiffness in AIS: A Preoperative and Noninvasive Method","volume":"24","author":"Berger","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_8","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":"Negrini","year":"2018","journal-title":"Scoliosis Spinal Disord."},{"key":"ref_9","first-page":"20584601211043256","article-title":"Intervariability in Radiographic Parameters and General Evaluation of a Low-Dose Fluoroscopic Technique in Patients with Idiopathic Scoliosis","volume":"10","author":"Wong","year":"2021","journal-title":"Acta Radiol. Open"},{"key":"ref_10","unstructured":"KERN & SOHN GmbH KERN FH500 (2023, March 14). Universelles Digitales Kraftmessger\u00e4t F\u00fcr Zug- Und Druckkraftmessungen Mit RS-232 Schnittstelle. Available online: https:\/\/docs.rs-online.com\/e1e1\/0900766b816836cc.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1097\/BRS.0000000000002503","article-title":"Predictability of Supine Radiographs for Determining In-Brace Correction for Adolescent Idiopathic Scoliosis","volume":"43","author":"Cheung","year":"2018","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1097\/CORR.0000000000000989","article-title":"Does Curve Regression Occur During Underarm Bracing in Patients with Adolescent Idiopathic Scoliosis?","volume":"478","author":"Cheung","year":"2020","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1001\/jama.289.2.223","article-title":"Pressure Ulcer Prevention and Management","volume":"289","author":"Lyder","year":"2003","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.clinbiomech.2016.10.014","article-title":"Intra-Operative Measurement of Applied Forces during Anterior Scoliosis Correction","volume":"40","author":"Fairhurst","year":"2016","journal-title":"Clin. Biomech."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Koutras, C., P\u00e9rez, J., Kardash, K., and Otaduy, M.A. (2021). A Study of the Sensitivity of Biomechanical Models of the Spine for Scoliosis Brace Design. Comput. Methods Programs Biomed., 207.","DOI":"10.1016\/j.cmpb.2021.106125"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/BRS.0b013e318193a23d","article-title":"Assessment of Spinal Flexibility in Adolescent Idiopathic Scoliosis: Suspension versus Side-Bending Radiography","volume":"34","author":"Lamarre","year":"2009","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Koutras, C., Shayestehpour, H., P\u00e9rez, J., Wong, C., Rasmussen, J., Tournier, M., Nesme, M., and Otaduy, M.A. (2022). Biomechanical Morphing for Personalized Fitting of Scoliotic Torso Skeleton Models. Front. Bioeng. Biotechnol., 10.","DOI":"10.3389\/fbioe.2022.945461"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/BRS.0b013e3181b664b1","article-title":"In Vivo Distribution of Spinal Intervertebral Stiffness Based on Clinical Flexibility Tests","volume":"35","author":"Lafon","year":"2010","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.clinbiomech.2011.05.004","article-title":"Effects of Surgical Joint Destabilization on Load Sharing between Ligamentous Structures in the Thoracic Spine: A Finite Element Investigation","volume":"26","author":"Little","year":"2011","journal-title":"Clin. Biomech."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E76","DOI":"10.1097\/BRS.0b013e31818ad584","article-title":"The Effect of Soft Tissue Properties on Spinal Flexibility in Scoliosis: Biomechanical Simulation of Fulcrum Bending","volume":"34","author":"Little","year":"2009","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1007\/s00586-013-2693-9","article-title":"Measuring Procedures to Determine the Cobb Angle in Idiopathic Scoliosis: A Systematic Review","volume":"22","author":"Langensiepen","year":"2013","journal-title":"Eur. Spine J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7809\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:56:45Z","timestamp":1760115405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,20]]},"references-count":21,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13247809"],"URL":"https:\/\/doi.org\/10.3390\/jcm13247809","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,12,20]]}}}