Dear Editor,
We read with great interest the article by Morino et al, entitled “Trends in the Prevalence of Adolescent Idiopathic Scoliosis in a Japanese Prefecture: A 25-Year Population-Based School Screening Study Using Moire Topography.”
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This long-term study offers valuable insights into the increasing prevalence of adolescent idiopathic scoliosis (AIS) in Ehime, Japan. We commend the authors for their thorough analysis and contribution to our current understanding of AIS trends.
We would like to offer the following observations, thereby potentially further enriching the discussion of the results.
First, the study reveals a significant increase in AIS prevalence over 25 years. While the authors suggest this reflects a true epidemiological shift, we were pondering on whether the authors could further explore the role of lifestyle factors (eg, increased sedentary behavior and changes in posture) in contributing to this rise. Although the study mentions modern sedentary lifestyles as a potential factor, a deeper examination of how these factors might interact with growth patterns could further strengthen this hypothesis. Previous studies have highlighted the role of sedentary behavior in the development of musculoskeletal disorders, including scoliosis.
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Second, the study established that boys displayed a significantly lower positive predictive value (PPV) compared to girls, especially in younger students. We were wondering whether future research could explore sex-specific screening thresholds to improve AIS screening program efficiency. Gender-adjusted diagnostic criteria could help reduce unnecessary referrals and improve diagnostic accuracy. Gender differences are reportedly significant in scoliosis prevalence and screening outcomes.
Third, the authors propose that rising AIS prevalence might be driven by a combination of adolescent growth trends and lifestyle changes. Therefore, a reasonable question would be whether future studies could also examine other potential factors, such as genetic predispositions or family history, that might contribute to this trend. These additional factors could contribute to a more comprehensive understanding of AIS development. Genetic factors have been identified as key AIS contributors, with several studies supporting the role of genetic predisposition in its progression.
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Finally, while the consistent screening method presented in the study provides strong evidence for the observed trend, we suggest that future research could explore the role of early interventions, particularly non-surgical treatments like bracing. Moreover, considering regional differences in AIS prevalence (eg, the impact of urban vs rural living conditions, healthcare access, and lifestyle) could help further explain the rise in prevalence across different areas. Regional and environmental factors can reportedly influence scoliosis prevalence and screening program efficacy.
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We appreciate the significant contribution of the authors to this important field and look forward to their response to these observations. Their findings emphasize the ongoing importance of school-based screening for early AIS detection. We hope that these discussions would guide future research into the environmental, developmental, and genetic factors driving this common spinal deformity.
