Visual analysis of treatment of adolescent idiopathic scoliosis

doi:10.12307/2025.137

Abstract

Abstract: BACKGROUND: At present, the incidence of scoliosis is increasing year by year, especially in adolescent idiopathic scoliosis. Therefore, it is more and more important to strengthen the research on the treatment of adolescent scoliosis.
OBJECTIVE: To summarize the current status, hotspots, emerging trends, and frontiers of global research on the treatment of adolescent idiopathic scoliosis to provide reference and guidance for future related research.
METHODS: The literature related to the treatment of adolescent idiopathic scoliosis was retrieved on the Web of Science Core Collection (WOSCC) database from 2013 to 2023. CiteSpace 6.2.R1 software was used for visual analysis of countries, institutions, authors, and keywords.
RESULTS AND CONCLUSION: (1) A total of 561 English articles were included in this study. Among countries, institutions, and authors, the United States has contributed the most. Nanjing University and Qiu, Yong (Affiliated Drum Tower Hospital, Nanjing University School of Medicine) are the most published institution and author. The academic journal with the largest number of articles is the European Spine Journal. (2) In the analysis of cited literature, the top 10 most cited articles mainly describe the effects of surgical treatment and conservative treatment on improving adolescent idiopathic scoliosis, especially improving the curvature of patients. (3) Through the summary of highly cited articles and the keyword clustering, keyword prominence in-depth mining, the research hotspots are currently the relationship between Cobb angle and treatment choice, the therapeutic effect of exercise therapy and the therapeutic effect of posterior vertebral fusion. (4) The prognosis of patients with different curvatures has not been studied in depth, and the etiology of adolescent idiopathic scoliosis has not been clarified, so the relationship between curvature and prognosis and the etiology of adolescent idiopathic scoliosis may be a new research trend in the future.

Key words: bibliometrics, adolescent idiopathic scoliosis, treatment, CiteSpace, visual analysis, Cobb angle, hot spots, trends

CLC Number:

Zheng Xiaodong, Gao Shan, Han Wenjin, Liu Lijun, Jia Menglong, Yu Longtan. Visual analysis of treatment of adolescent idiopathic scoliosis[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(3): 645-653.

Figures/Tables 8

2.3 合作分析 2.3.1 国家的合作分析以国家作为节点类型，分析不同国家在研究青少年特发性脊柱侧弯的治疗方面的贡献及合作程度，见图3。国家网络图中由47个节点与136条线路组成，网络密度为0.125 8。其中以美国的贡献最大，共计发文155篇(22.21%)，其次是中国与加拿大，分别是120篇(17.19%)、51篇(7.31%)。发文量排名前3位的国家总计发文量为326篇，在总发文量中的占比为46.71%。在中心性中，美国的占比最高，为0.36，其次是加拿大，为0.22，并且与其他国家之间保持着紧密的合作，见表2。 2.3.2 机构合作分析为了分析机构与机构之间的协作关系，挑选出有贡献的机构生成了机构网络图，见图4。在机构网络图中包含253个节点，569条链路，网络密度为0.017 8。其中南京大学的发文量最大为22篇(2.98%)，其次是费城Shriners儿童医院，发文量为16篇(2.17%)。在发文量排名前10位的机构中以大学占比为主，占比为60%。在这些机构中，机构与机构之间的合作性是比较弱的，其中只有蒙特利尔大学(中心性0.17)以及香港理工大学(中心性0.12)具有较高的相关性，见表2。 2.3.3 作者合作分析为了研究该研究课题中相关文献的核心作者以及他们之间的合作情况，绘制了作者之间协作的网络图，见图5。在该网络图中有332个节点，435条链路，网络密度为0.007 9。虽然网络密度小于0.1，说明作者之间的协作度很低，但是网络图中仍然可以看到明显的节点及团队关系，见图5。在总发文量中，QIU，YONG的发文量最多，为21篇(3.74%)，其次为Parent，Stefan，发文量为11篇(1.96%)，Newton，Peter O发文量为10篇(1.78%)。通过表中数据可见作者的相关性大都小于0.03，这就说明作者与作者之间的合作性相对较低，见表2。 2.4 关键词分析 2.4.1 关键词聚类分析可以用于分析关于青少年特发性脊柱侧弯的治疗的热点和趋势。在关键词聚类的网络图中共有节点351个，链路 2 348条，密度为0.038 2。关于青少年特发性脊柱侧弯治疗的最常见的关键词为“AIS”“外科手术”“置入”等，其中中心性排名前5位的是：“青少年”“跟进”“外科手术治疗”“融合”“结果”，见表3。关键词被聚类为8组，分别是“生活质量”“椎弓根螺钉”“支具治疗”“小儿科的”“后路脊柱融合”“椎体系扎术”“选择性胸椎融合术”“椎弓根螺钉置入”，见图6。因为Q值=0.357 8 > 0.3，S值=0.708 2 > 0.5，所以聚类合理。 2.4.2 关键词突现分析进行关键词突现是研究青少年脊柱侧弯治疗的前沿方向。在CiteSpace中可视化的关键词在短时间内出现数量显著增加，凸显出了关键词爆发的强度和时间，见图7。该研究在关于青少年脊柱侧弯治疗的研究中发现了持续时间大于1年的关键词，共计25个，强度均值在2以上。其中，“Cobb角”的爆发强度最高(强度为7)。“矢状序列”的持续时间最长，为2018-2021年。“Cobb角”“施罗特氏练习”“骨骼未成熟患者”“椎体束缚”“生长调节”“练习”“与健康有关的生活质量”“成功”“冲击”“保守治疗”的爆发时间一直持续到今天，并且有可能成为下一个研究热点的趋势。由关键词聚类图中可见，图中爆发共分为3个阶段，其中第1阶段代表词为手术矫正，第2个阶段代表词为矢状序列，第3个阶段代表词为Cobb角。 2.5 文献共被引时间轴分析通过对共引时间轴的分析，文章能够总结出青少年脊柱侧弯治疗方面的进展与趋势，见图8。在该共引时间轴网络图中共有节点502个，网络链路1 746条，网络密度为0.013 9。该网络图被分为10个集合，最大的集合是“3D矫形(3d correction)”，其次为“治疗结果(treatment outcome)”“矢状位(sagittal alignment)”。在该网络图中Q值=0.763 3，S值=0.829 3，所以该聚类合理。此外自2012年开始节点数量开始增多，大部分节点集中在2012-2016年之间。引文爆发节点浓度最高的是第0组“3D矫形(3d correction)”、第1组“治疗结果(treatment outcome)”和第3组“外科手术矫形(surgical correction)”。文章列出了10篇与青少年脊柱侧弯治疗相关的代表性文献[7-16]，见表4。排名前10位的文献发表于2010-2020年，大约有8篇发表于Q1的期刊，占比为80%。影响因子大于3的文献占比为80%。前2位分别是被引用次数最多的论文(n=44)，以及影响因子最高的论文(影响因子=158.5)。其他8篇文献包括2篇综述类文章(第3，7篇)，4篇队列研究类文章(第4，8，9，10篇)以及1篇指南(第6篇)。这10篇高被引用文献的热点概述内容主要为手术治疗与保守治疗对于改善患者曲率的效果分析，但是缺乏对青少年特发性脊柱侧弯病因的明确解释，以及对于不同曲率患者的预后是否相同的研究。通过对上述10篇高被引文献的内容进行深入挖掘与分析，发现有关青少年特发性脊柱侧弯的治疗主要分为两个阶段，首先由最开始的手术治疗逐渐演变成以支具治疗为主，研究主要包括支具治疗的效果[7]、支具治疗疗效的影响因素[8-9]，但是随着时间的发展，受制于支具治疗的不方便性以及价格昂贵等缺点，运动疗法逐渐走入人们的视野，并逐渐成为当下研究的热点。在上述文献中贯穿始终的关键词为Cobb角，对于Cobb角研究的从未过时，也是当下的一个重要研究热点。作为手术治疗中的常规手术，椎体后路融合术的研究在当下也逐渐成为热点。"

References

[1] ALZAKRI A, ALMUHID F, ALMOUSA N, et al. Saudi patients outcomes after surgical treatment of adolescent idiopathic scoliosis. J Orthop Surg Res. 2023;18(1): 450.
[2] ZALE CL, MCINTOSH AL. Adolescent idiopathic scoliosis for pediatric providers. Pediatr Ann. 2022;51(9):E364-E369.
[3] FAHIM T, VIRSANIKAR S, MANGHARAMANI D, et al. Physiotherapy interventions for preventing spinal curve progression in adolescent idiopathic scoliosis: a systematic review. Cureus. 2022;14(10): e30314.
[4] BIERNAT M, BAK-SOSNOWSKA M. The impact of body posture on self-image and psychosocial functioning during adolescence. Pediatria I Medycyna Rodzinna-Paediatrics and Family Medicine. 2018;14(3):282-285.
[5] LEE H, CHOI J, HWANG JH, et al. Health-related quality of life of adolescents conservatively treated for idiopathic scoliosis in Korea: a cross-sectional study. Scoliosis Spinal Disord. 2016;11:11.
[6] CHEN CM. Searching for intellectual turning points: progressive knowledge domain visualization. Proc Natl Acad Sci U S A. 2004;101:5303-5310.
[7] THOMPSON RM, HUBBARD EW, JO CH, et al. Brace success is related to curve type in patients with adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2017;99(11):923-928.
[8] EL HAWARY R, ZAAROOR-REGEV D, FLOMAN Y, et al. Brace treatment in adolescent idiopathic scoliosis: risk factors for failure-a literature review. Spine J. 2019;19(12): 1917-1925.
[9] KATZ DE, HERRING JA, BROWNE RH, et al. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010;92A(6):1343-1352.
[10] NEGRINI S, DONZELLI S, AULISA AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3.
[11] DOLAN LA, WRIGHT JG, WEINSTEIN SL. Effects of bracing in adolescents with idiopathic scoliosis reply. New Engl J Med. 2014;370(7):681-681.
[12] NEWTON PO, KLUCK DG, SAITO W, et al. Anterior spinal growth tethering for skeletally immature patients with scoliosis a retrospective look two to four years postoperatively. J Bone Joint Surg Am. 2018;100(19):1691-1697.
[13] KAROL LA, VIROSTEK D, FELTON K, et al. Effect of compliance counseling on brace use and success in patients with adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2016;98(1):9-14.
[14] KURU T, YELDAN I, DERELI EE, et al. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil. 2016;30(2):181-190.
[15] NEGRINI S, AULISA AG, AULISA L, et al. 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012; 7(1):3.
[16] NEWTON PO, BARTLEY CE, BASTROM TP, et al. Anterior spinal growth modulation in skeletally immature patients with idiopathic scoliosis a comparison with posterior spinal fusion at 2 to 5 years postoperatively. J Bone Joint Surg Am. 2020;102(9):769-777.
[17] ZAVATSKY JM, PETERS AJ, NAHVI FA, et al. Disease severity and treatment in adolescent idiopathic scoliosis: the impact of race and economic status. Spine Journal. 2015;15(5):939-943.
[18] WU H, LI Y, TONG L, et al. Worldwide research tendency and hotspots on hip fracture: a 20-year bibliometric analysis. Arch Osteoporos. 2021;16(1):73.
[19] WU H, SUN Z, TONG L, et al. Bibliometric analysis of global research trends on male osteoporosis: a neglected field deserves more attention. Arch Osteoporos. 2021;16(1):154.
[20] KIM H, KIM HS, MOON ES, et al. Scoliosis imaging: what radiologists should know. Radiographics. 2010;30(7):1823-1842.
[21] WEINSTEIN SL, DOLAN LA, SPRATT KF, et al. Health and function of patients with untreated idiopathic scoliosis - A 50-year natural history study. JAMA. 2003;289(5): 559-567.
[22] YANG P, XING J, CHEN B, et al. The clinical use of the enriched bone marrow obtained by selective cell retention technology in treating adolescent idiopathic scoliosis. J Orthop Translat. 2021;27:146-152.
[23] NEGRINI A, DONZELLI S, VANOSSI M, et al. Sports participation reduces the progression of idiopathic scoliosis and the need for bracing: an observational study of 511 adolescents with Risser 0-2 maturation stage. Eur J Phys Rehabil Med. 2023;59(2):222-227.
[24] DOBOSIEWICZ K, DURMALA J, CZERNICKI K, et al. Pathomechanic basics of conservative treatment of progressive idiopathic scoliosis according to Dobosiewicz method based upon radiologic evaluation. Stud Health Technol Inform. 2002;91:336-341.
[25] 常赢,夏渊,孙韫頔,等.不同特定运动治疗青少年特发性脊柱侧弯有效性的网状Meta分析[J].中国组织工程研究,2024, 28(36):5899-5904.
[26] MIYAGI M, SAITO W, MIMURA Y, et al. Posterior spinal fusion surgery for neuromuscular disease patients with severe scoliosis whose cobb angle was over 100 degrees. Medicina (Kaunas). 2023; 59(6):1090.
[27] AHONEN M, SYVANEN J, HELENIUS L, et al. Back pain and quality of life 10 years after segmental pedicle screw instrumentation for adolescent idiopathic scoliosis. Spine. 2023;48(10):665-671.
[28] LIMBERG AK, TIBBO ME, PAGNANO MW, et al. Varus-valgus constraint in 416 revision total knee arthroplasties with cemented stems provides a reliable reconstruction with a low subsequent revision rate at early to mid-term review. Bone Joint J. 2020; 102B(4):458-462.
[29] WANG H, ZHANG T, ZHANG C, et al. An intelligent composite model incorporating global / regional X-rays and clinical parameters to predict progressive adolescent idiopathic scoliosis curvatures and facilitate population screening. Ebiomedicine. 2023;95:104768.
[30] SARWARK JF, DAVIS MM. Evolving recommendations for scoliosis screening a compelling need for further research. JAMA. 2018;319(2):127-129.
[31] HUNG VWY, QIN L, CHEUNG CSK, et al. Osteopenia: a new prognostic factor of curve progression inadolescent idiopathic scoliosis. J Bone Joint Surg Am. 2005;87A(12):2709-2716.
[32] CHEUNG KMC, WANG T, QIU GX, et al. Recent advances in the aetiology of adolescent idiopathic scoliosis. Int Orthop. 2008;32(6):729-734.
[33] BURWELL RG, DANGERFIELD PH, FREEMAN BJC. Concepts on the pathogenesis of adolescent idiopathic scoliosis. Bone growth and mass, vertebral column, spinal cord, brain, skull, extra-spinal left-right skeletal length asymmetries, disproportions and molecular pathogenesis. Stud Health Technol Inform. 2008;135:3-52.
[34] WANG WJ, YEUNG HY, CHU WCW, et al. Top theories for the etiopathogenesis of adolescent idiopathic scoliosis. J Pediatr Orthop. 2011;31:S14-S27.
[35] WISE CA, GAO X, SHOEMAKER S, et al. Understanding genetic factors in idiopathic scoliosis, a complex disease of childhood. Curr Genomics. 2008;9(1):51-59.
[36] BURWELL RG, AUJLA RK, GREVITT MP, et al. Pathogenesis of adolescent idiopathic scoliosis in girls - a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy. Scoliosis. 2009;4:24-24.
[37] LOWE TG, EDGAR M, CHIR M, et al. Current concepts review - Etiology of idiopathic scoliosis: current trends in research. J Bone Joint Surg Am. 2000;82A(8):1157-1168.
[38] ACAROGLU E, BOBE R, ENOUF J, et al. The metabolic basis of adolescent idiopathic scoliosis: 2011 report of the “metabolic” workgroup of the Fondation Yves Cotrel. Eur Spine J. 2012;21(6):1033-1042.
[39] MARYA S, TAMBE AD, MILLNER PA, et al. Adolescent idiopathic scoliosis : a review of aetiological theories of a multifactorial disease. Bone Joint J. 2022;104B(8):915-921.
[40] WU H, ZHOU Y, WANG Y, et al. Current state and future directions of intranasal delivery route for central nervous system disorders: a scientometric and visualization analysis. Front Pharmacol. 2021;12:717192.