Construction of a Screening and Precision Intervention System for Adolescent Idiopathic Scoliosis Based on the DIERS Spinal Moiré System

Against the backdrop of the Healthy China Strategy, the state attaches great importance to the health of adolescents and children. The "Healthy China 2030" Planning Outline puts forward the concept of "shifting the health threshold forward", identifying adolescents as a key population for prevention and control. On February 1, 2021, the Ministry of Education of China explicitly issued a document stating that scoliosis prevention should be incorporated into school health education and the monitoring network for common student diseases. In the same year, the National Health Commission released the Technical Guidelines for the Prevention and Control of Spinal Deformities in Children and Adolescents, which provides a reference framework for the prevention and control of spinal health in this population.

In this context, establishing a scientific and comprehensive policy for the screening and monitoring of adolescent scoliosis is of great practical significance for the early detection, early intervention and early treatment of scoliosis, as well as for safeguarding the spinal health of adolescents and children. However, domestically, only Shenzhen incorporated spinal screening into the compulsory education physical examination items in 2022, adopting the "five-step method" (including the use of a trunk rotation meter) for testing. In contrast, clinical palpation methods (such as the Adam's Forward Bend Test) have a specificity of only 60-70%, and traditional X-ray examinations are still widely used for subsequent rechecks.

Main Research Content Part 1: Establish a Comprehensive Scoliosis Screening Process Set up a research team and clarify the division of responsibilities among members. The Municipal Health Commission and Education Bureau shall demarcate the screening jurisdictions for each hospital; the Department of Spinal Surgery of the Municipal First People's Hospital shall take the lead in organizing training on on-site screening and monitoring for all participating hospitals, and formulate screening and monitoring procedures. The Municipal Education Bureau shall determine the number of subjects to be screened and specify the screening schedule. All hospitals shall collaborate with schools to organize screening for eligible adolescents and children. For children with abnormal results in the initial screening, it is recommended that they undergo an examination using the DIERS Spinal Moiré System.

Part 2: Analyze the Data from the Spinal Moiré System and Establish a Specialized Database for Adolescent Scoliosis For patients with abnormal results in the initial screening, it is recommended that they undergo a re-examination using the DIERS 4D Spinal Moiré System at Nantong First People's Hospital. All patients shall complete two sets of full-spine examinations with the DIERS 4D System in different positions: the standing position with arms hanging naturally and the standing position with elbows bent and hands on shoulders, in addition to a 4D motion examination. The DIERS 4D measurements shall be conducted independently by two physicians, with the average value taken as the final result. The operation of the DIERS 4D System shall be performed by professionally trained technicians, and the system will automatically generate the measured Cobb angle values and spine-pelvis related parameters. All collected data shall be deployed on a cloud computing server.

For the clinical data of all patients with adolescent idiopathic scoliosis (AIS), changes in the Cobb angle, vertebral rotation angle, pelvic parameters (pelvic torsion, pelvic rotation, pelvic inclination) and coronal plane balance measured by the DIERS 4D System in the two positions (arms hanging naturally vs. elbows bent and hands on shoulders) shall be observed, so as to analyze the impact of measurement position differences on the spine-pelvis morphological parameters. Pearson correlation analysis, Logistic regression and Wilcoxon test shall be adopted to evaluate parameter differences and high-risk factors.

Construction of the Prediction Model: Taking Cobb angle progression (an increase of ≥ 5° within 6 months) as the outcome indicator, variables including pelvic parameters, body posture difference parameters, age and bone age shall be incorporated. A biomechanical prediction model shall be established using multivariate regression analysis or machine learning algorithms (e.g., random forest). The model performance (e.g., AUC value, accuracy rate) shall be evaluated through internal validation (20% of the samples shall be selected for testing) and external validation (comparison with AIS data from other regions).

Part 3: Develop Personalized Treatment Plans for Adolescent Scoliosis Based on the Analysis Results of the Spinal Moiré System Data.

Based on DIERS parameters (such as scoliosis severity, rotation angle, and pelvic imbalance type) and the prediction model results, hierarchical rehabilitation programs are formulated:

Mild cases (Cobb angle: 10°-25°): Modified Spinal Balance Exercises based on the German Schroth Method plus biofeedback training (correcting poor posture through visual/auditory feedback).

Moderate cases (Cobb angle: 25°-45°): Brace wearing (adjusting brace stress points based on DIERS parameters) plus personalized exercise prescriptions (e.g., core muscle training targeting pelvic rotation).

Verification of Intervention Effectiveness Recruit 500 adolescent idiopathic scoliosis (AIS) patients as volunteers, and divide them into the precision intervention group and the conventional program group according to Lenke classification for a 1-year intervention. Evaluate changes in spine-pelvis parameters via the DIERS system every 3 months. The control group adopts conventional intervention programs (e.g., universal exercise therapy). Compare the two groups in terms of Cobb angle progression rate (proportion of patients with a progression ≥ 5° after intervention), improvement degree of pelvic compensation, and patient compliance.

Part 4: Formulation of Standardized Procedures and Pilot Promotion Procedure Integration Based on the results of screening, diagnosis, intervention, and management, a standardized procedure is formed as follows: Initial Screening (Modified Five-Step Method) → Re-examination (DIERS System) → Diagnosis (Combined with Cobb Angle and Lenke Classification) → Personalized Intervention (Guided by DIERS Parameters) → Regular Follow-up (DIERS Monitoring).

Pilot Promotion Pilot the procedure in 3-5 primary and secondary schools and 2-3 primary medical institutions in Nantong City, and evaluate the screening coverage rate (target: ≥ 80%), re-examination rate of patients with abnormal results (target: ≥ 60%), and intervention effective rate (target: ≥ 60%).

Collect feedback from the pilot sites and optimize procedural details (e.g., simplifying the operation steps of the DIERS system and adding a parental education module).

VII. Data Statistics and Outcome Dissemination Statistical analysis is performed using SPSS 26.0 or R software. Measurement data are expressed as mean ± standard deviation; inter-group comparisons are conducted using t-test or analysis of variance (ANOVA). Enumeration data are analyzed using the chi-square test. A value of P < 0.05 is considered statistically significant.

Compile research reports, 1-2 SCI-indexed papers, and the Guidelines for Screening and Intervention of Adolescent Scoliosis in Nantong City, and promote the popularization of research outcomes among regional medical institutions and schools.