Discrepancy Between Radiographic Correction and Cosmetic Improvement in Adolescent Idiopathic Scoliosis: The Role of Extremely Low BMI.
- 1Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
- 2Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
Abstract
Study DesignRetrospective matched cohort study.ObjectivesTo investigate the association between body mass index (BMI) and postoperative cosmetic improvement in adolescent idiopathic scoliosis (AIS).MethodsAmong 737 female AIS patients, the 10th percentile of the raw BMI distribution was used to define "extremely low BMI". Lenke type 1 patients with extremely low BMI were matched 1:1 to non-extremely low BMI patients by age, apical vertebra, and preoperative Cobb angle. Sex, Risser sign category, curve pattern and surgical approach were standardized through the inclusion criteria. Pre- and 1-year postoperative radiographic and cosmetic parameters and SRS-22 scores were compared using paired analyses accounting for matched-pair design. The primary outcome was the between-group difference in postoperative cosmetic improvement; all other analyses were prespecified as secondary or exploratory.ResultsThe BMI threshold for extremely low BMI was 15.57 kg/m². Radiographic correction was comparable between cohorts. However, the non-extremely low BMI group improved more in shoulder area indices (SAI1/SAI2), shoulder (SA) and axilla (AA) angles, right-left waist angle difference (RLWAD), and posterior superior iliac spine (PSIS) angle (all P < 0.05). The extremely low BMI group had lower SRS-22 self-image (3.3±0.6 vs. 4.2±0.8) and mental health (3.4±0.4 vs. 4.1±0.3) scores (both P ≤ 0.010). Fisher's r-to-z test showed significantly weaker or directionally different radiographic-cosmetic correlations in the extremely low BMI group (P<0.05).ConclusionsExtremely low BMI was associated with poorer cosmetic improvement, worse self-image, and weaker radiographic-cosmetic correlations, suggesting a wider discrepancy between radiographic correction and cosmetic improvement.
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BibTeX
@article{chu2026discrepancy,
title = {{Discrepancy Between Radiographic Correction and Cosmetic Improvement in Adolescent Idiopathic Scoliosis: The Role of Extremely Low BMI.}},
author = {Weihang Chu and Abdukahar Kiram and Jie Li and Zongshan Hu and Benlong Shi and Jun Qiao and Saihu Mao and Xiaodong Qin and Yong Qiu and Zezhang Zhu and Zhen Liu},
journal = {Global spine journal},
year = {2026},
month = oct,
doi = {10.1177/21925682261501029},
url = {https://europepmc.org/article/MED/42920304},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Discrepancy Between Radiographic Correction and Cosmetic Improvement in Adolescent Idiopathic Scoliosis: The Role of Extremely Low BMI.
AU - Weihang Chu
AU - Abdukahar Kiram
AU - Jie Li
AU - Zongshan Hu
AU - Benlong Shi
AU - Jun Qiao
AU - Saihu Mao
AU - Xiaodong Qin
AU - Yong Qiu
AU - Zezhang Zhu
AU - Zhen Liu
PY - 2026
DA - 2026/10/23
JO - Global spine journal
DO - 10.1177/21925682261501029
UR - https://europepmc.org/article/MED/42920304
AB - Study DesignRetrospective matched cohort study.ObjectivesTo investigate the association between body mass index (BMI) and postoperative cosmetic improvement in adolescent idiopathic scoliosis (AIS).MethodsAmong 737 female AIS patients, the 10th percentile of the raw BMI distribution was used to define "extremely low BMI". Lenke type 1 patients with extremely low BMI were matched 1:1 to non-extremely low BMI patients by age, apical vertebra, and preoperative Cobb angle. Sex, Risser sign category, curve pattern and surgical approach were standardized through the inclusion criteria. Pre- and 1-year postoperative radiographic and cosmetic parameters and SRS-22 scores were compared using paired analyses accounting for matched-pair design. The primary outcome was the between-group difference in postoperative cosmetic improvement; all other analyses were prespecified as secondary or exploratory.ResultsThe BMI threshold for extremely low BMI was 15.57 kg/m². Radiographic correction was comparable between cohorts. However, the non-extremely low BMI group improved more in shoulder area indices (SAI1/SAI2), shoulder (SA) and axilla (AA) angles, right-left waist angle difference (RLWAD), and posterior superior iliac spine (PSIS) angle (all P < 0.05). The extremely low BMI group had lower SRS-22 self-image (3.3±0.6 vs. 4.2±0.8) and mental health (3.4±0.4 vs. 4.1±0.3) scores (both P ≤ 0.010). Fisher's r-to-z test showed significantly weaker or directionally different radiographic-cosmetic correlations in the extremely low BMI group (P<0.05).ConclusionsExtremely low BMI was associated with poorer cosmetic improvement, worse self-image, and weaker radiographic-cosmetic correlations, suggesting a wider discrepancy between radiographic correction and cosmetic improvement.
SN - 2192-5682
SN - 2192-5690
ER -