Co-occurrence of suspected scoliosis and sagittal spinal deviations among early adolescents: a school-based cross-sectional study of prevalence and associated factors

Aims: This study aimed to investigate the prevalence and patterns of spinal postural abnormalities, particularly the co-occurrence of suspected scoliosis and sagittal spinal deviation, and to identify associated biological, behavioral, and psychosocial factors among early adolescents aged 12 to14 years. Methods: A school-based, cross-sectional study was conducted among 255 school children aged 12 to 14 years. The standardized postural assessments and validated questionnaires were used to obtain data on the spinal alignment, anthropometric measures, pain location, and behavioral and psychosocial characteristics. Frontal and sagittal deviations were assessed through standardized visual inspection procedures. Frontal deviations indicating suspected scoliosis were further examined using the Adam's forward bending test and the angle of trunk rotation (ATR) measured with a scoliometer. Behavioral variables included screen time and preferred posture during screen use, while psychosocial variables comprised knowledge, attitude, and practice (KAP) and self-postural awareness questionnaires. Associated factors were identified by performing comparative analyses and binary logistic regression. Results: Combined suspected scoliosis and sagittal spinal deviations were found in 21.2 percent of participants, with flattened thoracic curvature being the most frequent sagittal abnormality. Logistic regression revealed greater body height (AOR = 1.06, 95% CI: 1.02-1.11), lower KAP scores (AOR = 0.80, 95% CI: 0.72-0.89), while screen time (AOR = 1.22, 95% CI: 1.01-1.49) showed a more limited association with combined spinal deviations. Participants with suspected scoliosis reported more frequent upper back pain and lower self-postural awareness than those without deviations. Conclusion: A noteworthy proportion of early adolescents exhibited combined spinal deformities associated with biological and psychosocial-behavioral factors. Greater body height and lower KAP scores showed clearer associations with these conditions, whereas screen time demonstrated a tendency toward an association. These findings highlight the importance of incorporating posture assessment and health education into school-based initiatives. Improving early identification and encouraging healthy lifestyle behaviors may contribute to better spinal health and help reduce the risk of long-term musculoskeletal problems during adolescence.