Most 3D reconstruction studies for adolescent idiopathic scoliosis lack external validation

In a systematic review of 115 studies on 3D spinal reconstruction for adolescent idiopathic scoliosis (AIS), only 3.5% achieved workflow/generalization-level validation and none reached clinical-translation-level validation, highlighting a gap in AIS-specific external validation.

• 28 studies (24.3%) only achieved image/segmentation-level validation (L1), 49 (42.6%) anatomical-structure-level (L2), and 34 (29.6%) clinical-parameter-level (L3); only 4 (3.5%) reached workflow/generalization (L4), and none L5.
• No explicit AIS-specific external validation was identified, and the principal challenge is now translating structural fidelity into reliable clinical parameters across diverse populations and systems.
• CT and EOS offer relatively stronger evidence for osseous reconstruction and weight-bearing 3D assessment, while MRI-based and limited-projection methods are still evolving.

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