APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

Abstract

Study DesignProspective study.PurposeTo determine the risk of clinically significant curve progression in adolescent idiopathic scoliosis (AIS) based on the initial Cobb angle and to test the utility of the distal radius and ulna (DRU) classification in predicting these outcomes.Overview of LiteratureDetermining the remaining growth potential in AIS patients is necessary for predicting prognosis and initiating treatment. Limiting the maturity Cobb angle to <40° and <50° reduces the risk of adulthood progression and need for surgery, respectively. The risk of curve progression is the greatest with skeletally immature patients and thus warrants close monitoring or early intervention. Many parameters exist for measuring the skeletal maturity status in AIS patients, but the DRU classification has been shown to be superior in predicting peak growth and growth cessation. However, its predictive capabilities for curve progression are unknown.MethodsTotally, 513 AIS patients who presented with Risser 0–3 were followed until either skeletal maturity or the need for surgery, with a minimum 2-year follow-up period. Outcomes of 40° and 50° were used for probability analysis based on the cut-offs of adulthood progression risk and surgical threshold, respectively.ResultsAt the R6/U5 grade, most curves (probability of ≥48.1%–55.5%) beyond a Cobb angle of 25° progressed to the 40° threshold. For curves of ≥35°, there was a high risk of unfavorable outcomes, regardless of skeletal maturity. Most patients with the R9 grade did not progress, regardless of the initial curve magnitude (probability of 0% to reach the 50° threshold for an initial Cobb angle of ≥35°).ConclusionsThis large-scale study illustrates the utility of the DRU classification for predicting curve progression and how it may effectively guide the timing of surgery. Bracing may be indicated for skeletally immature patients at an initial Cobb angle of 25°, and those with a scoliosis ≥35° are at an increased risk of an unfavorable outcome, despite being near skeletal maturity.

Reliability Comparison between “Distal Radius and Ulna” and “Simplified Tanner–Whitehouse III” Assessments for Patients with Adolescent Idiopathic Scoliosis

“…With regard to surgical decision-making, brace weaning at stage 7 of sTW3 and R9U7 of DRU shows a high risk of curve progression [18], and a Cobb angle of >40° at stage 7 is associated with a significantly high risk of curve progression to >50° at skeletal maturity or the need for surgical treatment [19]. It is also possible to predict the possible Cobb angle at skeletal maturity using DRU staging and the Cobb angle at the first outpatient clinic visit; thus, both would be useful for surgical decision-making [20].…”

Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

“…One study which compared laminoplasty versus laminectomy and fusion for patients with multi-level OPLL showed that laminectomy and fusion was superior in maintaining cervical lordosis compared to laminoplasty in patients with OPLL [ 58 ]. There was also no significant difference in pre-operative and post-operative JOA scores of patients in either approach so both methods could achieve similar clinical improvement [ 58 ]. There was no significant difference in the rate of C5 palsy and axial pain with either approach but laminectomy and fusion had more blood loss ( P < 0.03) [ 58 ].…”

“…There was also no significant difference in pre-operative and post-operative JOA scores of patients in either approach so both methods could achieve similar clinical improvement [ 58 ]. There was no significant difference in the rate of C5 palsy and axial pain with either approach but laminectomy and fusion had more blood loss ( P < 0.03) [ 58 ]. Another study showed that laminectomy and fusion was able to significantly reduce the OPLL growth rate compared to laminoplasty [ 46 ].…”

Controversies with nonoperative management for adolescent idiopathic scoliosis: Study from the APSS Scoliosis Focus Group

“…1 The main aim of nonoperative treatment is to prevent curve progression and adulthood progression. 2,3 However, the options of nonoperative treatment are highly variable without clear consensus. 4,5 Standardization of care is important to improve overall healthcare efficiency as well as for comparative research.…”

“…Journal of Orthopaedic Surgery 28(2) least 14 years for girls and 16 years for boys. Most (49.4%) selected a gradual weaning protocol of brace-wear time reduction over the course of 6 months, while 25.3% switched to nocturnal wear for 3-12 months, and 21.7% selected immediate weaning.…”