Is It Growth or Natural History? Increasing Spinal Deformity After Sanders Stage 7 in Females With AIS

Grothaus, Olivia; Molina, Domingo; Jacobs, Cale A.; Talwalkar,; Iwinski, Henry J.; Muchow, Ryan D.

doi:10.1097/bpo.0000000000001415

Cited by 16 publications

(11 citation statements)

References 27 publications

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“…This indicates that, in addition to DRU, it is an adequate indicator of skeletal maturity due to its high reliability [10]. 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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Study Design: This is a retrospective clinical study.Purpose: In this study, we aim to evaluate the reliability of the distal radius and ulna assessment (DRU) and simplified Tanner-Whitehouse III classification (sTW3) in Japanese patients with adolescent idiopathic scoliosis (AIS).Overview of Literature: The greatest curvature of a scoliotic spine occurs at peak-height velocity (PHV), which is the time during which an individual’s height increases at the maximum rate. Diagnosing and appropriately treating AIS before PHV is the most effective way in order to prevent unnecessary deterioration of the scoliosis curve. Although it is difficult to detect scoliosis before PHV, DRU and sTW3, which involve evaluations using a left-hand radiograph, have been reported to be effective.Methods: We retrospectively evaluated 54 hands of 40 girls with AIS who visited Nara Medical University Hospital from 2000 to 2015 using previously collected radiographs. The examiners included a spine surgeon and a pediatric orthopedic surgeon, each with over 10 years of experience. The reliability of the DRU and sTW3 was evaluated using the kappa coefficient.Results: The left-hand radiographs of 40 female patients with AIS (mean age, 13.9±1.7 years; N=54 hands) were evaluated by two blinded examiners using the sTW3 and DRU methods. The highest inter-observer and intra-observer reliabilities (kappa, 0.64 and 0.62, respectively) for radius evaluation were determined. Radius evaluation by the DRU showed the highest agreement rate and smallest error between the inter- and intra-observer examinations.Conclusions: The DRU was the most reliable assessment tool, and it has the potential to be useful for precisely determining the stage of skeletal maturity in outpatient clinics.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…12 Given these classifications and their associated implications for a patient's growth trajectory, we feel that our consolidated skeletal maturity scale is well justified. Given differences in curve behavior between Sanders stage 7 and 8, 24,25 investigation into treatment decision making regarding when to stop bracing and the implications on nonoperative treatment success is warranted. Also, given that Cobb angle radiographic measurement has been shown to demonstrate a 4 to 8 degrees interrater disagreement, [26][27][28][29] we felt that stratifying curves by 10 degrees provides more assurance against misclassification bias within each strata.…”

Section: Discussionmentioning

confidence: 99%

Risk of Scoliosis Progression in Nonoperatively Treated Adolescent Idiopathic Scoliosis Based on Skeletal Maturity

Johnson

Flynn

Anari

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Hand radiographs for skeletal maturity staging are now frequently used to evaluate remaining growth potential for patients with adolescent idiopathic scoliosis (AIS). Our objective was to create a model predicting a patient's risk of curve progression based on modern treatment standards. Methods: We retrospectively reviewed all AIS patients presenting with a major curve <50 degrees, available hand radiographs, and complete follow up through skeletal maturity at our institution over a 3-year period. Patients with growth remaining underwent rigid bracing of curves > 25 degrees, whereas patients between 10 and 25 degrees were observed. Treatment success was defined as reaching skeletal maturity with a major curve <50 degrees. Four risk categories were identified based on likelihood of curve progression.Results: Of 609 AIS patients (75.4% female) presenting with curves over 10 degrees and reaching skeletal maturity at most recent follow up, 503 (82.6%) had major thoracic curves. 16.3% (82/503) of thoracic curves progressed into surgical treatment range. The highest risk group (Sanders 1 to 6 and curve 40 to 49 degrees, Sanders 1 to 2 and curve 30 to 39) demonstrate a 30% success rate with nonoperative treatment. This constitutes an 111.1 times (95% confidence interval: 47.6 to 250.0, P < 0.001) higher risk of progression to surgical range than patients in the lowest risk categories (Sanders 1 to 8 and curve 10 to 19 degrees, Sanders 3 to 8 and curve 20 to 29 degrees, Sanders 5 to 8 and curve 30 to 39 degrees). Conclusions: Skeletal maturity and curve magnitude have strong predictive value for future curve progression. The results presented here represent a valuable resource for orthopaedic providers regarding a patient's risk of progression and ultimate surgical risk.

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“…As side bending radiographs were not available for some patients, modified Lenke (mLenke) classification system was used instead of the original Lenke system [ 28 , 51 ]. The major curve was defined as that with the greatest Cobb angle, and the minor curve with a Cobb angle ≥ 80% of the major curve magnitude was defined as structural.…”

Section: Methodsmentioning

confidence: 99%

Predicting curve progression for adolescent idiopathic scoliosis using random forest model

2022

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Background Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional (3D) spinal deformity characterized by coronal curvature and rotational deformity. Predicting curve progression is important for the selection and timing of treatment. Although there is a consensus in the literature regarding prognostic factors associated with curve progression, the order of importance, as well as the combination of factors that are most predictive of curve progression is unknown. Objectives (1) create an ordered list of prognostic factors that most contribute to curve progression, and (2) develop and validate a Machine Learning (ML) model to predict the final major Cobb angle in AIS patients. Methods 193 AIS patients were selected for the current study. Preoperative PA, lateral and lateral bending radiographs were retrospectively obtained from the Shriners Hospitals for Children. Demographic and radiographic features, previously reported to be associated with curve progression, were collected. Sequential Backward Floating Selection (SBFS) was used to select a subset of the most predictive features. Based on the performance of several machine learning methods, a Random Forest (RF) regressor model was used to provide the importance rank of prognostic features and to predict the final major Cobb angle. Results The seven most predictive prognostic features in the order of importance were initial major Cobb angle, flexibility, initial lumbar lordosis angle, initial thoracic kyphosis angle, age at last visit, number of levels involved, and Risser "+" stage at the first visit. The RF model predicted the final major Cobb angle with a Mean Absolute Error (MAE) of 4.64 degrees. Conclusion A RF model was developed and validated to identify the most important prognostic features for curve progression and predict the final major Cobb angle. It is possible to predict the final major Cobb angle value within 5 degrees error from 2D radiographic features. Such methods could be directly applied to guide intervention timing and optimization for AIS treatment.

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Is It Growth or Natural History? Increasing Spinal Deformity After Sanders Stage 7 in Females With AIS

Cited by 16 publications

References 27 publications

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

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

Risk of Scoliosis Progression in Nonoperatively Treated Adolescent Idiopathic Scoliosis Based on Skeletal Maturity

Predicting curve progression for adolescent idiopathic scoliosis using random forest model

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