It's not just the big kids: Both high and low BMI impact bracing success for adolescent idiopathic scoliosis

Goodbody, Christine; Asztalos, Ivor; Sankar, Wudbhav N.; Flynn, John M.

doi:10.1007/s11832-016-0763-3

Cited by 41 publications

(47 citation statements)

References 22 publications

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“…Relevant articles identified from the search are listed in Table 1 and more detailed description is available in the supplementary data section of this article. Although some of the risk factors were specific to only one article, seven risk factors were repeatedly mentioned in the literature: Poor brace compliance was mentioned as a major risk factor in eight studies [10,11,13−18], low values of skeletal maturity in six studies [9,19−23], Cobb angle over a certain value at the beginning of brace treatment in six studies [6,19,21−24], in-brace curve correction in three studies [9,18,25], significant vertebral rotation (apical vertebra rotation, Rib Hump, and Rib Vertebral Angle) in four studies [22,25−27], Osteopenia in two studies [21,28] and thoracic curve type in two studies [6,21]. These main risks are discussed in detail below.…”

Section: Identified Risk Factorsmentioning

confidence: 99%

“…Three articles identified initial in-brace correction as a predictive outcome for curve progression [9,18,25]. A study conducted by Xu et al [9] evaluated a cohort of 488 AIS patients with a 2-year follow-up after brace treatment.…”

Section: Low Value Of In-brace Correctionmentioning

confidence: 99%

“…The third article by Goodbody et al [18] aimed to study whether body mass index (BMI) affects brace treatment. A cohort of 166 patients was grouped according to patient BMI.…”

Section: Low Value Of In-brace Correctionmentioning

confidence: 99%

See 2 more Smart Citations

Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review

Hawary

Zaaroor-Regev²,

Floman

et al. 2019

The Spine Journal

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Brace treatment is the most common nonoperative treatment for the prevention of curve progression in adolescent idiopathic scoliosis. The success reported in level 1 and 2 clinical trials is approximately 75%. The aim of this review was to identify the main risk factors that significantly reduce success rate of brace treatment.A literature search using the MEDLINE and Embase databases was conducted. Studies were included if they identified specific risk factor(s) for curve progression. Studies that looked at nighttime braces, superiority of one type of brace over another, the effect of physical therapy on brace performance, cadaver or nonhuman studies were excluded. A total of 1,022 articles were identified of which 25 met all of the inclusion criteria. Seven risk factors were identified: Poor brace compliance (eight studies), lack of skeletal maturity (six studies), Cobb angle over a certain threshold (six studies), poor in-brace correction (three studies), vertebral rotation (four studies), osteopenia (two studies), and thoracic curve type (two studies). Three risk factors were highly repeated in the literature which identified specific subgroups of patients who have a much higher risk to fail brace treatment and to progress to fusion. This data demonstrates that 60% to 70% of the patients referred to bracing are Risser 0 and 30% to 70% of this group will not wear the brace enough to ensure treatment efficacy. Furthermore, Risser 0 patients who reach the accelerated growth phase with a curve ≥40˚are at 70% to 100% risk of curve progression to the fusion surgical threshold despite proper brace wear. Skeletally immature patients with relatively large magnitude scoliosis who are noncompliant FDA device/drug status: Not applicable.

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Section: Identified Risk Factorsmentioning

confidence: 99%

Section: Low Value Of In-brace Correctionmentioning

confidence: 99%

See 1 more Smart Citation

Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review

Hawary

Zaaroor-Regev²,

Floman

et al. 2019

The Spine Journal

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“…Это может быть обусловлено отбором пациентов в соответствии с критериями ОИС [15], исключающими пациентов младше 10 лет, у которых обычно прогрессирование деформации более выражено. Очевидно, что негативным фактором, ассоциированным с низкой эффек тивностью ношения корсета Шено, была избыточная масса тела, что описано в литературе [23].…”

Section: Discussionunclassified

Spinal deformity in adolescent idiopathic scoliosis at the end of Chêneau brace treatment

Tsaknakis

Braunschweig

Лена

et al. 2020

Pediatr Traum Orthop Reconstr Surg

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Background. Brace treatment is frequently used in adolescent idiopathic scoliosis (AIS). However, due to different brace models, long-term results on spinal deformity development at the end of Chneau brace treatment are not often described and differ in results. Aim. The aim of this work was to analyze clinical and radiological data of AIS patients treated with Chneau braces from the beginning of treatment until the end of growth and brace therapy in order to define realistic treatment results and expectations in an everyday setting. Materials and methods. 52 AIS patients with Chneau brace treatment were followed from the beginning of treatment until the end of growth. Clinical data such as the initial Risser sign, age at treatment, gender, curve patterns and body mass index were analyzed. Results. At the beginning of brace therapy, the average age was 13.1 years and patients showed a mean scoliotic curve angle of 30.9. Four months of brace use reduced the scoliotic curve to 20.1. Nine months after the end of brace treatment and an average treatment duration of 17 months, scoliosis has increased up to 30.3 again. In children with a lower maturity status, the initial scoliotic curve was less than in more mature patients leading to less spinal deformity at the end of treatment. In addition, obese children had less scoliosis correction during brace therapy than normalweight children. Conclusion. In patients with AIS treated with a Chneau brace, the initial curvature correction was 35%. Nine months after the end of brace treatment, scoliotic curves identical to the deformities at the beginning of treatment could be observed.

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“…[17] Patient height and weight were used to calculate BMI, and the corresponding percentile categories were determined (1, BMI >85th percentile (high-BMI group); 2, BMI <20th percentile (low-BMI group); and 3, BMI=20–85th percentile (mid-BMI group)). [18,19] The angle velocity was calculated as (angle velocity n – angle velocity n –1 )/[time interval ( n –( n –1))] (where n represents the 1 visit, and n –1 represents the follow-up preceding n). PAV was defined as the peak of the scoliosis angle velocity curves during the entire follow-up period during puberty; it is a maximum value; PAV's judgment is the key to the study.…”

Section: Methodsmentioning

confidence: 99%

The radiographic parameter risk factors of rapid curve progression in Lenke 5 and 6 adolescent idiopathic scoliosis

Chen

et al. 2017

Medicine

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Various parameters related to growth and maturity have been shown to be risk factors for scoliosis curve progression. We previously identified correlations between curve progression and radiographic parameters in clinical practice, but there is a lack of research.The aim of this study was to investigate and identify the radiographic parameters that are risk factors for rapid curve progression in Lenke 5 or 6 adolescent idiopathic scoliosis (AIS).A retrospective review of patients who were prospectively enrolled at the initiation of brace wear and followed through completion of bracing or surgery was performed. The inclusion criteria were as follows: a Lenke type 5 or 6 classification, Risser sign grade 0 or 1 at the initial outpatient examination, a follow-up period of 6 months including a minimum of 4 follow-ups, At each visit, the whole spine x-ray was completed, the following data were measured and collected: angle of the lumbar curve (LC), rotation of the apical vertebra (RAV) in the LC, deviation of the apical vertebra (DAV) in the lumbar curve, clavicle angle, L5 tilt angle (TA), body mass index, flexibility of the LC (FLC), and peak angle velocity (PAV). A binary logistic regression analysis was used to assess the contribution of each variable to PAV onset. The touch types for the determination of the lowest instrumented vertebra (LIV) were compared at both the PAV and final follow-up.Thirty-six AIS patients were recruited. The binary logistic regression model indicated that the following variable values significantly contributed to a high risk of PAV occurrence: LC ≥30° (OR = 6.153, 95%CI = 1.683-22.488, P = .006), RAV ≥III (OR = 15.484, 95%CI = 4.535-52.865, P <.001), DAV ≥40 mm (OR = 8.599, 95%CI = 2.483-29.784, P <.001), and TA ≥10° (OR = 2.223, 95%CI = 3.094-27.563, P <.001). The touch types for LIV determination changed in 12 of 36 patients, with at least 1 segment added as the LIV between the PAV and the final visit.LC ≥30°, RAV ≥III, DAV ≥40 mm, and L5 TA≥10° were radiographic parameters associated with an increased risk of curve progression in Lenke 5 and 6 AIS. The orthopedic surgery performed at the PAV is the ideal timing, and it will preserve 1 active segment than later surgery.Level of evidence was 4.

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It's not just the big kids: Both high and low BMI impact bracing success for adolescent idiopathic scoliosis

Cited by 41 publications

References 22 publications

Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review

Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review

Spinal deformity in adolescent idiopathic scoliosis at the end of Chêneau brace treatment

The radiographic parameter risk factors of rapid curve progression in Lenke 5 and 6 adolescent idiopathic scoliosis

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