Predicting final results of brace treatment of adolescents with idiopathic scoliosis: first out-of-brace radiograph is better than in-brace radiograph—SOSORT 2020 award winner

Abstract

Purpose In-brace radiograph of adolescents with idiopathic scoliosis (AIS) has been shown to reflect brace efficacy and the possibility of achieving curve correction. Conversely, the first out-of-brace radiograph could demonstrate the patient’s ability to maintain the correction. We aimed to determine which of the two radiographs is the best predictor of the Cobb angle at the end of treatment (final radiograph). Design Retrospective cohort study of a prospective dataset. Methods The population was selected based on the following inclusion criteria: AIS, age 10–18 years; Risser score 0–2; Cobb angle 25–40°; brace treatment; availability of all radiographs. Statistics: Pearson correlations provide a first exploration of data. The univariate and multivariate logistic regression model tested the predictors. Finally ROC curve provided a check of model accuracy. Results A total of 131 patients were included (mean age 13.0 ± 1.3, Cobb angle 33.2 ± 5.5°; 78% females). At the end of treatment, 56% had stabilised, 9% had progressed, and 44% had improved. The difference between the in-brace and final radiographs was 8.0 ± 6.0°, while the difference between the first out-of-brace and final radiographs was 1.8 ± 5.2°. The best predictor of final outcome was the first out-of-brace radiograph (0.80), compared to in-brace (0.68) and baseline (0.59) radiographs. The best cut-offs to predict avoidance of progression were 30% and 10% of the correction rates for the in-brace and first out-of-brace radiographs, respectively. Conclusion The first out-of-brace radiograph predicts end results better than the in-brace radiograph. It offers an excellent clinical reference for clinicians and patients. The first out-of-brace radiograph should be considered an essential element of future predictive models. Level of Evidence 1 Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Impact of the Free-Pelvis Innovation in Very Rigid Braces for Adolescents with Idiopathic Scoliosis: Short-Term Results of a Matched Case-Control Study

“…Another issue is the matching confounders: we tried to be as comprehensive as possible, including most of the confounders known in the literature. The short-term results may change over a longer observation time, even if the current literature supports their use [ 24 , 25 ]. The study’s strength is the broad population considered, particularly in the matched sample, which could minimize the risk of poor matching: at baseline, the differences were minimal and not clinically significant.…”

Bracing Interventions Can Help Adolescents with Idiopathic Scoliosis with Surgical Indication: A Systematic Review

“…All these papers included patients who refused surgery and wanted to be treated with a brace. With this premise, it is reasonable to try a bracing approach, also considering that in about 6 months it is possible to have a quite reliable prediction of the final results [ 28 ], thus allowing to go on with even more motivation or eventually shift to surgery. Despite a common trend, there were differences in the results of the treatment.…”

Finite element simulation of growth modulation during brace treatment of adolescent idiopathic scoliosis

“…8,41,43 In the current study, reported correlations between simulated and actual 2-year Cobb angle values were comparable or better than other predictive models that leverage parameters related to IB 3D correction or other radiographic measurements at subsequent follow-ups. 9,44 However, the reported approach provides the significant benefit that an estimate of the 2-year evolution can be calculated before brace manufacturing.…”

“…The immediate IB correction is often used as an initial predictor of treatment success 8 . However, this metric captures solely the immediate effects and correlates only moderately to the curve severity at skeletal maturity 9 . Most centers still use it to validate brace effectiveness at the fitting visit and combine it with a posteriori metrics such the treatment success rate to report clinical results 4 .…”

“…8 However, this metric captures solely the immediate effects and correlates only moderately to the curve severity at skeletal maturity. 9 Most centers still use it to validate brace effectiveness at the fitting visit and combine it with a posteriori metrics such the treatment success rate to report clinical results. 4 Despite standardization efforts, these studies are difficult to compare because of biases and heterogenous patient cohorts.…”