Prediction of Curve Progression in Idiopathic Scoliosis

Sitoula, Prakash; Verma, Kushagra; Holmes, Laurens; Gabos, Peter G.; Sanders, James O.; Yorgova, Petya; Neiss, Geraldine; Rogers, Kenneth; Shah, Suken A.

doi:10.1097/brs.0000000000000952

Cited by 77 publications

(46 citation statements)

References 14 publications

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“…Similar findings were also reported by Sitoula et al [24] who retrospectively studied a sample of 161 patients from initial diagnosis until reaching skeletal maturity, curve progression to ≥50˚, or spinal fusion. Fifty-one percent of the patients in the study were braced and half of them progressed at endpoint.…”

Section: Initial Cobb Anglesupporting

confidence: 88%

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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: Initial Cobb Anglesupporting

confidence: 88%

“…Another study by Whitaker et al [37] looked specifically at the value of bracing patients that are 40˚or more and found that of the Risser 0 patients that are >40˚, 84% had surgery or were >50˚at the end of treatment. Sitoula et al [24] found that 100% of the patients with curves ≥40˚and Risser ≤4 progress to the surgery threshold.…”

Section: Discussionmentioning

confidence: 99%

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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“…The accurate prediction of which AIS patients will experience curve progression is dependent on the clinician's ability to interpret the remaining growth potential. At initial presentation, the severity of the deformity measured by the Cobb angle and growth rate can provide useful information regarding the likely future curve behavior [ 5 21 ]. Many radiographic parameters exist to predict growth but have known limitations, including poor prediction of PHV for the timing of brace treatment [ 22 23 24 25 26 ], concerns with inter-observer reliability and complexity [ 27 28 29 ], and the cumbersome nature of using them in a busy clinical setting [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Determining a child's remaining skeletal growth is crucial for the management of adolescent idiopathic scoliosis (AIS) [ 1 2 3 ]. This is particularly important for brace treatment because the prompt initiation of this management approach can reduce the number of AIS patients undergoing surgery [ 4 5 6 ]. Generally, the goal of a bracing treatment is to prevent a patient from reaching the commonly described surgical threshold of >50°.…”

Section: Introductionmentioning

confidence: 99%

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

Samartzis

Luk

2018

Asian Spine J

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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.

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“…It identifies 8 stages of progression from ‘juvenile slow’ to ‘mature’. This classification compares the Cobb angle and digital skeletal age to predict the likelihood of curve progression [ 17 , 18 ].…”

Section: Natural Historymentioning

confidence: 99%

Adolescent Idiopathic Scoliosis

Choudhry¹,

Ahmad²,

Verma³

2016

TOORTHJ

160

117

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Background:Scoliosis refers to deviation of spine greater than 10 degrees in the coronal plane. Idiopathic Scoliosis is the most common spinal deformity that develops in otherwise healthy children. The sub types of scoliosis are based on the age of the child at presentation. Adolescent idiopathic scoliosis (AIS) by definition occurs in children over the age of 10 years until skeletal maturity.Objective: The objective of this review is to outline the features of AIS to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.Method: A thorough literature search was performed using available databases, including Pubmed and Embase, to cover important research published covering AIS.Conclusion:AIS results in higher incidence of back pain and discontent with body image. Curves greater than 50 degrees in thoracic region and greater than 30 degrees in lumbar region progress at a rate of 0.5 to 1 degree per year into adulthood. Curves greater than 60 degrees can lead to pulmonary functional deficit. Therefore once the disease is recognized, effective treatment should be instituted to address the deformity and prevention of its long-term sequelae.

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Prediction of Curve Progression in Idiopathic Scoliosis

Abstract: 3.

Cited by 77 publications

References 14 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

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

Adolescent Idiopathic Scoliosis

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