Predictors of Clinically Meaningful Results of Bracing in a Large Cohort of Adolescents with Idiopathic Scoliosis Reaching the End of Conservative Treatment

Donzelli, Sabrina; Fregna, Giulia; Zaina, Fabio; Livetti, Giulia; Reitano, Maria Chiara; Négrini, Stefano

doi:10.3390/children10040719

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…Patient demographics are presented in Table I. Curve progression (>5°increase in the major Cobb angle) was demonstrated in 18.8% (38) of the patients, and 2.5% required surgical intervention.…”

Section: Resultsmentioning

confidence: 99%

“…However, PFMI grades 0 and 1 appear less relevant to our study population as the PFMI provides coverage of the peripubertal growth, and the timing of AIS presentation (10 to 18 years of age) does not coincide with the onset of the pubertal growth spurt 37 . Despite laying the foundation for the clinical utility of the PFMI in braced patients, validation in other ethnic groups and other regions should be performed 38 .…”

Section: Discussionmentioning

confidence: 99%

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Using the Proximal Femur Maturity Index at Brace Initiation for Adolescent Idiopathic Scoliosis Predicts Curve Progression Risk

Cheung,

Wong,

Luk

et al. 2024

Journal of Bone and Joint Surgery

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Background: The Proximal Femur Maturity Index (PFMI) can be used to assess skeletal maturity on existing whole-spine radiographs without additional radiation. However, the relationship between the PFMI at the initiation of bracing for adolescent idiopathic scoliosis (AIS) and subsequent curve progression remains unknown. This study aimed to investigate the relationship between the PFMI and curve progression, and the predictability of risks to adulthood curve progression and surgical thresholds based on the PFMI grade at brace initiation. Methods: This was a prospective study of 202 patients with AIS who were prescribed underarm bracing according to the Scoliosis Research Society criteria and had good brace-wear compliance. The patients were followed from brace initiation until complete skeletal maturity. Longitudinal data on the coronal Cobb angle and skeletal maturity assessments using Risser staging, Sanders staging, the distal radius and ulna classification, and the PFMI were collected. Each patient was assessed on whether the major curve progressed to ≥40° (adulthood deterioration) and ≥50° (the surgical threshold). Logistic regressions were used to predict probabilities of curve progression to the 2 thresholds, adjusted for factors that were significant in univariate analyses. Results: The PFMI correlated with the other skeletal maturity indices (rs [Spearman rank correlation] = 0.60 to 0.72, p < 0.001 for all). The pre-brace PFMI grade correlated with progression to ≥40° (rrb [rank-biserial correlation] = −0.30, p < 0.001) and to ≥50° (rrb = −0.20, p = 0.005). Based on regression models (p < 0.001) adjusted for the pre-brace major Cobb angle and curve type, brace initiation at PFMI grades 2 and 3 for a curve of ≥30° had predicted risks of 30% (95% confidence interval [CI], 4% to 55%) and 12% (95% CI, 7% to 17%), respectively, for progression to the surgical threshold. Brace initiation at PFMI grade 5 had 0% progression risk. Conclusions: The PFMI can be used for predicting curve progression and prognosticating brace outcomes in AIS. Patients with brace initiation at PFMI grade 4 for a curve of <30° or at grade 5 were unlikely to progress to the adulthood deterioration or surgical threshold. In comparison, skeletally immature patients initiating bracing at a PFMI grade of ≤3 for a major curve of ≥30° had a higher risk of progression despite compliant brace wear. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using the Proximal Femur Maturity Index at Brace Initiation for Adolescent Idiopathic Scoliosis Predicts Curve Progression Risk

Cheung,

Wong,

Luk

et al. 2024

Journal of Bone and Joint Surgery

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Does the coronal deformity angular ratio affect bracing outcome in adolescent idiopathic scoliosis?

Ragborg,

Thornberg,

Johnson

et al. 2024

Eur Spine J

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Purpose To examine if coronal deformity angular ratio (C-DAR) serves as a predictor for progression to surgical magnitude in patients with Adolescent Idiopathic Scoliosis (AIS) treated with thoracolumbar sacral orthosis (TLSO). Methods Patients with AIS, prescribed a full-time TLSO, Cobb angle 20–40°, Risser 0–2, who wore the brace ≥ 12.9 h and reached skeletal maturity/surgery were included retrospectively. C-DAR was defined as the Cobb angle divided by the number of vertebrae in the curve, yielding a larger value in short curves. The association between C-DAR and the risk of progression to surgical magnitude (> 45°) was assessed. Secondly, we evaluated the association between pre-treatment Cobb angle and in-brace correction on the risk of progression to > 45°. Results We included 165 patients with a mean Cobb angle of 30 ± 6°. Of these, 46/165 (28%) progressed ≥ 6° and 26/165 (16%) reached surgical magnitude at the end of treatment. C-DAR was a significant predictor for risk of progression to surgical magnitude with an OR of 1.9 (CI 1.2–2.9) per unit increase in C-DAR. A threshold value of 5.15 was established and demonstrated an OR 5.9 (CI 2.1–17.9) for curve progression to a surgical magnitude. Likewise, pre-treatment Cobb angle showed a significant OR 1.3(CI 1.2–1.4) per degree increase in Cobb, whereas in-brace % correction showed OR 0.96 (CI 0.93–0.98). Conclusion C-DAR is an independent predictor for progression to a surgical magnitude in AIS patients treated with bracing. Patients with a higher C-DAR should be counseled to help set realistic expectations regarding the likelihood of curve progression despite compliance with brace wear.

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Results of bracing adolescent idiopathic scoliosis in the context of clinical practice and the Scoliosis Research Society’s criteria: 5-year observational study from a German orthopaedic university hospital

Delbrück,

Karl,

Hildebrand

et al. 2024

Eur J Med Res

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Background Brace therapy’s influence on adolescent idiopathic scoliosis’s (AIS) natural course is inconclusive. Methods Brace-treated AIS patients from 2016 to 2020 were examined regarding four endpoints at brace weaning: surgery need, curve progress ≥ 6° and > 45°, and curve improvement ≥ 6°. Prediction variables’ influence was computed for the all-patients group and three subgroups (Subgroup 1: fulfilling the Scoliosis Research Society’s [SRS] criteria, Subgroup 2: initial Cobb angle < 25°, Subgroup 3: initial Cobb angle > 40°). According to the data characteristics, parametric and non-parametric tests and binary logistic regression were performed. Results The research included 69 patients. Overall, after brace weaning surgery was recommended for 20.3% of them, curve progression was ≥ 6° in 23.2%, the Cobb angle was beyond 45° in 11.6%, and the Cobb angle improved by ≥ 6° in 20.3%. Patients needing surgery had a significantly higher initial Cobb angle (38.8° ± 9.8° vs 27.8° ± 7.6°, p < 0.001), lower Risser stages (p = 0.010), and higher Nash and Moe degrees (p = 0.030). Patients with curve progress ≥ 6° were younger at first curve notification (12.4 ± 1.5 vs 13.7 ± 1.7 years, p = 0.011) and older at menarche (13.4 ± 1.1 vs 12.6 ± 1.2 years, p = 0.037). Furthermore, 21.6% of all Risser 3 and 4 patients had still curve progress ≥ 6°. In-brace correction was significantly higher in patients with curve improvement ≥ 6° vs < 6° (54.0% ± 31.2% vs 31.9% ± 30.7%; p = 0.019). Nine patients fulfilled the SRS criteria, 22 had initial Cobb angles < 25°, and 11 had > 40°. Real brace wear (RBW) in all groups had no significant effect on outcome. Two significant subgroup differences were found: Surgery recommendation and curve progression beyond 45° were significantly more frequent in the initial Cobb angle > 40° subgroup. Conclusions Brace effectiveness can be assumed because curve improvement was achieved in nearly one-fifth with sufficient in-brace correction. However, no significant influence of RBW on the outcome endpoints was demonstrated. To clarify conflicting results, big data management, including untreated patients, must be employed to further research AIS’s multifactorial influenced aetiology and course. Meanwhile, it is worth starting bracing in AIS in practice also beyond the SRS’s criteria.

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Predictors of Clinically Meaningful Results of Bracing in a Large Cohort of Adolescents with Idiopathic Scoliosis Reaching the End of Conservative Treatment

Cited by 3 publications

References 40 publications

Using the Proximal Femur Maturity Index at Brace Initiation for Adolescent Idiopathic Scoliosis Predicts Curve Progression Risk

Using the Proximal Femur Maturity Index at Brace Initiation for Adolescent Idiopathic Scoliosis Predicts Curve Progression Risk

Does the coronal deformity angular ratio affect bracing outcome in adolescent idiopathic scoliosis?

Results of bracing adolescent idiopathic scoliosis in the context of clinical practice and the Scoliosis Research Society’s criteria: 5-year observational study from a German orthopaedic university hospital

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