Rib-vertebral angle measurements predict brace treatment outcome in Risser grade 0 and premenarchal girls with adolescent idiopathic scoliosis

Sun, Xu; Ding, Qi; Sha, Shifu; Mao, Saihu; Zhu, Feng; Zhu, Zezhang; Qian, Bangping; Wang, Bin; Cheng, Jack C. Y.; Qiu, Yong

doi:10.1007/s00586-015-4372-5

Cited by 8 publications

(9 citation statements)

References 32 publications

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“…Maruyama et al [25] described above found that better results were predicted for patients with less clinical rotation. Sun et al [26] retrospectively evaluated 48 braced AIS girls at Risser 0 and found that the angle between the rib and the vertebra also serves as an indicator for the likelihood of the curve to progress >6˚. The authors describe that curve progression was significantly higher in patients with initial rib vertebral angle difference ≥20˚versus patients with initial rib vertebral angle difference <20˚, or convex initial rib vertebral angle ≤68˚versus convex initial rib vertebral angle >68˚.…”

Section: Vertebral Rotationmentioning

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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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: Vertebral Rotationmentioning

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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“…Six studies found no association between Cobb angle and outcome of progression. However, five of these studied Cobb angle in univariate analysis only, 17 , 21 , 23 , 26 , 34 without accounting for its interaction with age and maturity. Only Ohrt-Nissen et al 31 showed that initial Cobb angle was not predictive of curve progression after adjusting for age and menarchal status.…”

Section: Resultsmentioning

confidence: 99%

Curve type, flexibility, correction, and rotation are predictors of curve progression in patients with adolescent idiopathic scoliosis undergoing conservative treatment

Wong

Cheung

2022

The Bone & Joint Journal

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Aims The aim of this study was to review the current evidence surrounding curve type and morphology on curve progression risk in adolescent idiopathic scoliosis (AIS). Methods A comprehensive search was conducted by two independent reviewers on PubMed, Embase, Medline, and Web of Science to obtain all published information on morphological predictors of AIS progression. Search items included ‘adolescent idiopathic scoliosis’, ‘progression’, and ‘imaging’. The inclusion and exclusion criteria were carefully defined. Risk of bias of studies was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. In all, 6,286 publications were identified with 3,598 being subjected to secondary scrutiny. Ultimately, 26 publications (25 datasets) were included in this review. Results For unbraced patients, high and moderate evidence was found for Cobb angle and curve type as predictors, respectively. Initial Cobb angle > 25° and thoracic curves were predictive of curve progression. For braced patients, flexibility < 28% and limited in-brace correction were factors predictive of progression with high and moderate evidence, respectively. Thoracic curves, high apical vertebral rotation, large rib vertebra angle difference, small rib vertebra angle on the convex side, and low pelvic tilt had weak evidence as predictors of curve progression. Conclusion For curve progression, strong and consistent evidence is found for Cobb angle, curve type, flexibility, and correction rate. Cobb angle > 25° and flexibility < 28% are found to be important thresholds to guide clinical prognostication. Despite the low evidence, apical vertebral rotation, rib morphology, and pelvic tilt may be promising factors. Cite this article: Bone Joint J 2022;104-B(4):424–432.

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“…Brace applies forces on the rib prominence postero-laterally and results in derotation of the spine [20], however, the role of the shape of the rib cage, particularly the angle between the ribs and vertebrae on the bracing outcomes are not well-determined. Rib-vertebrae angle differentiated between progressive versus non-progressive pediatric scoliosis [10, 21, 22]. A higher curve progression was observed in patients with an initial rib-vertebra angle asymmetry higher than 20° or a rib-vertebra angle smaller than 68° on the convex side [10]; however, it was not discussed whether this observation could have been related to the curve severity.…”

Section: Discussionmentioning

confidence: 99%

“…Rib-vertebrae angle differentiated between progressive versus non-progressive pediatric scoliosis [10, 21, 22]. A higher curve progression was observed in patients with an initial rib-vertebra angle asymmetry higher than 20° or a rib-vertebra angle smaller than 68° on the convex side [10]; however, it was not discussed whether this observation could have been related to the curve severity. The angle between the rib and vertebra can impact the rib loading under an exterior force [23].…”

Section: Discussionmentioning

confidence: 99%

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3D spinal and rib cage predictors of brace effectiveness in adolescent idiopathic scoliosis

Pasha

2019

BMC Musculoskelet Disord

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Background Scoliotic braces are the standard of curve for management of moderate spinal deformities in pediatric patients. The effectiveness of this treatment method has been shown; however, the spinal and rib cage parameters, in the three anatomical planes, that are associated with bracing outcome in adolescent idiopathic scoliosis (AIS) are not fully identified. Methods A total number of 45 right thoracic AIS patients who had received a thoraco-lumbo-scaral brace for the first time were included retrospectively. For each patient, radiographic images at three visits, pre-brace, in-brace, and at least 1 year after the first brace fit were included. Age, sex, Risser sign, and curve type at pre-brace, and thoracic and lumbar frontal and sagittal Cobb angles, thoracic and lumbar apical rotations, sagittal and frontal balances at pre-brace and in-brace were determined. Two sagittal curve types (hypothoracolumbar and normal/hyperthoracolumbar kyphosis), two rib cage types based on the costovertebral joints (drooping and horizontal), and two axial shapes of the spine (S shaped and V shaped) were used to stratify the patients. Feature selection and linear regression with regularization determined the parameters and the interaction terms that predicted the brace effectiveness significantly. Results Smaller in-brace thoracic Cobb and larger in-brace lordosis predicted brace effectiveness, p < 0.05. Impact of the out of brace lordosis on the brace success increased as the in brace kyphosis angle decreased, p = 0.046. A larger out of brace lordosis in hypothoracolumbar sagittal profile type patients improved the outcomes, p = 0.031. A smaller out of brace thoracic rotation improved the bracing outcomes in patients with horizontal ribs, p = 0.040. Conclusion Both 3D patient specific parameters (lordosis, thoracic rotation, shape of the rib cage, and sagittal profile) and brace design (which allows larger in brace lordosis, better in brace Cobb correction) are important predictors of the brace effectiveness in AIS. Electronic supplementary material The online version of this article (10.1186/s12891-019-2754-2) contains supplementary material, which is available to authorized users.

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Rib-vertebral angle measurements predict brace treatment outcome in Risser grade 0 and premenarchal girls with adolescent idiopathic scoliosis

Abstract: The initial RVAD ≥20° and CRVA ≤68° serve as valid factors in predicting the risk of curve progression during bracing in early AIS. Constant watch on RVAD and CRVA can help to more accurately predict the effectiveness of bracing in these patients.

Cited by 8 publications

References 32 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

Curve type, flexibility, correction, and rotation are predictors of curve progression in patients with adolescent idiopathic scoliosis undergoing conservative treatment

3D spinal and rib cage predictors of brace effectiveness in adolescent idiopathic scoliosis

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