Intermediate-term annualized curve progression of adolescent idiopathic scoliosis curves measuring 40° or greater

Ward, W. Timothy; Crasto, Jared A.; Kenkre, Tanya S.; Dede, Özgür; Bosch, Patrick; Roach, James W.

doi:10.1007/s43390-020-00088-3

Cited by 8 publications

(11 citation statements)

References 13 publications

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“…Several studies analysed an ACP defining the growth of the Cobb angle over one year. In a prospective cohort study, Ward et al [35] found ACP was not linear over time in curves > 40° Cobb angles in 738 patients. Mean ACP was 6.3 ± 10.4°, yet, in the first year of follow-up, ACP was 11.5.…”

Section: Annual Curve Progression (Acp)mentioning

confidence: 97%

Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression

et al. 2021

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Introduction Idiopathic scoliosis, defined as a > 10° curvature of the spine in the frontal plane, is one of the most common spinal deformities. Age, initial curve magnitude and other parameters define whether a scoliotic deformity will progress or not. Still, their interactions and amounts of individual contribution are not fully elaborated and were the aim of this systematic review. Methods A systematic literature search was conducted in the common databases using MESH terms, searching for predictive factors of curve progression in adolescent idiopathic scoliosis (“adolescent idiopathic scoliosis” OR “ais” OR “idiopathic scoliosis”) AND (“predictive factors” OR “progression” OR “curve progression” OR “prediction” OR “prognosis”). The identified and analysed factors of each study were rated to design a top five scale of the most relevant factors. Results Twenty-eight investigations with 8255 patients were identified by literature search. Patient-specific risk factors for curve progression from initial curve were age (at diagnosis < 13 years), family history, bone mineral status (< 110 mg/cm3 in quantitative CT) and height velocity (7–8 cm/year, peak 11.6 ± 1.4 years). Relevant radiological criteria indicating curve progression included skeletal maturity, marked by Risser stages (Risser < 1) or Sanders Maturity Scale (SMS < 5), the initial extent of the Cobb angle (> 25° progression) and curve location (thoracic single or double curve). Discussion This systematic review summarised the current state of knowledge as the basis for creation of patient-specific algorithms regarding a risk calculation for a progressive scoliotic deformity. Curve magnitude is the most relevant predictive factor, followed by status of skeletal maturity and curve location.

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Section: Annual Curve Progression (Acp)mentioning

confidence: 97%

Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression

et al. 2021

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“…Although a main study objective was to identify patients requiring surgery via determinants of progression during early adulthood, we were unable to account for "late" progression extending beyond the average 12-year observational period. We also assumed a linear rate of Cobb angle change, but there are reports to the contrary among large untreated curves 31 .…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Post-Maturity Progression in Adolescent Idiopathic Scoliosis Curves of 40° to 50°

Cheung

et al. 2023

Journal of Bone and Joint Surgery

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Background:Adolescent idiopathic scoliosis (AIS) curves of 50° to 75° are inclined to progress and are thus indicated for surgery. Nevertheless, the natural history of curves of 40° to 50° following skeletal maturity remains uncertain and presents a clinical dilemma. The aim of this study was to determine the prevalence, rate, and prognostic indicators of curve progression within this patient group.Methods:This was a retrospective study of 73 skeletally mature patients with AIS. Following yearly or more frequent follow-up, patients were stratified as having no progression (<5° increase) or progression (≥5° increase). Those with progression were further differentiated as having standard progression (<2° increase/year) or fast progression (≥2° increase/year). Radiographic parameters (coronal balance, sagittal balance, truncal shift, apical translation, T1 tilt, apical vertebral wedging) and height were determined on skeletal maturity. Parameters that were significantly associated with progression were subject to receiver operating characteristic (ROC) curve analysis.Results:The average period of post-maturity follow-up was 11.8 years. The prevalence of progression was 61.6%. Among those with progression, the curve increased by a mean of 1.47° ± 1.22° per year, and among those with fast progression, by 3.0° ± 1.2° per year. Thoracic apical vertebral wedging (concave/convex vertebral height × 100) was more apparent in those with progression than in those without progression (84.1 ± 7.5 versus 88.6 ± 3.1; p = 0.003). Increased coronal imbalance (C7 plumb line to central sacral vertebral line) differentiated those with fast progression from others (16.0 ± 11.0 versus 8.7 ± 7.7 mm; p = 0.007). An ROC curve of height-corrected coronal balance demonstrated an area under the curve (AUC) of 0.722, sensitivity of 75.0%, and specificity of 72.5% in identifying fast progression. An ROC curve of height-corrected coronal balance together with apical vertebral wedging to identify those with progression demonstrated an AUC of 0.746, with specificity of 93.7% and sensitivity of 64.5%.Conclusions:While the majority of curves progressed, the average rate of progression was slow, and thus, yearly observation was a reasonable management approach. Upon validation in larger cohorts, apical wedging and coronal imbalance may identity patients suited for closer monitoring and early spinal fusion.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…Bracing is recommended for curves between 25−45 degrees, and surgery is considered for angles at or above 45 degrees. 2 In the absence of treatment, curvature is estimated to increase at a rate of 1% per year, although growth and vulnerability greatly accelerate curve increase in some adolescents, 3,4 and authors disagree about the natural history. 3,4…”

Section: Introductionmentioning

confidence: 99%

“…2 In the absence of treatment, curvature is estimated to increase at a rate of 1% per year, although growth and vulnerability greatly accelerate curve increase in some adolescents, 3,4 and authors disagree about the natural history. 3,4…”

Section: Introductionmentioning

confidence: 99%

“…Bracing is recommended for curves between 25À45 degrees, and surgery is considered for angles at or above 45 degrees. 2 In the absence of treatment, curvature is estimated to increase at a rate of 1% per year, although growth and vulnerability greatly accelerate curve increase in some adolescents, 3,4 and authors disagree about the natural history. 3,4 The International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT), a prominent group of scoliosis physicians, patients, their parents and therapists has recently delineated avoidance of surgery as the chief goal of conservative therapy.…”

Section: Introductionmentioning

confidence: 99%

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Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis—A Nonrandomized Control Trial

Fishman

2021

Glob Adv Health Med

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Objective Assess therapeutic value of specific yoga poses for thoracic and lumbar adolescent idiopathic scoliosis (AIS) taught in office or Internet. Study Design Nonrandomized control trial: Fifty-six adolescents (mean age 14.0 years; mean Risser 3.0) were recruited from our clinic; 41 did the side-plank, the half-moon and elevated side plank poses as appropriate (treatment group) and 15 did not (controls). Thirty curves were treated in office, 30 via Internet. Curve change was evaluated by blinded serial Cobb angles, and analyzed using Mann-Whitney U, paired t-tests and χ2. Results Mean lumbar and thoracolumbar Cobb angle change was −9.2 (95% CI = −11.8, −6.6) in the treatment group and 5.4 (95% CI = 1.7, 9.0) in controls. Both treatment group improvement and deterioration in controls were significant (treatment group: paired t-test t = −7.1, df = 40, p = .000; controls: t = 3.2, df = 12, p = .008). Mean thoracic Cobb angle change was −7.1 (95% CI = −13.1, −1.2) in the treatment group and 9.3 (95% CI = 4.5, 14.6) in controls. Both changes were significant (paired t-test t = −3.3, df = 21, p = .022 for treatment group; t = 4.5, df = 5, p = .006 for controls). Nine Internet patients were non-compliant vs. 6 office patients. Office patients improved 1.6 degrees/month or 5.5%/month; Internet patients improved .72 degrees/month or 3.3%/month. Conclusion These yoga poses show promise for reversing adolescent idiopathic scoliosis. Telemedicine had greater non-compliance and lower efficacy but still produced patient improvement.

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Intermediate-term annualized curve progression of adolescent idiopathic scoliosis curves measuring 40° or greater

Cited by 8 publications

References 13 publications

Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression

Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression

Post-Maturity Progression in Adolescent Idiopathic Scoliosis Curves of 40° to 50°

Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis—A Nonrandomized Control Trial

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