Staying ahead of the curve: the use of spinopelvic parameters to predict curve progression and bracing success in adolescent idiopathic scoliosis

Catanzano, Anthony A.; Esposito, Valentine; Dial, Brian; Wu, Chuansha; Hinton, Zoe W.; Risoli, Thomas; Green, Cynthia L.; Fitch, Robert D.; Lark, Robert K.

doi:10.1007/s43390-020-00159-5

Cited by 6 publications

(13 citation statements)

References 33 publications

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“…Of these, 126 articles were assessed for eligibility by full-text screening and 26 publications from 25 datasets were finally selected for inclusion. 2 , 11 , 12 , 17 - 39 …”

Section: Methodsmentioning

confidence: 99%

“…evidence is very low for Pt as a predictor of curve progression in braced patients. Both Catanzano et al17 and Guo et al21 found Pt to be predictive of curve progression in braced patients. Catanzano et al17 found that Pt > 8.5° significantly predicted good brace outcome (OR 0.7), adjusted for Cobb angle and Risser stage.…”

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confidence: 98%

“…Both Catanzano et al17 and Guo et al21 found Pt to be predictive of curve progression in braced patients. Catanzano et al17 found that Pt > 8.5° significantly predicted good brace outcome (OR 0.7), adjusted for Cobb angle and Risser stage. Guo et al 21 also found Pt to be predictive of curve progression in a multivariable analysis adjusting for Cobb angle and Risser stage (p < 0.01).…”

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confidence: 98%

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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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“…Of these, 126 articles were assessed for eligibility by full-text screening and 26 publications from 25 datasets were finally selected for inclusion. 2 , 11 , 12 , 17 - 39 …”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 98%

See 1 more Smart Citation

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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“…Non-modifiable intrinsic variations in spinal and trunk morphology may also play a role in brace function. Factors previously examined in the literature include the spinopelvic relation, 16 , 17 vertebral rotation, 11 , 18 curve type, 19 and curve flexibility. 11 , 13 However, there is a lack of prospective studies with sufficient sample size to examine the effect of these morphological factors on the outcome of bracing.…”

Section: Introductionmentioning

confidence: 99%

Supine correction index as a predictor for brace outcome in adolescent idiopathic scoliosis

Wong

Cheung

2022

The Bone & Joint Journal

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Aims The aim of this study was to assess the ability of morphological spinal parameters to predict the outcome of bracing in patients with adolescent idiopathic scoliosis (AIS) and to establish a novel supine correction index (SCI) for guiding bracing treatment. Methods Patients with AIS to be treated by bracing were prospectively recruited between December 2016 and 2018, and were followed until brace removal. In all, 207 patients with a mean age at recruitment of 12.8 years (SD 1.2) were enrolled. Cobb angles, supine flexibility, and the rate of in-brace correction were measured and used to predict curve progression at the end of follow-up. The SCI was defined as the ratio between correction rate and flexibility. Receiver operating characteristic (ROC) curve analysis was carried out to assess the optimal thresholds for flexibility, correction rate, and SCI in predicting a higher risk of progression, defined by a change in Cobb angle of ≥ 5° or the need for surgery. Results The baseline Cobb angles were similar (p = 0.374) in patients whose curves progressed (32.7° (SD 10.7)) and in those whose curves remained stable (31.4° (SD 6.1)). High supine flexibility (odds ratio (OR) 0.947 (95% CI 0.910 to 0.984); p = 0.006) and correction rate (OR 0.926 (95% CI 0.890 to 0.964); p < 0.001) predicted a lower incidence of progression after adjusting for Cobb angle, Risser sign, curve type, menarche status, distal radius and ulna grading, and brace compliance. ROC curve analysis identified a cut-off of 18.1% for flexibility (sensitivity 0.682, specificity 0.704) and a cut-off of 28.8% for correction rate (sensitivity 0.773, specificity 0.691) in predicting a lower risk of curve progression. A SCI of greater than 1.21 predicted a lower risk of progression (OR 0.4 (95% CI 0.251 to 0.955); sensitivity 0.583, specificity 0.591; p = 0.036). Conclusion A higher supine flexibility (18.1%) and correction rate (28.8%), and a SCI of greater than 1.21 predicted a lower risk of progression. These novel parameters can be used as a guide to optimize the outcome of bracing. Cite this article: Bone Joint J 2022;104-B(4):495–503.

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“…AIS affects 0.47-5.2% of adolescents aged 10-16 years old [2]. Bracing is the most efficient non-surgical approach for controlling curve progression in AIS cases who are most at risk (curves 25°-45° and Risser sign 0-2) [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Coronal deformity angular ratio as a predictive factor for in-brace curve correction and long-term outcome of brace treatment in adolescents with idiopathic scoliosis

et al. 2022

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Purpose To investigate the relationship between coronal deformity angular ratio (C-DAR) and in-brace correction (IBC) and their role in predicting the long-term bracing outcome in adolescents with idiopathic scoliosis (AIS). Methods In this retrospective multicenter study, the patient's sex, age, primary curve Cobb angle (at initiation of brace treatment, best in-brace, before spinal fusion, and final follow-up), curve pattern, duration of brace treatment, brace type, and C-DAR at initiation of bracing were recorded. The C-DAR values were classified as < 5, 5 ≤ to ≤ 6, and > 6. The IBC values were classified as ≥ 50%, 40% ≤ to ≤ 49%, and < 40%. We classified the patients into two groups of success and failure according to the Cobb angle at the final follow-up. Results A total of 164 patients (25 boys and 119 girls) were included. Bracing was successful in 60.4% of them. There was a significant association between C-DAR and bracing outcome (p < 0.0001). 63.9% of the patients with C-DAR < 5 had an IBC ≥ 50%. However, when C-DAR was 5 ≤ to ≤ 6 and > 6, 29.2% and 16.9% of the patients had an IBC of ≥ 50%, respectively. For patients with IBC ≥ 50%, the success rate of bracing was 89.2%. Results of logistic regression analysis revealed that the strongest predictor for brace treatment outcome was the C-DAR, with an odds ratio of 2.11. Conclusion C-DAR may be used as a predictive factor for the long-term outcome of brace treatment in AIS. Level of evidence IV.

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Staying ahead of the curve: the use of spinopelvic parameters to predict curve progression and bracing success in adolescent idiopathic scoliosis

Cited by 6 publications

References 33 publications

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

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

Supine correction index as a predictor for brace outcome in adolescent idiopathic scoliosis

Coronal deformity angular ratio as a predictive factor for in-brace curve correction and long-term outcome of brace treatment in adolescents with idiopathic scoliosis

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