Curve progression risk in a mixed series of braced and nonbraced patients with idiopathic scoliosis related to skeletal maturity assessment on the olecranon

Purpose The EOS-imaging system is increasingly adopted for clinical follow-up in scoliosis with the advantages of simultaneous biplanar imaging of the spine in an erect position. Skeletal maturity assessment using a hand radiograph is an essential adjunct to spinal radiography in scoliosis follow-up. This study aims at testing the feasibility and validity of a newly proposed EOS workflow with sequential spine-hand radiography for skeletal maturity assessment and bracing recommendation. Methods EOS spine-hand radiographs from patients with diagnosis of idiopathic scoliosis, including both sexes and an age range of ten to 14 years, were scored using the Thumb Ossification Composite Index (TOCI), Sanders and Risser methods. Intraclass correlation coefficients (ICCs) were calculated for inter/intraobserver agreement and were tested with Cronbach’s alpha values. Results In all, 60 EOS-spine hand radiographs selected from subjects with diagnosis of adolescent idiopathic scoliosis (AIS), including 32 male patients (mean age 11.53 years; 10 to 14) and 28 female patients (mean age 11.50 years; 10 to 13) who underwent sequential spine-hand low dose EOS imaging were generated for analysis. The overall interobserver (ICC = 0.997) and intraobserver agreement (α > 0.9) demonstrated excellent agreement for TOCI staging; ICC > 0.994 for both TOCI and Sanders staging comparing traditional digital versus EOS hand radiography; ICC ≥ 0.841 for agreement on bracing recommendation among TOCI versus the Risser and Sanders system. Conclusion With the proposed new EOS workflow it was feasible to produce high image quality for skeletal maturity assessment with excellent reliability and validity to inform consistent bracing recommendation in AIS. The workflow is applicable for busy daily clinic settings in tertiary scoliosis centres with reduced time cost, improved efficiency and throughput of the radiology department. Level of evidence III

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

Asian Spine Journal ◽

10.4184/asj.2018.12.2.202 ◽

2018 ◽

Vol 12 (2) ◽

pp. 202-213 ◽

Cited By ~ 10

Author(s):

Jason Pui Yin Cheung ◽

Prudence Wing Hang Cheung ◽

Dino Samartzis ◽

Keith Dip-Kei Luk

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Distal Radius ◽

Skeletal Maturity ◽

Curve Progression ◽

Close Monitoring ◽

Skeletally Immature ◽

Increased Risk ◽

Curve Magnitude

<sec><title>Study Design</title>Prospective study.</sec><sec><title>Purpose</title>To 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.</sec><sec><title>Overview of Literature</title>Determining 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.</sec><sec><title>Methods</title>Totally, 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.</sec><sec><title>Results</title>At 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°).</sec><sec><title>Conclusions</title>This 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.</sec>

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Maturity Assessment and Curve Progression in Girls with Idiopathic Scoliosis

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.f.00067 ◽

2007 ◽

Vol 89 (1) ◽

pp. 64-73 ◽

Cited By ~ 134

Author(s):

James O. Sanders ◽

Richard H. Browne ◽

Sharon J. McConnell ◽

Susan A. Margraf ◽

Timothy E. Cooney ◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Curve Progression ◽

Maturity Assessment

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Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients

Prosthetics and Orthotics International ◽

10.1080/03093640108726570 ◽

2001 ◽

Vol 25 (1) ◽

pp. 60-70 ◽

Cited By ~ 23

Author(s):

M.S. Wong ◽

A.F.T. Mak ◽

K.D.K. Luk ◽

J.H. Evans ◽

B. Brown

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Skeletal Maturity ◽

Curve Progression ◽

Long Term Study ◽

Cobb’S Angle ◽

Spinal Control ◽

Risk Curves ◽

Spinal Muscles ◽

Postural Training

The possibility of using learned physiological responses in control of progressive adolescent idiopathic scoliosis (AIS) was investigated. Sixteen (16) AIS patients with progressing or high-risk curves (Cobb's angle between 25° and 35° at start and reducible by lateral bending) were fitted with a device with tone alarm for poor posture. In the first 18 months of application, 3 patients defaulted and 4 showed curve progression > 10° (2 changed to rigid spinal orthoses and 2 underwent surgery). The curves for the other 9 patients were kept under control (within ±5° of Cobb's angle) and 5 of them have reached skeletal maturity and terminated the application. The remaining 4 patients were still using the devices until skeletal maturity or curve progression. The curve control rate was 69%. A long-lasting active spinal control could be achieved through the patient's own spinal muscles. Nevertheless, before the postural training device could become a treatment modality, a long-term study for more AIS patients was necessary. This project is ongoing in the Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong.

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

European Spine Journal ◽

10.1007/s00586-021-06817-0 ◽

2021 ◽

Author(s):

Maximilian Lenz ◽

Stavros Oikonomidis ◽

Arne Harland ◽

Philipp Fürnstahl ◽

Mazda Farshad ◽

...

Keyword(s):

Systematic Review ◽

Idiopathic Scoliosis ◽

Predictive Factors ◽

Literature Search ◽

Skeletal Maturity ◽

Curve Progression ◽

Patient Specific ◽

Initial Curve ◽

Scoliotic Deformity ◽

Curve Magnitude

Abstract 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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