Improvement in axial rotation with bracing reduces the risk of curve progression in patients with adolescent idiopathic scoliosis.

IF 1.6 Q3 CLINICAL NEUROLOGY Spine deformity Pub Date : 2024-09-01 Epub Date: 2024-05-02 DOI:10.1007/s43390-024-00888-x

Michael W Fields, Christina C Rymond, Matan S Malka, Ritt R Givens, Matthew E Simhon, Hiroko Matsumoto, Gerard F Marciano, Afrain Z Boby, Benjamin D Roye, Michael G Vitale

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Abstract

Purpose: New evidence highlights the significance of 3D in-brace correction for Adolescent Idiopathic Scoliosis (AIS) patients. This study explores how axial parameters relate to treatment failure in braced AIS patients.

Methods: AIS patients (Sanders 1-5) undergoing Rigo-Chêneau bracing at a single institution were included. Axial vertebral rotation (AVR) was determined by utilizing pre-brace and in-brace 3D reconstructions from EOS® radiographs. The primary outcome was treatment failure: surgery or coronal curve progression > 5°. Minimum follow-up was two years.

Results: 75 patients (81% female) were included. Mean age at bracing initiation was 12.8 ± 1.3 years and patients had a pre-brace major curve of 31.0° ± 6.5°. 25 patients (76% female) experienced curve progression > 5°, and 18/25 required surgical intervention. The treatment failure group had larger in-brace AVR than the success group (5.8° ± 4.1° vs. 9.9° ± 7.6°, p = 0.003), but also larger initial coronal curve measures. In-brace AVR did not appear to be associated with treatment failure after adjusting for the pre-brace major curve (Hazard Ratio (HR):0.99, 95% Confidence Interval (CI):0.94-1.05, p = 0.833). Adjusting for pre-brace major curve, patients with AVR improvement with bracing had an 85% risk reduction in treatment failure versus those without (HR:0.15, 95% CI:0.02-1.13, p = 0.066). At the final follow-up, 42/50 (84%) patients without progression had Sanders ≥ 7.

Conclusions: While in-brace rotation was not an independent predictor of curve progression (due to its correlation with curve magnitude), improved AVR with bracing was a significant predictor of curve progression. This study is the first step toward investigating the interplay between 3D parameters, skeletal maturity, compliance, and brace efficacy, allowing a future prospective multicenter study.

Level of evidence: Retrospective study; Level III.

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青少年特发性脊柱侧凸患者使用矫正器改善轴向旋转，可降低曲线恶化的风险。

目的：有新证据表明，三维支架内矫正对青少年特发性脊柱侧凸（AIS）患者具有重要意义。本研究探讨了轴向参数与矫形AIS患者治疗失败的关系：方法：纳入在一家医疗机构接受 Rigo-Chêneau 支架矫正的 AIS 患者（桑德斯 1-5）。轴向椎体旋转（AVR）通过使用 EOS® 放射线照片的支架前和支架内三维重建来确定。主要结果是治疗失败：手术或冠状曲线进展大于 5°。最短随访时间为两年：共纳入 75 名患者（81% 为女性）。开始接受矫形时的平均年龄为（12.8 ± 1.3）岁，矫形前的主要弯曲度为（31.0 ± 6.5）°。25 名患者（76% 为女性）的曲线进展大于 5°，其中 18/25 名患者需要手术治疗。治疗失败组的带环内反向屈曲比成功组大（5.8° ± 4.1° vs. 9.9° ± 7.6°，p = 0.003），但初始冠状曲线测量值也更大。在调整了臂前主要曲线后，臂内 AVR 似乎与治疗失败无关（危险比 (HR)：0.99，95% 置信区间 (CI)：0.94-1.05，p = 0.833）。调整支架前主要曲线后，使用支架改善房室重建的患者与未使用支架的患者相比，治疗失败的风险降低了 85%（HR：0.15，95% 置信区间（CI）：0.02-1.13，p = 0.066）。在最终随访中，42/50（84%）名无进展的患者的桑德斯≥7.结论：尽管支架内旋转不是曲线进展的独立预测因素（因为它与曲线幅度相关），但通过支架改善自动脉复位是曲线进展的重要预测因素。这项研究为研究三维参数、骨骼成熟度、顺应性和支具疗效之间的相互作用迈出了第一步，使未来的前瞻性多中心研究成为可能：回顾性研究；III 级。

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.