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Initial Cobb angle reduction velocity following bracing as a new predictor for curve progression in adolescent idiopathic scoliosis

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Abstract

Purpose

The initial correction rate (ICR) has been widely used as a predictor for curve progression in adolescent idiopathic scoliosis (AIS) undergoing bracing treatment. We proposed a new parameter, the initial Cobb angle reduction velocity (ARV), for prediction of curve progression. The purpose of this study was to identify whether the initial ARV was a more effective predictor than ICR for curve progression in AIS patients undergoing brace treatment, and to evaluate the ideal cut-off point of initial ARV for prediction of curve progression.

Methods

This was a retrospective cohort study on AIS girls receiving standardized bracing treatment regularly followed up every 3–6 months. Standardized SRS criteria for bracing study were utilized in the case selection. The demographic data, maturity status and Cobb angle of each visit were recorded. The initial ARV and ICR were identified. Patients were divided into progressive (≥6°) and non-progressive (<6°) groups based on their final bracing outcome. Differences between two groups were identified and logistic regression analysis was applied to compare the predictive values of initial ARV and ICR for curve progression during bracing treatment.

Results

Seventy-six patients were included in the non-progressive group and 19 in the progressive group. Significant differences between non-progressive and progressive groups were found in terms of initial ARV (12.8 ± 21.4°/year vs −5.4 ± 15.2°/year, P = 0.001) and ICR (12.1 ± 20.7 % vs −5.8 ± 18.0 %, P = 0.001). The logistic regression analysis revealed that age at initial visit (OR 1.742, P = 0.043) and initial ARV (OR 1.057, P = 0.002) had higher predictive values than ICR (P = 0.601) for curve progression in braced AIS girls. The ideal cut-off point of initial ARV was 10°/year (OR 8.959, P = 0.005) for the prediction of curve progression.

Conclusions

The initial Cobb angle reduction velocity serves as a better predictor for curve progression than initial correction rate in braced AIS patients with follow-up interval of 3–6 months. At the second visit following bracing prescription, those AIS patients with reduction velocity in Cobb angle lower than 10°/year have significantly higher risk of curve progression.

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Acknowledgments

This work was financially supported by the National Natural Science Foundation of China (81301603).

Conflict of interest

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Author notes

    Authors and Affiliations

    1. Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China

      Saihu Mao, Benlong Shi, Leilei Xu, Zezhang Zhu & Yong Qiu

    2. Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China

      Zhiwei Wang, Alec Lik Hang Hung, Tsz Ping Lam, Fiona Wai Ping Yu, Kwong Man Lee, Bobby Kin Wah Ng & Jack Chun Yiu Cheng

    3. Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China

      Saihu Mao, Benlong Shi, Leilei Xu, Zhiwei Wang, Tsz Ping Lam, Fiona Wai Ping Yu, Jack Chun Yiu Cheng, Zezhang Zhu & Yong Qiu

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    1. Saihu Mao
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    Correspondence to Yong Qiu.

    Additional information

    S. Mao, B. Shi and L. Xu contributed equally to this work.

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    Mao, S., Shi, B., Xu, L. et al. Initial Cobb angle reduction velocity following bracing as a new predictor for curve progression in adolescent idiopathic scoliosis. Eur Spine J 25, 500–505 (2016). https://doi.org/10.1007/s00586-015-3937-7

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    • DOI: https://doi.org/10.1007/s00586-015-3937-7

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