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“Will I Need a Brace?”: likelihood of curve progression to bracing range in adolescent idiopathic scoliosis

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Abstract

Purpose

Bracing treatment for adolescent idiopathic scoliosis (AIS) is typically initiated in skeletally immature patients with primary curves greater than 25°. The goal of this study was to develop a model predicting a patient’s likelihood of progressing to bracing treatment.

Methods

All patients with AIS presenting to a large pediatric spine center with a primary curve below 25° and skeletally immature (Sanders stage 1–6) were included. A patient was considered to have progressed into the bracing range if their primary curve reached a 25° threshold prior to skeletal maturity. Binary logistic regression analysis was performed to predict the likelihood of curve progression into bracing range.

Results

A total of 180 patients (71% female) were included in this study with an average presenting age of 13.2 ± 1.4 years. At presentation, 31 (17%) were pre-peak height velocity, 62 (34%) were at their peak height velocity, and 87 (48%) were in the late adolescent growth stage. The high-risk patient group was defined as Sanders 1–2 and curve size > 10 and < 25° or Sanders 3–6 and curve size > 20 but < 25°. Those in the high-risk group demonstrated an over 5 times higher risk of progression to bracing range when accounting for age, sex, and curve location (OR: 5.168, 95% CI: 2.212–12.071, p < 0.001).

Conclusion

Patient’s curve magnitude and skeletal maturity can be used to predict their likelihood of curve progression to greater than 25° and thus require bracing treatment. Orthopaedic providers can consider earlier treatment interventions or stricter follow-up adherence for patients at high risk for progression.

Level of evidence

3—retrospective cohort study.

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Division of Orthopaedics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Mitchell A. Johnson, Shivani Gohel, John M. Flynn, Jason B. Anari, Patrick J. Cahill, Jennifer J. Winell & Keith D. Baldwin

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Mitchell A. Johnson

Authors
  1. Mitchell A. Johnson
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  2. Shivani Gohel
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  3. John M. Flynn
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  4. Jason B. Anari
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  5. Patrick J. Cahill
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  6. Jennifer J. Winell
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  7. Keith D. Baldwin
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Contributions

Conception or design of work: MAJ, SG, JMF, JBA, PJC, JJW, and KDB. Acquisition, analysis, or interpretation of data for the work: MAJ, SG, JMF, JBA, PJC, JJW, and KDB. Drafting of work or revising it critically for important intellectual content: MAJ, SG, JMF, JBA, PJC, JJW, and KDB. Final approval of version to be published: MAJ, SG, JMF, JBA, PJC, JJW, and KDB.

Corresponding author

Correspondence to Keith D. Baldwin.

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All authors have no relevant financial or non-financial interests to disclose.

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This study was conducted with IRB approval.

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Johnson, M.A., Gohel, S., Flynn, J.M. et al. “Will I Need a Brace?”: likelihood of curve progression to bracing range in adolescent idiopathic scoliosis. Spine Deform 10, 537–542 (2022). https://doi.org/10.1007/s43390-021-00457-6

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  • DOI: https://doi.org/10.1007/s43390-021-00457-6

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