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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

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Abstract

Study design

Retrospective cohort study.

Objectives

To investigate radiographic sagittal and spinopelvic parameters of patients with adolescent idiopathic scoliosis (AIS) treated with bracing and assess differences among those treated successfully and unsuccessfully.

Summary of background data

AIS is a three-dimensional deformity of the spine, sharing an intricate relationship with pelvic morphology. However, the most relevant predictors of curve progression have historically been coronal parameters and skeletal maturity. Sagittal and spinopelvic parameters have not been thoroughly investigated as predictors of curve progression and brace treatment success.

Methods

Retrospective review of AIS patients who underwent brace treatment. Coronal Cobb angles (CC), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and thoracic spinopelvic angles (T1SP, T9SP) were measured prior to initiation of bracing. The sagittal and spinopelvic parameters of patients requiring surgical treatment due to curve progression were compared to those treated successfully with bracing.

Results

No significant differences were found for age, race, gender, Risser category (0/1 vs 2/3), initial CC, TK, LL, T1SP, or T9SP between cohorts. The cohort requiring surgery had significantly lower PI (p  <  0.001, 42.0 v. 54.6), SS (p  <  0.001, 37.0 v. 44.5), and PT (p  =  0.003, 5.0 v. 10.2) compared to those successfully treated with bracing. Multivariable models controlling for Risser stage and Initial CC revealed the odds for successful brace treatment increases with an increase in PI (OR  =  1.47, CI 1.18–1.83, p  <  0.001), SS (OR  =  1.26, CI 1.07–1.48, p  =  0.006), and PT (OR  =  1.43, CI 1.09–1.86, p  =  0.006) (Table 3). The odds of successful brace treatment is given per one-unit increase for each radiographic measure after adjusting for Initial CC and Risser sign which were forced into each multivariable model.

Conclusions

Spinopelvic parameters may indicate potential spine adaptability and skeletal maturity. For these reasons, we proposed that spinopelvic parameters may be a potential predictor of curve progression and brace treatment success. Our results demonstrated a higher risk of curve progression with lower PI, PT, or SS which support this hypothesis, however, given the small sample size and high variability, the magnitude of this effect should be viewed with caution and should serve as an impetus to further, larger scale studies to investigate the value spinopelvic parameters in curve progression and bracing efficacy.

Level of evidence

IV.

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Funding

No funding sources were used for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University Health System, DUMC Box 3000, Durham, 27710, NC, USA

    Anthony A. Catanzano Jr., Brian L. Dial, Robert D. Fitch & Robert K. Lark

  2. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, USA

    Thomas J. Risoli & Cynthia L. Green

  3. Duke University School of Medicine, Durham, USA

    Valentine R. Esposito, Christine J. Wu & Zoe W. Hinton

Authors
  1. Anthony A. Catanzano Jr.
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  2. Valentine R. Esposito
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  3. Brian L. Dial
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  4. Christine J. Wu
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  5. Zoe W. Hinton
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  6. Thomas J. Risoli
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  7. Cynthia L. Green
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  8. Robert D. Fitch
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Contributions

AAC Jr.: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. Drafting the work or revising it critically for important intellectual content Final approval of the version to be published. VRE: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published. BLD: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published. CJW: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published. ZWH: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published. TJR: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published. CLG: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published. RDF: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work Drafting the work or revising it critically for important intellectual content Final approval of the version to be published. RKL: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work Drafting the work or revising it critically for important intellectual content Final approval of the version to be published.

Corresponding author

Correspondence to Anthony A. Catanzano Jr..

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No copyrighted materials were used in this manuscript. This study was reviewed and approved by our institution’s Institutional Review Board (IRB), protocol number: Pro00090509.

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Catanzano, A.A., Esposito, V.R., Dial, B.L. et al. Staying ahead of the curve: the use of spinopelvic parameters to predict curve progression and bracing success in adolescent idiopathic scoliosis. Spine Deform 8, 1213–1222 (2020). https://doi.org/10.1007/s43390-020-00159-5

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  • DOI: https://doi.org/10.1007/s43390-020-00159-5

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