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How do we follow-up patients with adolescent idiopathic scoliosis? Recommendations based on a multicenter study on the distal radius and ulna classification

Abstract

Purpose

To determine the capability of the distal radius and ulna (DRU) classification for predicting the scoliosis progression risk within 1 year in patients with adolescent idiopathic scoliosis (AIS) and to develop simple recommendations for follow-up durations.

Methods

Medical records of patients with AIS at two tertiary scoliosis referral centers were retrospectively reviewed for their DRU classification and major curve Cobb angles. Baseline DRU grades and Cobb angles with subsequent 1-year follow-up curve magnitudes were studied for scoliosis progression, which was defined as exacerbation of the Cobb angle by ≥ 6°. The relationship between DRU classification and scoliosis progression risk within 1 year was investigated. Patients were divided into three groups according to the Cobb angle (10°–19°, 20°–29°, ≥ 30°).

Results

Of the 205 patients with 283 follow-up visits, scoliosis progression occurred in 86 patients (90 follow-up visits). Radius and ulna grades were significantly related to scoliosis progression (p < 0.001). R6, R7, and U5 grades were significantly related to scoliosis progression risk. The curve progression probability increased as the Cobb angle increased. Cobb angles ≥ 30°, with these grades, led to progression in > 80% of patients within 1 year. Curve progression was less likely for grades R9 and U7. Most patients with more mature DRU grades did not experience progression, even with Cobb angles ≥ 30°.

Conclusion

With R6, R7, and U5, scoliosis may progress within a short period; therefore, careful follow-up with short intervals within 6 months is necessary. R9 and U7 may allow longer 1-year follow-up intervals due to the lower progression risk.

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Acknowledgements

One author, Yusuke Yamamoto, has full control of all primary data, and the authors agree to allow the journal to review their data if requested.

Funding

This study was supported by the General Research Fund of the Research Grants Council #17156416.

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Authors and Affiliations

Authors

Contributions

YY collected the data, performed the statistical analysis, and wrote the manuscript. HS designed the study, collected the data, performed the statistical analysis, and wrote and edited the manuscript. PWHC, AO, and SK collected patients’ data and reviewed and approved the manuscript. YT collected patients’ data, provided critical feedback on the study, and reviewed and approved the manuscript. JPYC designed the study, collected the data, performed the statistical analysis, and wrote and edited the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hideki Shigematsu or Jason Pui Yin Cheung.

Ethics declarations

Conflict of interest

Yusuke Yamamoto, Hideki Shigematsu, Prudence Wing Hang Cheung, Akinori Okuda, Sachiko Kawasaki, Yasuhito Tanaka, and Jason Pui Yin Cheung declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards; the Institutional review board of Nara Medical University; Reference No.: 2171; and the Institutional review board of University of Hong Kong/ Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB); Reference No.: UW 17-361.

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Yamamoto, Y., Shigematsu, H., Cheung, P.W.H. et al. How do we follow-up patients with adolescent idiopathic scoliosis? Recommendations based on a multicenter study on the distal radius and ulna classification. Eur Spine J 29, 2064–2074 (2020). https://doi.org/10.1007/s00586-020-06441-4

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  • DOI: https://doi.org/10.1007/s00586-020-06441-4

Keywords

  • Adolescent idiopathic scoliosis
  • Distal radius and ulna classification
  • Bone age
  • Cobb angle
  • Curve progression
  • Follow-up duration