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Assessment of malalignment at early stage in adolescent idiopathic scoliosis: a longitudinal cohort study

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Abstract

Introduction

Our objective was to assess abnormalities of the odontoid-hip axis (OD-HA) angle in a mild scoliotic population to determine whether screening for malalignment would help predict the distinction between progressive and stable adolescent idiopathic scoliosis (AIS) at early stage.

Materials and methods

All patients (non-scoliotic and AIS) underwent a biplanar X-ray between 2013 and 2020. In AIS, inclusion criteria were Cobb angle between 10° and 25°; Risser sign lower than 3; age higher than 10 years; and no previous treatment. A 3D spine reconstruction was performed, and the OD-HA was computed automatically. A reference corridor for OD-HA values in non-scoliotic subjects was calculated as the range [5th–95th percentiles]. A severity index, helping to distinguish stable and progressive AIS, was calculated and weighted according to the OD-HA value.

Results

Eighty-three non-scoliotic and 205 AIS were included. The mean coronal and sagittal OD-HA angles in the non-scoliotic group were 0.2° and −2.5°, whereas in AIS values were 0.3° and −0.8°, respectively. For coronal and sagittal OD-HA, 27.5% and 26.8% of AIS were outside the reference corridor compared with 10.8% in non-scoliotic (OR = 3.1 and 3). Adding to the severity index a weighting factor based on coronal OD-HA, for thoracic scoliosis, improved the positive predictive value by 9% and the specificity by 13%.

Conclusion

Analysis of OD-HA suggests that AIS patients are almost three times more likely to have malalignment compared with a non-scoliotic population. Furthermore, analysis of coronal OD-HA is promising to help the clinician distinguish between stable and progressive thoracic scoliosis.

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Abbreviations

3D:

Three-dimensional

OD-HA:

The odontoid-hip axis angle

AIS:

Adolescent idiopathic scoliosis

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Acknowledgements

The authors are grateful to the BiomecAM chair programme on subject-specific musculoskeletal modelling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Covea and Proteor).

Funding

This study has received funding from the BiomecAM chair programme on subject-specific musculoskeletal modelling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Covea and Proteor).

Author information

Authors and Affiliations

  1. Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France

    Tristan Langlais, Claudio Vergari, Laurent Gajny, Ayman Assi, Jean Dubousset & Wafa Skalli

  2. Service Orthopédie et Traumatologie, Hôpital des Enfants, Purpan, Toulouse Université, Toulouse, France

    Tristan Langlais

  3. Service Orthopédie et Traumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, APHP, Paris, France

    Gregoire Rougereau

  4. Service Orthopédie et Traumatologie, Hôpital Necker Enfants Malades, Paris cité Université, APHP, Paris, France

    Mathilde Gaume

  5. Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge Française. Centre Médico-Chirurgical Et de Réadaptation Des Massues, Lyon, France

    Kariman Abelin-Genevois & Jean Claude Bernard

  6. SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Zongshan Hu & Jack Chun Yiu Cheng

  7. Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Winnie Chiu Wing Chu

  8. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Joseph University of Beirut, SaintBeirut, Lebanon

    Ayman Assi, Mohamad Karam & Ismat Ghanem

  9. Department of Orthopedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon

    Ismat Ghanem

  10. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Tito Bassani, Luca Maria Sconfienza & Marco Brayda-Bruno

  11. Spine Center, Schulthess Clinic, Zurich, Switzerland

    Fabio Galbusera

  12. Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy

    Luca Maria Sconfienza

  13. Unite Rachis, CHU - Hopital Bellevue, Saint-Etienne, France

    Isabelle Courtois & Eric Ebermeyer

  14. Sorbonne Université, Service Orthopédie et Traumatologie, Hôpital A. Trousseau, APHP, Paris, France

    Raphael Vialle

Authors
  1. Tristan Langlais
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  2. Claudio Vergari
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Corresponding author

Correspondence to Tristan Langlais.

Ethics declarations

Competing interest

Wafa Skalli has a patent related to biplanar X-rays and associated 3D reconstruction methods, with no personal financial benefit (royalties rewarded for research and education) licenced to EOS imaging. Raphael Vialle reports personal fees and grants (unrelated to this study) from Stryker. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical approval and informed consent

Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Data availability statements

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

  • (N = 138) Vergari et al. 2022: Spine slenderness is not an early sign of progression in adolescent idiopathic scoliosis. Medical Engineering and Physics

  • (N = 205) Vergari et al., 2021: Effect of curve location on the severity index for adolescent idiopathic scoliosis: a longitudinal cohort study. European Radiology

  • (N = 55) Vergari et al., 2019: Quasi-automatic early detection of progressive idiopathic scoliosis from biplanar radiography a preliminary validation. European Spine Journal

  • (N = 65) Skalli et al., 2017: Early detection of progressive adolescent idiopathic scoliosis a severity index. Spine

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Langlais, T., Vergari, C., Rougereau, G. et al. Assessment of malalignment at early stage in adolescent idiopathic scoliosis: a longitudinal cohort study. Eur Spine J 33, 1665–1674 (2024). https://doi.org/10.1007/s00586-024-08178-w

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