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Improvement in axial rotation with bracing reduces the risk of curve progression in patients with adolescent idiopathic scoliosis

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Abstract

Purpose

New evidence highlights the significance of 3D in-brace correction for Adolescent Idiopathic Scoliosis (AIS) patients. This study explores how axial parameters relate to treatment failure in braced AIS patients.

Methods

AIS patients (Sanders 1–5) undergoing Rigo-Chêneau bracing at a single institution were included. Axial vertebral rotation (AVR) was determined by utilizing pre-brace and in-brace 3D reconstructions from EOS® radiographs. The primary outcome was treatment failure: surgery or coronal curve progression > 5°. Minimum follow-up was two years.

Results

75 patients (81% female) were included. Mean age at bracing initiation was 12.8 ± 1.3 years and patients had a pre-brace major curve of 31.0° ± 6.5°. 25 patients (76% female) experienced curve progression > 5°, and 18/25 required surgical intervention. The treatment failure group had larger in-brace AVR than the success group (5.8° ± 4.1° vs. 9.9° ± 7.6°, p = 0.003), but also larger initial coronal curve measures. In-brace AVR did not appear to be associated with treatment failure after adjusting for the pre-brace major curve (Hazard Ratio (HR):0.99, 95% Confidence Interval (CI):0.94–1.05, p = 0.833). Adjusting for pre-brace major curve, patients with AVR improvement with bracing had an 85% risk reduction in treatment failure versus those without (HR:0.15, 95% CI:0.02–1.13, p = 0.066). At the final follow-up, 42/50 (84%) patients without progression had Sanders ≥ 7.

Conclusions

While in-brace rotation was not an independent predictor of curve progression (due to its correlation with curve magnitude), improved AVR with bracing was a significant predictor of curve progression. This study is the first step toward investigating the interplay between 3D parameters, skeletal maturity, compliance, and brace efficacy, allowing a future prospective multicenter study.

Level of evidence

Retrospective study; Level III.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity, confidentiality, and IRB compliance.

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Funding

This work was conducted with the support of a grant from the Scoliosis Research Society used to fund imaging analysis provided by EOS® imaging (Paris, France).

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA

    Michael W. Fields, Christina C. Rymond, Matan S. Malka, Ritt R. Givens, Matthew E. Simhon, Gerard F. Marciano & Afrain Z. Boby

  2. Department of Orthopaedic Surgery and Sports Medicine, Boston Children’s Hospital, Boston, MA, USA

    Hiroko Matsumoto

  3. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA

    Hiroko Matsumoto

  4. Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA

    Benjamin D. Roye & Michael G. Vitale

  5. Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center, 3959 Broadway, Chony 8-N, New York, NY, 10032-3784, USA

    Matan S. Malka, Ritt R. Givens, Benjamin D. Roye & Michael G. Vitale

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  1. Michael W. Fields
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Contributions

MWF, CCR, MSM, RRG, MES, HM, GFM, ASB, BDR, MGV—Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data, or the creation of new software used in the work. Drafted the work or revised it critically for important intellectual content. Approved of the version to be published. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ritt R. Givens.

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Conflict of interest

MWF has no conflicts of interest to disclose. CCR has no conflicts of interest to disclose. MSM has no conflicts of interest to disclose. RRG has no conflicts of interest to disclose. MES has no conflicts of interest to disclose. HM has no conflicts of interest to disclose. GFM has no conflicts of interest to disclose. AZB has no conflicts of interest to disclose. BDR has received grants from the Pediatric Orthopaedic Society of North America and Orthopedic Science Research Foundation. MGV has received grants from the Pediatric Orthopaedic Society of North America, Orthopedic Science Research Foundation, Pediatric Spine Foundation, and Setting Scoliosis Straight Foundation and royalties from Biomet. He is a paid consultant for Stryker, Biomet, and NuVasive. MGV is on the Board of Directors of Pediatric Spine Foundation, Pediatric Spine Study Group, and C4K. He is former president of Pediatric Orthopaedic Society of North America and is a Board Member, and Chair Emeritus of the International Pediatric Orthopaedic Symposium.

Ethics approval

This study was approved by the Columbia University Institutional Review Board (Protocol AAAS5931) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

This study qualifies for a waiver of consent because it is a retrospective chart review. It does not require patient participation, as all data has already been collected during routine clinical care. There is no potential to adversely affect the rights or welfare of subjects since this is a chart review.

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Fields, M.W., Rymond, C.C., Malka, M.S. et al. Improvement in axial rotation with bracing reduces the risk of curve progression in patients with adolescent idiopathic scoliosis. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00888-x

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