Associations between spinal flexibility and bracing outcomes in adolescent idiopathic scoliosis: a literature review

Chang Liang Luo; Christina Zong Hao Ma; Yi Ying Zou; Li Sha Zhang; Man Sang Wong

doi:10.1186/s13018-023-04430-z

Associations between spinal flexibility and bracing outcomes in adolescent idiopathic scoliosis: a literature review

J Orthop Surg Res. 2023 Dec 11;18(1):955. doi: 10.1186/s13018-023-04430-z.

Authors

Chang Liang Luo^{1

2}, Christina Zong Hao Ma¹, Yi Ying Zou¹, Li Sha Zhang^{1

3}, Man Sang Wong⁴

Affiliations

¹ Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR.
² Department of Prosthetic and Orthotic Engineering, School of Rehabilitation, Kunming Medical University, Kunming, China.
³ Suzhou Vocational Health College, Suzhou, China.
⁴ Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR. m.s.wong@polyu.edu.hk.

Abstract

Objectives: To identify the existing assessment methods used to measure the spinal flexibility of adolescents with idiopathic scoliosis before bracing and to evaluate the predictive effect of spinal flexibility on bracing outcomes.

Methods: A broad literature search was performed in the PubMed, Web of Science, EMBASE, CINAHL, Scopus, and Cochrane Library databases to obtain relevant information about spinal flexibility and bracing outcomes. All literature was retrieved by October 14, 2023. The inclusion and exclusion criteria were meticulously determined. The quality of each included study and the level of evidence were evaluated by the Quality in Prognosis Studies (QUIPS) method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively.

Results: After screening 1863 articles retrieved from databases, a total of 14 studies with 2261 subjects were eligible for the final analysis in this review. Overall, nine methods of flexibility assessment were identified, including supine radiographs, supine lateral bending radiographs, lateral bending radiographs but without clear positions, hanging radiographs, fulcrum bending physical method, and ultrasound imaging in the positions of supine, prone, sitting with side bending and prone with side bending. In addition, five studies demonstrated that flexibility had a strong correlation with in-brace correction, and eleven studies illustrated that spinal flexibility was a predictive factor of the bracing outcomes of initial in-brace Cobb angle, initial in-brace correction rate, curve progression, and curve regression. The results of GRADE demonstrated a moderate-evidence rating for the predictive value of spinal flexibility.

Conclusion: Supine radiography was the most prevalent method for measuring spinal flexibility at the pre-brace stage. Spinal flexibility was strongly correlated with the in-brace Cobb angle or correction rate, and moderate evidence supported that spinal flexibility could predict bracing outcomes.

Keywords: Adolescent idiopathic scoliosis; Bracing; Predictor; Spinal flexibility.

Publication types

Review

MeSH terms

Adolescent
Braces
Humans
Prognosis
Radiography
Scoliosis* / diagnostic imaging
Scoliosis* / therapy
Spine