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

Michael W Fields; Christina C Rymond; Matan S Malka; Ritt R Givens; Matthew E Simhon; Hiroko Matsumoto; Gerard F Marciano; Afrain Z Boby; Benjamin D Roye; Michael G Vitale

doi:10.1007/s43390-024-00888-x

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

Spine Deform. 2024 May 2. doi: 10.1007/s43390-024-00888-x. Online ahead of print.

Authors

Michael W Fields¹, Christina C Rymond¹, Matan S Malka^{1

2}, Ritt R Givens^{3

4}, Matthew E Simhon¹, Hiroko Matsumoto^{5

6}, Gerard F Marciano¹, Afrain Z Boby¹, Benjamin D Roye^{7

2}, Michael G Vitale^{7

2}

Affiliations

¹ Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
² 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.
³ Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA. givens.ritt@gmail.com.
⁴ 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. givens.ritt@gmail.com.
⁵ Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA.
⁶ Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.
⁷ Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.

PMID: 38698106
DOI: 10.1007/s43390-024-00888-x

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.

Keywords: 3D correction; Adolescent idiopathic scoliosis; Axial parameters; Bracing.