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Dufvenberg M, Charalampidis A, Diarbakerli E, Öberg B, Tropp H, Ahl AA, Wezenberg D, Hedevik H, Möller H, Gerdhem P, Abbott A. Prognostic model development for risk of curve progression in adolescent idiopathic scoliosis: a prospective cohort study of 127 patients. Acta Orthop 2024; 95:536-544. [PMID: 39287215 PMCID: PMC11395820 DOI: 10.2340/17453674.2024.41911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND AND PURPOSE The study's purpose was to develop and internally validate a prognostic survival model exploring baseline variables for adolescent idiopathic scoliosis curve progression. METHODS A longitudinal prognostic cohort analysis was performed on trial data (n = 135) including girls and boys, Cobb angle 25-40°, aged 9-17 years, remaining growth > 1 year, and previously untreated. Prognostic outcome was defined as curve progression of Cobb angle of > 6° prior to skeletal maturity. 34 candidate prognostic variables were tested. Time-to-event was measured with 6-month intervals. Cox proportional hazards regression survival model (CoxPH) was used for model development and validation in comparison with machine learning models (66.6/33.3 train/test data set). The models were adjusted for treatment exposure. RESULTS The final primary prognostic model included 127 patients, predicting progress with acceptable discriminative ability (concordance = 0.79, 95% confidence interval [CI] 0.72-0.86). Significant prognostic risk factors were Risser stage of 0 (HR 4.6, CI 2.1-10.1, P < 0.001), larger major curve Cobb angle (HRstandardized 1.5, CI 1.1-2.0, P = 0.005), and higher score on patient-reported pictorial Spinal Appearance Questionnaire (pSAQ) (HRstandardized 1.4, CI 1.0-1.9, P = 0.04). Treatment exposure, entered as a covariate adjustment, contributed significantly to the final model (HR 3.1, CI 1.5-6.0, P = 0.001). Sensitivity analysis displayed that CoxPH maintained acceptable discriminative ability (AUC 0.79, CI 0.65-0.93) in comparison with machine learning algorithms. CONCLUSION The prognostic model (Risser stage, Cobb angle, pSAQ, and menarche) predicted curve progression of > 6° Cobb angle with acceptable discriminative ability. Adding patient report of the pSAQ may be of clinical importance for the prognosis of curve progression.
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Affiliation(s)
- Marlene Dufvenberg
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.
| | - Anastasios Charalampidis
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm; Department of Reconstructive Orthopaedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Elias Diarbakerli
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm; Department of Reconstructive Orthopaedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Hans Tropp
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping; Center for Medical Image Science and Visualization, Linköping University, Linköping; Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden
| | - Anna Aspberg Ahl
- Department of Orthopaedics, Ryhov County Hospital, Jönköping, Sweden
| | - Daphne Wezenberg
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping; Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden
| | - Henrik Hedevik
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Hans Möller
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm; Stockholm Center for Spine Surgery, Stockholm, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm; Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Uppsala; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping; 2 Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm; Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden
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Altered mechanotransduction in adolescent idiopathic scoliosis osteoblasts: an exploratory in vitro study. Sci Rep 2022; 12:1846. [PMID: 35115632 PMCID: PMC8813918 DOI: 10.1038/s41598-022-05918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the most prevalent pediatric spinal deformity. We previously demonstrated elongated cilia and an altered molecular mechanosensory response in AIS osteoblasts. The purpose of this exploratory study was to characterize the mechanosensory defect occurring in AIS osteoblasts. We found that cilia length dynamics in response to flow significantly differ in AIS osteoblasts compared to control cells. In addition, strain-induced rearrangement of actin filaments was compromised resulting in a failure of AIS osteoblasts to position or elongate in function of the bidirectional-applied flow. Contrary to control osteoblasts, fluid flow had an inhibitory effect on AIS cell migration. Moreover, flow induced an increase in secreted VEGF-A and PGE2 in control but not AIS cells. Collectively our data demonstrated that in addition to the observed primary cilium defects, there are cytoskeletal abnormalities correlated to impaired mechanotransduction in AIS. Thus, we propose that the AIS etiology could be a result of generalized defects in cellular mechanotransduction given that an adolescent growing spine is under constant stimulation for growth and bone remodeling in response to applied mechanical forces. Recognition of an altered mechanotransduction as part of the AIS pathomechanism must be considered in the conception and development of more effective bracing treatments.
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