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Negrini F, Febbo F, Tessadri F, Zonta A, Tavernaro M, Donzelli S, Zaina F, Negrini S. The New Modular Sforzesco Brace (Modular Italian Brace) Is as Effective as the Classical One: A Retrospective Controlled Study from a Prospective Cohort. J Clin Med 2024; 13:2075. [PMID: 38610839 PMCID: PMC11012574 DOI: 10.3390/jcm13072075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The Sforzesco brace is a very rigid push-up brace effective in adolescent idiopathic scoliosis (AIS). We recently developed a new Sforzesco brace based on modularity (the Modular Italian brace-MI brace) that could allow standardization, facilitating global expertise diffusion, increased modifiability and adaptability, and cost savings due to longer brace life. We aimed to compare the short-term results of the two braces. Methods: The retrospective study included 231 consecutive AIS treated with a MI brace (N = 53) or Sforzesco brace (N = 178). The main outcome was the first 6-month follow-up out-of-brace radiograph Cobb angle change. Secondary outcomes included the in-brace Cobb degrees and aesthetics (TRACE), prominence (angle of trunk rotation and mm), kyphosis, and lordosis changes. Results: The two groups were similar at baseline, apart from more immature patients in MI brace. Both braces reduced the Cobb angle (-6° out-of-brace; -16° in-brace) without differences between groups. All secondary outcomes improved, apart from a statistically and clinically insignificant 3° kyphosis reduction. The MI brace participants were 4.9 times more likely to improve the Cobb angle than the Sforzesco brace (OR = 4.92; 95%CI 1.91-12.64; p = 0.001). Conclusions: These findings suggest that the MI-brace can be safely used instead of the classical Sforzesco brace. However, further studies of different designs and longer follow-ups are needed to confirm these findings.
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Affiliation(s)
- Francesco Negrini
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
- Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
| | - Francesca Febbo
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | | | - Andrea Zonta
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | - Marta Tavernaro
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, 20122 Milan, Italy;
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
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Fregna G, Rossi Raccagni S, Negrini A, Zaina F, Negrini S. Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis. SENSORS (BASEL, SWITZERLAND) 2023; 24:116. [PMID: 38202978 PMCID: PMC10780905 DOI: 10.3390/s24010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spine and trunk deformity. Bracing is an effective treatment for medium-degree curves. Thermal sensors help monitor patients' adherence (compliance), a critical issue in bracing treatment. Some studies investigated adherence determinants but rarely through sensors or in highly adherent cohorts. We aimed to verify the influence of personal and clinical variables routinely registered by physicians on adherence to brace treatment in a large cohort of consecutive AIS patients from a highly adherent cohort. We performed a cross-sectional study of patients consecutively recruited in the last three years at a tertiary referral institute and treated with braces for one year. To ensure high adherence, for years, we have provided specific support to brace treatment through a series of cognitive-behavioural interventions for patients and parents. We used iButton thermal sensor systematic data collection to precisely analyse the real brace-wearing time. We included 514 adolescents, age 13.8 ± 1.6, with the worst scoliosis curve of 34.5 ± 10.3° Cobb. We found a 95% (95CI 60-101%) adherence to the brace prescription of 21.9 ± 1.7 h per day. Determinants included gender (91% vs. 84%; females vs. males) and age < 14 years (92% vs. 88%). Brace hours prescription, BMI, and all clinical variables (worst curve Cobb degrees, angle of trunk rotation, and TRACE index for aesthetics) did not influence adherence.
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Affiliation(s)
- Giulia Fregna
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Sara Rossi Raccagni
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Alessandra Negrini
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, 20122 Milan, Italy;
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
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Roggio F, Trovato B, Sortino M, Onesta MP, Petrigna L, Musumeci G. The Role of Muscle Biomarkers in Adolescent Idiopathic Scoliosis. J Clin Med 2023; 12:7616. [PMID: 38137689 PMCID: PMC10743897 DOI: 10.3390/jcm12247616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the predominant orthopedic disorder in children, affecting 1-3% of the global population. Research in this field has tried to delineate the genetic factors behind scoliosis and its association with heredity since AIS is considered a polygenic disease and has different genetic and epigenetic factors. The current study conducted a narrative review of the literature, focusing on biomarkers in the pathophysiology of muscle in AIS patients. Articles were collected from Scopus, Pubmed, and Web of Science. The key screening parameters were scoliosis classification, sampling, and the biomarkers evaluated. This review emphasizes potential key mechanisms and molecular regulators in muscle tissue. While there has been limited focus on the proteins contributing to muscle changes in AIS, significant attention has been given to genomic studies of single-nucleotide polymorphisms, particularly in LBX1. Despite these efforts, the exact causes of AIS remain elusive, with several theories suggesting genetic and hormonal factors. This review identified critical protein biomarkers such as Gi-protein alpha subunits, fibrillin-1 and -2, and various differentially expressed proteins, which may be linked to muscle alterations in AIS. This field of research is still limited due to a lack of homogeneity in the distinction of patients by groups and curve severity. Although the pathophysiology of AIS is still unclear, molecular research is important to guide the treatment of AIS before achieving skeletal maturity, thus avoiding serious problems associated with posture changes and low quality of life. In the future, a more comprehensive synergy between orthopedic and molecular research might ameliorate the diagnosis and treatment of AIS patients.
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Affiliation(s)
- Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy
| | - Bruno Trovato
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | - Martina Sortino
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | | | - Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n 97, 95123 Catania, Italy
- Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
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Negrini F, Cina A, Ferrario I, Zaina F, Donzelli S, Galbusera F, Negrini S. Developing a new tool for scoliosis screening in a tertiary specialistic setting using artificial intelligence: a retrospective study on 10,813 patients: 2023 SOSORT award winner. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3836-3845. [PMID: 37650978 DOI: 10.1007/s00586-023-07892-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The study aims to assess if the angle of trunk rotation (ATR) in combination with other readily measurable clinical parameters allows for effective non-invasive scoliosis screening. METHODS We analysed 10,813 patients (4-18 years old) who underwent clinical and radiological evaluation for scoliosis in a tertiary clinic specialised in spinal deformities. We considered as predictors ATR, Prominence (mm), visible asymmetry of the waist, scapulae and shoulders, familiarity, sex, BMI, age, menarche, and localisation of the curve. We implemented a Logistic Regression model to classify the Cobb angle of the major curve according to thresholds of 15, 20, 25, 30, and 40 degrees, by randomly splitting the dataset into 80-20% for training and testing, respectively. RESULTS The model showed accuracies of 74, 81, 79, 79, and 84% for 15-, 20-, 25-, 30- and 40-degrees thresholds, respectively. For all the thresholds ATR, Prominence, and visible asymmetry of the waist were the top five most important variables for the prediction. Samples that were wrongly classified as negatives had always statistically significant (p ≪ 0.01) lower values of ATR and Prominence. This confirmed that these two parameters were very important for the correct classification of the Cobb angle. The model showed better performances than using the 5 and 7 degrees ATR thresholds to prescribe a radiological examination. CONCLUSIONS Machine-learning-based classification models have the potential to effectively improve the non-invasive screening for AIS. The results of the study constitute the basis for the development of easy-to-use tools enabling physicians to decide whether to prescribe radiographic imaging.
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Affiliation(s)
- Francesco Negrini
- Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy.
- Istituti Clinici Scientifici Maugeri IRCCS, 21049, Tradate, VA, Italy.
| | - Andrea Cina
- Spine Center, Schulthess Clinic, 8008, Zurich, Switzerland
- Biomedical Data Science Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Irene Ferrario
- ISICO (Italian Scientific Spine Institute), 20141, Milan, Italy
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141, Milan, Italy
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", 20122, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
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Zheng Q, Xie L, Xu J, Xia N, Ma CZH. A feasibility study of applying two-dimensional photogrammetry for screening and monitoring of patients with adolescent idiopathic scoliosis in clinical practice. Sci Rep 2023; 13:14273. [PMID: 37652928 PMCID: PMC10471746 DOI: 10.1038/s41598-023-41267-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
Standing posteroanterior radiographs have been the golden standard to quantify the severity of scoliosis deformity. However, it exposes ionizing radiation to scoliosis patients, and cannot be used for routine screening and monitoring. This study aimed to develop a protocol of measuring postural indexes by using the noninvasive and radiation-free two-dimensional (2D) photogrammetry method and identify its clinical value in scoliosis screening and monitoring. The five postural indexes were measured from the posterior view of 110 participants. One-way ANOVA with post hoc Tukey HSD/Games-Howell analysis was used to compare the differences between the participants in the scoliosis group and the non-scoliosis group. Pearson coefficients of correlation were analyzed to identify the relationships between Cobb angles and each of the five quantitative postural indexes. Based on 2D photogrammetry, the postural indexes of C7 deviation (p = 0.02), shoulder alignment (p < 0.001), scapula alignment (p < 0.001), waist angle discrepancy (p < 0.001), and PSIS alignment (p < 0.001) could significantly differentiate scoliosis and non-scoliosis patients during screening. The waist angle discrepancy (r = 0.4, p = 0.01; r = 0.8, p = 0.03; r = 0.7, p = 0.01) and shoulder alignment (r = 0.6, p = 0.03) had moderate to strong positive correlations with the Cobb angles, which supported their clinical values in monitoring scoliotic curvature changes of adolescent idiopathic scoliosis (AIS) patients.
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Affiliation(s)
- Qian Zheng
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, China
| | - Lingfeng Xie
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, China.
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, China
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, China
| | - Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, 999077, Hong Kong SAR, China
- Research Institute for Smart Aging, The Hong Kong Polytechnic University, Hung Hom, 999077, Hong Kong SAR, China
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Donzelli S, Fregna G, Zaina F, Livetti G, Reitano MC, Negrini S. Predictors of Clinically Meaningful Results of Bracing in a Large Cohort of Adolescents with Idiopathic Scoliosis Reaching the End of Conservative Treatment. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040719. [PMID: 37189968 DOI: 10.3390/children10040719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND We need good outcome predictors to maximize the treatment efficiency of adolescents with idiopathic scoliosis (AIS). The in-brace correction has shown an important predictive effect on brace failure, while the influence of other variables is still debated. We aimed to identify new outcome predictors from a big prospective database of AIS. METHODS Design: Retrospective analysis of prospectively collected data. INCLUSION CRITERIA AIS between 21 and 45°, Risser 0-2, brace prescription during the observation, treatment conclusion. All of the participants followed a personalized conservative approach according to the SOSORT Guidelines. OUTCOMES End of growth below 30°-40°-50°. The regression model included age, BMI, Cobb angle, ATR, TRACE score, real brace wear (RBW), and in-brace correction (IBC). RESULTS A total of 1050 patients, 84% females, ages 12.1 ± 1.1, 28.2 ± 7.9° Cobb. IBC increased by 30%, 24%, and 23% the odds of ending treatment below 30°, 40°, and 50°, respectively. The OR did not change after the covariate adjustment. Cobb angle and ATR at the start also showed a predictive effect. CONCLUSIONS The systematic evaluation of IBC in clinics is useful for individuating the patient response to brace treatment more accurately, even in relation to the Cobb angle and ATR degrees at the start. Further studies are needed to increase the knowledge on predictors of AIS treatment results.
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Affiliation(s)
| | - Giulia Fregna
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy
| | - Giulia Livetti
- IRCCS Eugenio Medea-Associazione La Nostra Famiglia, 23842 Bosisio Parini, Italy
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", 20122 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
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