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Julián C, Ricardo DN, Rodrigo R, A TC, Lucas P, Eduardo G, Pablo AJ, Mariano N. Adolescent idiopathic scoliosis: is there a relationship between Risser staging and the proximal humerus ossification system? Spine Deform 2024; 12:629-633. [PMID: 38316729 DOI: 10.1007/s43390-023-00812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/23/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To evaluate whether there is a mismatch between Risser staging and the proximal humerus ossification system (PHOS); and to analyze the correlation in the skeletal maturity stages between the two humeral epiphyses. METHODS Data from patients aged 10 to 18 years with adolescent idiopathic scoliosis (AIS) seen between 2018 to 2021 were analyzed. In an anteroposterior (AP) spine radiograph the ossification process was evaluated using the Risser classification method and bilateral PHOS (if both humeral epiphyses were visualized). A mismatch between methods was defined as a Risser 0-1 (relatively skeletally immature) with a PHOS 4-5 (skeletally mature), or a Risser 2-5 (relatively skeletally mature) with a PHOS 1-3 (skeletally immature). The McNemar test was used to calculate the significance of the mismatch. RESULTS A mismatch between Risser and PHOS stages was observed in 28.5% of 105 patients, which was statistically significant (p < 0.001). Of the 49 patients with a Risser 0-1, 55.1% (n = 27) had a PHOS 4-5. None of the patients with a Risser 2-5 had a PHOS 1-3. In the 47 patients in whom both humeri were visualized, the absolute correlation between the left and right PHOS values was 95.7%. CONCLUSION Of AIS patients who are relatively skeletally immature according to Risser staging, more than half may be skeletally mature when measured with PHOS. In patients with a Risser 0-1, it is recommended to measure skeletal maturity in an AP spine radiograph using the PHOS method, which may more accurately guide treatment decision-making, without the need to visualize both humeral epiphyses in this radiographic projection. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Calcagni Julián
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina.
| | - Davies Néstor Ricardo
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Remondino Rodrigo
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Tello Carlos A
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Piantoni Lucas
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Galaretto Eduardo
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Arispe Juan Pablo
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Noel Mariano
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
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Manzetti M, Ruffilli A, Barile F, Viroli G, Traversari M, Vita F, Cerasoli T, Arceri A, Artioli E, Mazzotti A, Faldini C. Is there a skeletal age index that can predict accurate curve progression in adolescent idiopathic scoliosis? A systematic review. Pediatr Radiol 2024; 54:299-315. [PMID: 38158439 DOI: 10.1007/s00247-023-05834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The diagnosis of adolescent idiopathic scoliosis requires clinical and radiographic evaluation; the management options vary depending on the severity of the curve and potential for progression. Identifying predictors of scoliosis progression is crucial to avoid incorrect management; clinical and radiographic factors have been studied as potential predictors. The present study aims to review the literature on radiological indexes for the peak height velocity or curve acceleration phase to help clinicians manage treatment of patients with adolescent idiopathic scoliosis. METHODS This systematic review was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was carried out including only peer-reviewed articles written in English that described the radiological indexes assessing skeletal maturity in patients with adolescent idiopathic scoliosis and evaluated their correlation with curve progression, expressed as peak height velocity and/or curve acceleartion phase. RESULTS Thirteen studies were included and showed promising results in terms of reliable radiological indexes. Risser staging gives a general measure of skeletal maturity, but it cannot be used as a primary index for driving the treatment of patients with adolescent idiopathic scoliosis since more reliable indexes are available. CONCLUSION Skeletal maturity quantification for adolescent idiopathic scoliosis has the potential to significantly modify disease management. However, idiopathic scoliosis is a complex and multifactorial disease: therefore, it is unlikely that a single index will ever be sufficient to predict its evolution. Therefore, as more adolescent idiopathic scoliosis progression-associated indexes are identified, a collective scientific effort should be made to develop a therapeutic strategy based on reliable and reproducible algorithms.
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Affiliation(s)
- Marco Manzetti
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy.
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Alberto Ruffilli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesca Barile
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Viroli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Elena Artioli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Antonio Mazzotti
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Aulisa AG, Galli M, Giordano M, Falciglia F, Careri S, Toniolo RM. Initial In-Brace Correction: Can the Evaluation of Cobb Angle Be the Only Parameter Predictive of the Outcome of Brace Treatment in Patients with Adolescent Idiopathic Scoliosis? Children (Basel) 2022; 9. [PMID: 35327710 DOI: 10.3390/children9030338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022]
Abstract
Background: Patients with a better initial in-brace correction could show a higher probability of a successful outcome. However, no one has investigated whether parameters can affect the outcomes. The aim of this retrospective study was to evaluate if the initial correction rate (ICR) could be predictive of the bracing outcome and to determine the role of some mechanical and biological parameters in ICR. Methods: The study population comprised 449 patients who met the inclusion criteria. Curve correction > 10° Cobb defines brace treatment success. Success and failure groups were compared in terms of the Risser sign, initial Cobb angle, initial Perdriolle value and ICR. Results: ICR significantly correlates with initial Perdriolle. The success group had a significantly lower value of Pedriolle and initial Cobb angles, Risser sign and ICR than the failure group. The ICR and lower Risser were significantly associated with the brace treatment outcome. This seems particularly suitable for positivity prediction (Predicting value VP+: 87%). Conclusions: This study confirms that immediate in-brace correction can foretell the brace treatment outcome. Patients with a low Risser sign and a high rate of in-brace correction showed a bracing success of 87%. A correlation between rotation and in-brace correction confirms that rotation is among the parameters that influence the deformed spine reaction to corrective actions the most.
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Bernard J, Bishop T, Herzog J, Haleem S, Lupu C, Ajayi B, Lui DF. Dual modality of vertebral body tethering : anterior scoliosis correction versus growth modulation with mean follow-up of five years. Bone Jt Open 2022; 3:123-129. [PMID: 35119295 PMCID: PMC8886322 DOI: 10.1302/2633-1462.32.bjo-2021-0120.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected. Methods We conducted a retrospective analysis of clinical and radiological data of 20 patients aged between 9 and 17 years old, (with a 19 female: 1 male ratio) between January 2014 to December 2016 with a mean five-year follow-up (4 to 7). Results There were ten patients in each group with a total of 23 curves operated on. VBT-GM mean age was 12.5 years (9 to 14) with a mean Risser classification of 0.63 (0 to 2) and VBT-ASC was 14.9 years (13 to 17) with a mean Risser classification of 3.66 (3 to 5). Mean preoperative VBT-GM Cobb was 47.4° (40° to 58°) with a Fulcrum unbend of 17.4 (1° to 41°), compared to VBT-ASC 56.5° (40° to 79°) with 30.6 (2° to 69°)unbend. Postoperative VBT-GM was 20.3° and VBT-ASC Cobb angle was 11.2°. The early postoperative correction rate was 54.3% versus 81% whereas Fulcrum Bending Correction Index (FBCI) was 93.1% vs 146.6%. The last Cobb angle on radiograph at mean five years’ follow-up was 19.4° (VBT-GM) and 16.5° (VBT-ASC). Patients with open triradiate cartilage (TRC) had three over-corrections. Overall, 5% of patients required fusion. This one patient alone had a over-correction, a second-stage tether release, and final conversion to fusion. Conclusion We show a high success rate (95%) in helping children avoid fusion at five years post-surgery. VBT is a safe technique for correction of scoliosis in the skeletally immature patient. This is the first report at five years that shows two methods of VBT can be employed depending on the skeletal maturity of the patient: GM and ASC. Cite this article: Bone Jt Open 2022;3(2):123–129.
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Affiliation(s)
- Jason Bernard
- Complex Spinal Division, Neurosciences Atkinson Morley Wing, St. George's Hospital, London, UK
| | - Timothy Bishop
- Complex Spinal Division, Neurosciences Atkinson Morley Wing, St. George's Hospital, London, UK
| | - Jan Herzog
- Complex Spinal Division, Neurosciences Atkinson Morley Wing, St. George's Hospital, London, UK
| | - Shahnawaz Haleem
- Complex Spinal Division, Neurosciences Atkinson Morley Wing, St. George's Hospital, London, UK
| | - Cristina Lupu
- Complex Spinal Division, Neurosciences Atkinson Morley Wing, St. George's Hospital, London, UK
| | - Bisola Ajayi
- Complex Spinal Division, Neurosciences Atkinson Morley Wing, St. George's Hospital, London, UK
| | - Darren F Lui
- Complex Spinal Division, Neurosciences Atkinson Morley Wing, St. George's Hospital, London, UK
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Mahajan R, Kishan S, Mallepally AR, Shafer C, Marathe N, Chhabra HS. Evolution of casting techniques in early-onset and congenital scoliosis. J Clin Orthop Trauma 2020; 11:810-815. [PMID: 32879567 PMCID: PMC7452255 DOI: 10.1016/j.jcot.2020.06.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/17/2022] Open
Abstract
Casting is being utilized as a therapeutic strategy in some mild to moderate cases obviating surgical intervention for management of early-onset scoliosis (EOS). Bracing, another conservative modality, applies comparable correcting forces on chest wall and axial skeleton. But cast application carries additional advantage of sustained restorative force which bypasses issue of compliance seen with brace wear. There is no specific blanket treatment, conservative or surgical, for the early-onset spinal deformities. Serial cast application provides near total correction of less severe curves (less than 500 to 600) if treatment is initiated before age of 2 yrs. In this review article, we will assess the evolution of plaster cast application in management of EOS and also describe technique of EDF (Elongation- Derotation- Flexion) casting.
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Affiliation(s)
- Rajat Mahajan
- Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India
| | - Shyam Kishan
- Pediatric Orthopedics and Pediatric Orthopedic Trauma, Medical City Dallas Childrens Hospital, Southwest Pediatric Orthopedics, Southwest Scoliosis Institute, 7777 Forest Lane, Suite C-135, Dallas, TX, 75230, USA
| | - Abhinandan Reddy Mallepally
- Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India
| | - Cody Shafer
- Pediatric Orthopedics and Pediatric Orthopedic Trauma, Medical City Dallas Childrens Hospital, Southwest Pediatric Orthopedics, Southwest Scoliosis Institute, 7777 Forest Lane, Suite C-135, Dallas, TX, 75230, USA
| | - Nandan Marathe
- Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India
| | - Harvinder Singh Chhabra
- Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India
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Abstract
Management of pediatric spinal deformities requires an accurate prediction of growth spurts to allow for timely initiation of treatment and prevention of curve progression. Determining remaining growth potential is also important for avoiding prolonged unnecessary treatment, e.g. bracing for patients nearing skeletal maturity. Many clinical and radiological growth parameters have been developed to aid clinicians in growth prediction. Of these, several commonly used measures such as height and arm span growth trends, timing of menarche, and the Risser sign are mostly retrospective and lack strong predictive utility. Bone age assessments, such as digital skeletal age and the distal radius and ulna classification, are more accurate parameters, but further research is required to determine interethnic variations and develop their role in management decisions.
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