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Effect of curve location on the severity index for adolescent idiopathic scoliosis: a longitudinal cohort study

  • Musculoskeletal
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Abstract

Objectives

Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder in children. A severity index was recently proposed to identify the stable from the progressive scoliosis at the first standardized biplanar radiographic exam. The aim of this work was to extend the validation of the severity index and to determine if curve location influences its predictive capabilities.

Methods

AIS patients with Cobb angle between 10° and 25°, Risser 0–2, and no previous treatment were included. They underwent standing biplanar radiography and 3D reconstruction of the spine and pelvis, which allowed to calculate their severity index. Patients were grouped by curve location (thoracic, thoracolumbar, lumbar). Patients were followed up until skeletal maturity (Risser ≥ 3) or brace prescription. Their outcome was compared to the prediction made by the severity index.

Results

In total, 205 AIS patients were included; 82% of them (155/189, 95% confidence interval [74–90%]) were correctly classified by the index, while 16 patients were unclassified. Positive predictive ratio was 78% and negative predictive ratio was 86%. Specificity (78%) was not significantly affected by curve location, while patients with thoracic and lumbar curves showed higher sensitivity (≥ 89%) than those with thoracolumbar curves (74%).

Conclusions

In this multicentric cohort of 205 patients, the severity index was used to predict the risk of progression from mild to moderate scoliosis, with similar results of typical major curve types. This index represents a novel tool to aid the clinician and the patient in the modulation of the follow-up and, for progressive patients, their decision for brace treatment.

Key Points

• The severity index of adolescent idiopathic scoliosis has the potential to detect patients with progressive scoliosis as early as the first exam.

• Out of 205 patients, 82% were correctly classified as either stable or progressive by the severity index.

• The location of the main curve had small effect on the predictive capability of the index.

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Abbreviations

AIS:

Adolescent idiopathic scoliosis

AUC:

Area under the curve

ROC curve:

Receiver operating characteristic curve

SOSORT:

Society on Scoliosis Orthopaedic and Rehabilitation Treatment

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Acknowledgements

The authors are grateful to the BiomecAM chair program on subject-specific musculoskeletal modelling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Covea, and Proteor).

Funding

This study has received funding from the BiomecAM chair program on subject-specific musculoskeletal modelling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Covea, and Proteor).

Author information

Authors and Affiliations

  1. Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l’Hôpital, F-75013, Paris, France

    Claudio Vergari, Wafa Skalli & Jean Dubousset

  2. Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge française, Centre Médico-Chirurgical et de Réadaptation des Massues, Lyon, France

    Kariman Abelin-Genevois & Jean Claude Bernard

  3. SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR

    Zongshan Hu & Jack Chun Yiu Cheng

  4. Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR

    Winnie Chiu Wing Chu

  5. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon

    Ayman Assi, Mohammad Karam & Ismat Ghanem

  6. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Tito Bassani, Fabio Galbusera, Luca Maria Sconfienza & Marco Brayda-Bruno

  7. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy

    Luca Maria Sconfienza

  8. Unite Rachis, CHU - Hopital Bellevue, Saint-Etienne, France

    Isabelle Courtois & Eric Ebermeyer

  9. Sorbonne Université, Department of Pediatric Orthopaedics, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Raphael Vialle & Tristan Langlais

Authors
  1. Claudio Vergari
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  2. Wafa Skalli
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  3. Kariman Abelin-Genevois
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  4. Jean Claude Bernard
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  5. Zongshan Hu
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  8. Ayman Assi
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  9. Mohammad Karam
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  10. Ismat Ghanem
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  11. Tito Bassani
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  15. Isabelle Courtois
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  17. Raphael Vialle
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  18. Tristan Langlais
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  19. Jean Dubousset
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Corresponding author

Correspondence to Claudio Vergari.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Wafa Skalli.

Conflict of interest

Dr. Skalli has a patent related to biplanar X-rays and associated 3D reconstruction methods, with no personal financial benefit (royalties rewarded for research and education) licensed to EOS Imaging. Dr. Vialle reports personal fees and grants (unrelated to this study) from EOS Imaging.

Statistics and biometry

Several authors have significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

- (N=55) Vergari et al, 2019: Quasi-automatic early detection of progressive idiopathic scoliosis from biplanar radiography a preliminary validation. European Spine Journal.

- (N=65) Skalli et al, 2017: Early detection of progressive adolescent idiopathic scoliosis a severity index. Spine.

Methodology

• prospective and retrospective

• diagnostic study

• multicenter study

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Vergari, C., Skalli, W., Abelin-Genevois, K. et al. Effect of curve location on the severity index for adolescent idiopathic scoliosis: a longitudinal cohort study. Eur Radiol 31, 8488–8497 (2021). https://doi.org/10.1007/s00330-021-07944-4

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  • DOI: https://doi.org/10.1007/s00330-021-07944-4

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