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Cell-based Assay Protocol for the Prognostic Prediction of Idiopathic Scoliosis Using Cellular Dielectric Spectroscopy
Published on: October 16, 2013
A classification algorithm for prioritizing surgery in Pediatric patients with idiopathic scoliosis when Long
Matias Pereira-Duarte1,2, Antoine Dionne1, Julie Joncas2
1Université de Montréal, Montréal, Canada.
Insights
This study identifies key factors like Risser sign, menarchal status, and sex to predict scoliosis progression in patients awaiting surgery. It proposes a classification to prioritize surgical intervention for faster-progressing cases.
Area of Science:
- Orthopedics
- Spine Surgery
- Pediatric Deformity
Background:
- Idiopathic scoliosis (IS) requires surgical intervention for severe curves.
- Long surgical delays are common, necessitating prioritization strategies.
- Predicting curve progression during the wait is crucial for timely treatment.
Purpose of the Study:
- To identify clinical factors predicting the rate of idiopathic scoliosis progression.
- To develop a classification scheme for prioritizing patients for surgery during long wait times.
- To aid clinical decision-making in pediatric spine surgery scheduling.
Main Methods:
- Prospective cohort study of 214 patients scheduled for IS surgery (2004-2020).
- Analysis of baseline clinical and radiographic data, including Risser sign, menarchal status, and Cobb angle.
- Univariate and Regression Tree analysis to determine predictors of annual curve progression.
Main Results:
- Risser sign, menarchal status, and sex were significant predictors of curve progression rate.
- Three distinct patient groups identified: slow (3°/yr), moderate (8°/yr), and fast (15°/yr) progression.
- Progression rates varied based on Risser sign, menarchal status, and sex.
Conclusions:
- An evidence-based algorithm for surgical prioritization in pediatric idiopathic scoliosis was developed.
- This classification scheme can be implemented in clinical practice to manage surgical waitlists.
- Facilitates timely intervention for patients at high risk of rapid curve progression.
Purpose:
To identify the clinical phenotypes associated with the rate of progression while waiting for surgery and propose a classification scheme for identifying subgroups of patients to prioritize for surgery when long surgical delays are expected.
Methods:
We reviewed the clinical and radiographic data of a prospective cohort of patients scheduled for IS surgery from 2004 to 2020 with a minimum 1-year wait prior to surgery. Candidate predictors consisted of age, sex, Risser sign, menarchal status, angle of trunk rotation, scoliotic curve type, and main Cobb angle at baseline when scheduled for surgery. Univariate and Regression Tree analysis were performed to identify predictors associated with the annual curve progression rate in the main Cobb angle between baseline and surgery.
Results:
There were 214 patients (178 females) aged 15 ± 2 years, with a Risser sign 3.4 ± 1.6 and a main Cobb angle 55°±10° at baseline. The average wait prior to surgery was 1.3 ± 0.4 years. Only the Risser sign, menarchal status and sex were significantly associated with the annual progression rate. We have identified 3 clinically and significantly different groups of patients presenting slow (3 ± 4°/yr if Risser sign 3 to 5), moderate (8 ± 4°/yr if female with Risser sign 0 to 2 and post-menarchal), and fast (15 ± 10°/yr if Risser sign 0 to 2 and premenarchal or male) progression rates.
Conclusion:
We present an evidence-based surgical prioritization algorithm for pediatric idiopathic scoliosis that can easily be implemented in clinical practice when long surgical delays are expected.
