Bracing in severe skeletally immature adolescent idiopathic scoliosis: does a holding strategy change the surgical plan?

PURPOSE: The purpose of the study was to assess the changes in flexibility during night-time bracing in skeletally immature adolescent idiopathic scoliosis (AIS) with curves in the surgical range. MATERIALS AND METHODS: We included a consecutive cohort of 89 AIS patients with curves ≥ 45° and an estimated growth potential. All patients were eventually treated with fusion surgery, and all patients had side-bending radiographs prior to both bracing and surgery. Curves were classified as structural or non-structural curves according to Lenke at both timepoints. RESULTS: The main curve progressed by a mean of 12 ± 10° and the secondary curve by 8 ± 8°. Flexibility of the main curve decreased from 50 ± 19% to 44 ± 19% (p = 0.001) and the underlying curve from 85 ± 21% to 77 ± 22% (p = 0.005). In 69 patients (79%), the Lenke category did not progress during bracing. In 14 patients (15%), the progression in Lenke type occurred in the thoracic region (i.e., Lenke type 1 to type 2), while six patients (7%) progressed in the lumbar region (i.e., type 1 to type 3). In the 69 patients that did not progress, we found that the last touched vertebra moved distally by one or two levels in 26 patients. CONCLUSIONS: This is the first study to describe that curve flexibility decreases during bracing in severe AIS. However, this had only a modest impact on the surgical strategy. Bracing as a holding strategy can be applied, but the risk of losing flexibility in the lumbar spine should be outweighed against the risks of premature fusion surgery.

Reliability of the radiographic variables in the International Spinal Cord Injury Spinal Column Injury Basic Data Set compared with the AO classification.

STUDY DESIGN: Intra- and interrater reliability study for radiological variables of the International Spinal Cord Injury (SCI) Spinal Column Injury Basic Data Set. OBJECTIVES: To test reliability of the radiological variables in the International SCI Spinal Column Injury Basic Data Set and compare it with the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. SETTING: The database of Eastern Denmark Regional SCI Referral Center, Copenhagen, Denmark. METHODS: Ratings of the International SCI Spinal Column Injury Basic Data Set radiological variables and AO classification were obtained by two international observers for all the surgically treated spine trauma patients between 1st October 2010 and 31st December 2012 at the Spine Unit, Rigshospitalet, Denmark. Statistical analyses for intra- and interrater crude agreement and Cohen's unweighted kappa (κ) coefficients were performed. RESULTS: For 283 spine injuries, the intra- and interrater reliability for the individual radiological variables of the International SCI Spinal Column Injury Basic Data Set was at least substantial (κ=0.67-0.97 for interrater, κ=0.79-0.89 for the intrarater agreement). For the AO classification, intrarater reliability was moderate-to-substantial (κ=0.57-0.75), whereas interrater reliability was substantial (κ=0.67-0.69). The crude intra- and interrater agreement for a combined radiographic SCI Spinal Column Injury Basic Data Set variable showed no significant difference compared with the AO classification (P=0.067-0.895). CONCLUSIONS: The reliability of International SCI Spinal Column Injury Basic Data Set radiological variables is comparable to the AO classification system. We encourage its use for spinal column injury description, thus facilitating data collection and comparison between centres and countries.