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Article: Underarm bracing for adolescent idiopathic scoliosis leads to flatback deformity: the role of sagittal spinopelvic parameters

TitleUnderarm bracing for adolescent idiopathic scoliosis leads to flatback deformity: the role of sagittal spinopelvic parameters
Authors
Issue Date2019
PublisherBritish Editorial Society of Bone and Joint Surgery. The Journal's web site is located at http://www.bjj.boneandjoint.org.uk/
Citation
The Bone & Joint Journal, 2019, v. 101-B n. 11, p. 1370-1378 How to Cite?
AbstractThe aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes. Patients and Methods This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores. Results Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores. Conclusion Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life. ©2019 The British Editorial Society of Bone & Joint Surgery.
Persistent Identifierhttp://hdl.handle.net/10722/279694
ISSN
2023 Impact Factor: 4.9
2023 SCImago Journal Rankings: 2.280
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorCheung, JPY-
dc.contributor.authorChong, CHW-
dc.contributor.authorCheung, WHP-
dc.date.accessioned2019-12-09T06:44:33Z-
dc.date.available2019-12-09T06:44:33Z-
dc.date.issued2019-
dc.identifier.citationThe Bone & Joint Journal, 2019, v. 101-B n. 11, p. 1370-1378-
dc.identifier.issn2049-4394-
dc.identifier.urihttp://hdl.handle.net/10722/279694-
dc.description.abstractThe aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes. Patients and Methods This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores. Results Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores. Conclusion Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life. ©2019 The British Editorial Society of Bone & Joint Surgery.-
dc.languageeng-
dc.publisherBritish Editorial Society of Bone and Joint Surgery. The Journal's web site is located at http://www.bjj.boneandjoint.org.uk/-
dc.relation.ispartofThe Bone & Joint Journal-
dc.titleUnderarm bracing for adolescent idiopathic scoliosis leads to flatback deformity: the role of sagittal spinopelvic parameters-
dc.typeArticle-
dc.identifier.emailCheung, JPY: cheungjp@hku.hk-
dc.identifier.emailCheung, WHP: gnuehcp6@hku.hk-
dc.identifier.authorityCheung, JPY=rp01685-
dc.description.naturepostprint-
dc.identifier.doi10.1302/0301-620X.101B11.BJJ-2019-0515.R1-
dc.identifier.pmid31674249-
dc.identifier.scopuseid_2-s2.0-85074388444-
dc.identifier.hkuros308653-
dc.identifier.volume101-B-
dc.identifier.issue11-
dc.identifier.spage1370-
dc.identifier.epage1378-
dc.identifier.isiWOS:000493996400007-
dc.publisher.placeUnited Kingdom-
dc.identifier.issnl2049-4394-

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