Clinical predictive model of lumbar curve Cobb angle below selective fusion for thoracic adolescent idiopathic scoliosis: a longitudinal multicenter descriptive study.

Autor: Solla F; Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France., Lakhal W; Pediatric Orthopaedic Surgery Unit, University Hospital of Tours, Clocheville, France., Morin C; Pediatric Orthopaedic Surgery Unit, Institut Calot, Fondation Hopale, Berk, France., de Gauzy JS; Pediatric Orthopaedic Surgery Unit, University Hospital of Toulouse, Toulouse, France., Kreichati G; Hôtel-Dieu de France, Beyrouth, Lebanon., Obeid I; Spine Surgery Unit, University Hospital of Bordeaux, Bordeaux, France., Wolff S; Spine Surgery Unit, Saint Joseph hospital, Paris, France., Lechevallier J; Pediatric Orthopaedic Surgery Unit, University Hospital of Rouen, Rouen, France., Parent HF; Spine Surgery Unit, Trélazé, France., Clément JL; Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France., Bertoncelli CM; Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France. bertoncelli@unice.fr.; Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, USA. bertoncelli@unice.fr.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2022 Jul; Vol. 32 (5), pp. 827-836. Date of Electronic Publication: 2021 Jun 18.
DOI: 10.1007/s00590-021-03054-5
Abstrakt: Purpose: To implement a clinically applicable, predictive model for the lumbar Cobb angle below a selective thoracic fusion in adolescent idiopathic scoliosis.
Methods: A series of 146 adolescents with Lenke 1 or 2 idiopathic scoliosis, surgically treated with posterior selective fusion, and minimum follow-up of 5 years (average 7) was analyzed. The cohort was divided in 2 groups: if lumbar Cobb angle at last follow-up was, respectively, ≥ or < 10°. A logistic regression-based prediction model (PredictMed) was implemented to identify variables associated with the group ≥ 10°. The guidelines of the TRIPOD statement were followed.
Results: Mean Cobb angle of thoracic main curve was 56° preoperatively and 25° at last follow-up. Mean lumbar Cobb angle was 33° (20; 59) preoperatively and 11° (0; 35) at last follow-up. 53 patients were in group ≥ 10°. The 2 groups had similar demographics, flexibility of both main and lumbar curves, and magnitude of the preoperative main curve, p > 0.1. From univariate analysis, mean magnitude of preoperative lumbar curves (35° vs. 30°), mean correction of main curve (65% vs. 58%), mean ratio of main curve/distal curve (1.9 vs. 1.6) and distribution of lumbar modifiers were statistically different between groups (p < 0.05). PredictMed identified the following variables significantly associated with the group ≥ 10°: main curve % correction at last follow-up (p = 0.01) and distal curve angle (p = 0.04) with a prediction accuracy of 71%.
Conclusion: The main modifiable factor influencing uninstrumented lumbar curve was the correction of main curve. The clinical model PredictMed showed an accuracy of 71% in prediction of lumbar Cobb angle ≥ 10° at last follow-up.
Level of Evidence Iv: Longitudinal comparative study.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
Databáze: MEDLINE
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