Curve evolution during bracing in children with scoliosis secondary to early-onset neurofibromatosis type 1:indicators of rapid curve progression

Background:Scoliosis secondary to neurofibromatosis type 1(NF1)in children aged<10 years is an important etiology of earlyonset scoliosis(EOS).This study was performed to investigate the curve evolution of patients with EOS secondary to NF1 undergoing bracing treatment and to analyze high-risk indicators of rapid curve progression.Methods:Children with EOS due to NF1 who underwent bracing treatment from 2010 to 2017 were retrospectively reviewed.The angle velocity(AV)at each visit was calculated,and patients with rapid curve progression(AV of>10°/year)were identified.The age at modulation and the AV before and after modulation were obtained.Patients with(n=18)and without rapid curve progression(n=10)were statistically compared.Results:Twenty-eight patients with a mean age of 6.5±1.9 years at the initial visit were reviewed.The mean Cobb angle of the main curve was 41.7°±2.4°at the initial visit and increased to 67.1°±8.6°during a mean follow-up of 44.1±8.5 months.The overall AV was 6.6°±2.4°/year for all patients.At the last follow-up,all patients presented curve progression of>5°,and 20(71%)patients had progressed by>20°.Rapid curve progression was observed in 18(64%)patients and was associated with younger age at the initial visit and a higher incidence of modulation change during follow-up(t=2.868,P=0.008 and<0.001,respectively).The mean AV was 4.4°±1.2°/year before modulation and 11.8°±2.7°/year after modulation(t=11.477,P<0.010).Conclusions:Curve progression of>10°/year is associated with younger age at the initial visit,and modulation change indicated the occurrence of the rapid curve progression phase.

Schroth exercises improve health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients

Background:Finding an optimal treatment strategy for adolescent idiopathic scoliosis(AIS)patients remains challenging because of its intrinsic complexity.For mild to moderate scoliosis patients with lower skeletal growth potential(Risser 3-5),most clinicians agree with observation treatment;however,the curve progression that occurs during puberty,the adolescent period,and even in adulthood,remains a challenging issue for clinicians.The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential(Risser 3-5)and moderate scoliosis(Cobb angle 20°-40°).Methods:From 2015 to 2017,data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed.Forty-three patients underwent Schroth exercise were classified as Schroth group,and 21 patients underwent observation were classified as observation group.Outcomes were measured by health-related quality of life(HRQOL)and radiographic parameters.HRQOL was assessed using the visual analog scale(VAS)scores for back,Scoliosis Research Society-22(SRS-22)patient questionnaire.Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays.The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy.The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient(ICC).The pairedt test was used to examine HRQOL and radiographic parameters.Clinical relevance between C2-C7 sagittal vertical axis(SVA)and thoracic kyphosis was analyzed using Spearman correlation.Results:In Schroth group,VAS back score,SRS-22 pain,and SRS-22 self-image domain were significantly improved from pre-treatment 3.0±0.8,3.6±0.5,and 3.5±0.7 to post-treatment 1.6±0.6(t=5.578,P=0.013),4.0±0.3(t=-3.918,P=0.001),and 3.7±0.4(t=-6.468,P<0.001),respectively.No significant improvements of SRS-22 function domain(t=-2.825,P=0.088)and mental health domain(t=-3.174,P=0.061)were observed.The mean Cobb angle decreased from 28.9±5.5°to 26.3±5.2°at the final follow-up,despite no statistical significance was observed(t=1.853,P=0.102).The mean C2-C7 SVA value decreased from 21.7±8.4 mm to 17.0±8.0 mm(t=-1.224P=0.049)and mean T1 tilt decreased from 4.9±4.2°to 3.5±3.1°(t=2.913,P=0.011).No significant improvement of radiographic parameters and HRQOL were observed in observation group.Conclusions:For AIS patients with a Risser 3-5 and a Cobb angle 20°-40°,Schroth exercises improved HRQOL and halted curve progression during the follow-up period.Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises.We recommend Schroth exercises for patients with AIS.