Federico Solla1, Walid Lakhal2, Christian Morin3, Jerome Sales de Gauzy4, Gaby Kreichati5, Ibrahim Obeid6, Stéphane Wolff7, Joël Lechevallier8, Henry F Parent9, Jean-Luc Clément1, Carlo M Bertoncelli10,11. 1. Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France. 2. Pediatric Orthopaedic Surgery Unit, University Hospital of Tours, Clocheville, France. 3. Pediatric Orthopaedic Surgery Unit, Institut Calot, Fondation Hopale, Berk, France. 4. Pediatric Orthopaedic Surgery Unit, University Hospital of Toulouse, Toulouse, France. 5. Hôtel-Dieu de France, Beyrouth, Lebanon. 6. Spine Surgery Unit, University Hospital of Bordeaux, Bordeaux, France. 7. Spine Surgery Unit, Saint Joseph hospital, Paris, France. 8. Pediatric Orthopaedic Surgery Unit, University Hospital of Rouen, Rouen, France. 9. Spine Surgery Unit, Trélazé, France. 10. Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France. bertoncelli@unice.fr. 11. Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, USA. bertoncelli@unice.fr.
Abstract
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.
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.
Authors: J-L Clément; F Solla; A Tran; C Morin; W Lakhal; J Sales de Gauzy; J Leroux; J-M Gennari; F-H Parent; G Kreichati; S Wolf; I Obeid Journal: Orthop Traumatol Surg Res Date: 2017-05-27 Impact factor: 2.256
Authors: Carlo M Bertoncelli; Federico Solla; Peter R Loughenbury; Athanasios I Tsirikos; Domenico Bertoncelli; Virginie Rampal Journal: J Child Neurol Date: 2017-04-10 Impact factor: 1.987