Role of Sagittal Plane Alignment on the Etiopathogenesis of Frontal Plane Deformity in Idiopathic Scoliosis – a Prospective Longitudinal Study
Invited conference paper presented and published in conference proceedings
CUHK Authors
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AbstractIntroduction: What triggers the onset of scoliosis remains unresolved. This study aimed to evaluate if sagittal profile was associated with frontal plane deformity at the incipient phase of idiopathic thoracic scoliosis.
Methodology: 152 skeletally immature schoolchildren screened positive from Student Health Service Scoliosis Screening Program but with initial Cobb angle <10 degrees were recruited. They were prospectively followed beyond skeletal maturity for tracking if scoliosis defined as Cobb ≥ 10 degrees occurred (Scoliosis Subjects) or not (Controls). Biplanar EOS whole spine imaging was performed at baseline and sequent follow-up every 4 to 12 months. Skeletal maturity with Thumb Ossification Composite Index (TOCI) was documented at each visit, and sagittal alignment in form of posterior vertebral tilting at the thoracic spine was quantified as Vertebra Tilt Angle (VTA) of T12 and Thoracic Kyphosis Angle T5-T12 (TKA). The sagittal alignment of subjects the visit immediately prior to the development of scoliosis was then compared to the alignment of controls at the point of reaching skeletal maturity.
Results: 91 females and 61 males at a mean age of 12.7 (SD 1.5) years old were recruited. 91 subjects eventually developed scoliosis. Skeletally immature (TOCI 5) show significantly lower Thoracic kyphosis angle (18.9 ± 8.5 degrees) than controls (22.8 ± 7.5) prior the development of scoliosis (p=0.027).
Discussion and Conclusion: Schoolchildren who get a positive result from scoliosis screening may or may not develop scoliosis of more than 10 degrees by skeletal maturity. Results from the current study show evidence that sagittal alignment could have prognostic values on whether the individual will develop scoliosis depending on state of skeletal maturity. In children prior to reaching peak height velocity, a greater VTA at T12 is a poor prognostic factor. In children after reaching peak height velocity, a lower TKA is observed prior to development of scoliosis. With future studies of a larger sample size, we may be able to validate these findings aiming at identifying children at risk for prognostication, timely management and developing prophylactic sagittal-plane intervention.
Methodology: 152 skeletally immature schoolchildren screened positive from Student Health Service Scoliosis Screening Program but with initial Cobb angle <10 degrees were recruited. They were prospectively followed beyond skeletal maturity for tracking if scoliosis defined as Cobb ≥ 10 degrees occurred (Scoliosis Subjects) or not (Controls). Biplanar EOS whole spine imaging was performed at baseline and sequent follow-up every 4 to 12 months. Skeletal maturity with Thumb Ossification Composite Index (TOCI) was documented at each visit, and sagittal alignment in form of posterior vertebral tilting at the thoracic spine was quantified as Vertebra Tilt Angle (VTA) of T12 and Thoracic Kyphosis Angle T5-T12 (TKA). The sagittal alignment of subjects the visit immediately prior to the development of scoliosis was then compared to the alignment of controls at the point of reaching skeletal maturity.
Results: 91 females and 61 males at a mean age of 12.7 (SD 1.5) years old were recruited. 91 subjects eventually developed scoliosis. Skeletally immature (TOCI 5) show significantly lower Thoracic kyphosis angle (18.9 ± 8.5 degrees) than controls (22.8 ± 7.5) prior the development of scoliosis (p=0.027).
Discussion and Conclusion: Schoolchildren who get a positive result from scoliosis screening may or may not develop scoliosis of more than 10 degrees by skeletal maturity. Results from the current study show evidence that sagittal alignment could have prognostic values on whether the individual will develop scoliosis depending on state of skeletal maturity. In children prior to reaching peak height velocity, a greater VTA at T12 is a poor prognostic factor. In children after reaching peak height velocity, a lower TKA is observed prior to development of scoliosis. With future studies of a larger sample size, we may be able to validate these findings aiming at identifying children at risk for prognostication, timely management and developing prophylactic sagittal-plane intervention.
All Author(s) ListSheng A , Kwan CK, Lau AY, Yang GP, Hung AL, Lee WY, Kumar A, Zhang Z, Wan RC, Cheng JC, Lam TP
Name of ConferenceInternational Research Society of Spinal Deformities Scientific Meeting 2024
Start Date of Conference21/06/2024
End Date of Conference23/06/2024
Place of ConferenceHong Kong
Country/Region of ConferenceHong Kong
Year2024
LanguagesEnglish-United Kingdom
