Université de Montréal, Montréal, Canada.
Research Center, Sainte-Justine University Hospital Center, Montréal, Canada.
Spine (Phila Pa 1976). 2022 Aug 1;47(15):1063-1070. doi: 10.1097/BRS.0000000000004335. Epub 2022 Feb 3.
Observational cohort study.
To test the hypothesis that anterior vertebral body growth modulation (AVBGM) achieves 3D deformity correction after 2-year follow-up while brace treatment limits curve progression for moderate idiopathic scoliosis (30-50°).
For idiopathic scoliosis, bracing and AVBGM have overlapping indications in skeletally immature patients with moderate scoliosis curve angles, creating a grey zone in clinical practice between them. The relative 3D deformity control performance over a 2-year period between these fusionless treatments is still uncertain.
A retrospective review of a prospective idiopathic scoliosis patients database, recruited between 2013 and 2018 was performed. Inclusion criteria were skeletally immature patients (Risser 0-2), with Cobb angles between 30° and 50° and a 2-year follow-up after bracing or AVBGM. 3D radiological parameters and health related quality of life (HRQoL) scores were evaluated. Unpaired t test was used.
Thirty nine patients (12.7 ± 1.3 y.o.) with Cobb angles more than or equal to 30° treated with brace and 41 patients (11.8 ± 1.2 y.o.) with presenting Cobb angles less than or equal to 50° who received AVBGM were reviewed. The statistical analysis of 3D deformity measurements showed that at 2-year follow-up, only the 3D spine length and both sides apical vertebral heights changed significantly with brace treatment. While AVBGM treatment achieved statistically significant correction differences in thoracic and lumbar Cobb angles, TrueKyphosis, 3D spine length, and selective left apical vertebral height ( P < 0.05). 35% of brace patients had a curve progression of more than 5° at final follow-up while it was 0% for AVBGM. HRQoL assessment showed no statistically significant differences between pre and post SRS-22 total scores for each group ( P > 0.05).
Even though these two cohorts are not fully comparable, bracing seems to control progression for a significant portion of patients with moderate scoliosis curves, while AVBGM significantly corrected and maintained 3D deformity parameters at 2-year follow-up.
观察性队列研究。
验证以下假说，即在前椎体生长调节（AVBGM）治疗后 2 年的随访中可实现 3D 畸形矫正，而支具治疗可限制中度特发性脊柱侧凸（30-50°）的曲线进展。
对于特发性脊柱侧凸，支具和 AVBGM 在骨骼未成熟且脊柱侧凸曲线角度中度的患者中具有重叠的适应证，这在临床实践中造成了两者之间的灰色地带。在这两种无融合治疗方法中，2 年内相对 3D 畸形控制性能仍不确定。
对 2013 年至 2018 年间招募的前瞻性特发性脊柱侧凸患者数据库进行回顾性研究。纳入标准为骨骼未成熟（Risser 0-2）、Cobb 角在 30°至 50°之间、支具或 AVBGM 治疗后 2 年随访的患者。评估 3D 放射学参数和健康相关生活质量（HRQoL）评分。采用未配对 t 检验。
回顾了 39 名 Cobb 角≥30°且接受支具治疗的患者（12.7±1.3 岁）和 41 名 Cobb 角≤50°且接受 AVBGM 治疗的患者（11.8±1.2 岁）。3D 畸形测量的统计学分析显示，在 2 年随访时，仅支具治疗可显著改变 3D 脊柱长度和两侧顶椎高度。而 AVBGM 治疗可显著矫正胸椎和腰椎 Cobb 角、真实后凸角、3D 脊柱长度和选择性左侧顶椎高度的差异（P＜0.05）。在最终随访时，有 35%的支具患者的曲线进展超过 5°，而 AVBGM 组则为 0%。SRS-22 总分的术前和术后 HRQoL 评估在两组之间均无统计学差异（P＞0.05）。
即使这两个队列不完全可比，支具似乎可以控制大部分中度脊柱侧凸曲线患者的进展，而 AVBGM 则可在 2 年随访时显著矫正和维持 3D 畸形参数。
