Université de Montréal, Montréal, Canada.
Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
Eur Spine J. 2024 Oct;33(10):3792-3797. doi: 10.1007/s00586-024-08405-4. Epub 2024 Aug 3.
To identify the clinical phenotypes associated with the rate of progression while waiting for surgery and propose a classification scheme for identifying subgroups of patients to prioritize for surgery when long surgical delays are expected.
We reviewed the clinical and radiographic data of a prospective cohort of patients scheduled for IS surgery from 2004 to 2020 with a minimum 1-year wait prior to surgery. Candidate predictors consisted of age, sex, Risser sign, menarchal status, angle of trunk rotation, scoliotic curve type, and main Cobb angle at baseline when scheduled for surgery. Univariate and Regression Tree analysis were performed to identify predictors associated with the annual curve progression rate in the main Cobb angle between baseline and surgery.
There were 214 patients (178 females) aged 15 ± 2 years, with a Risser sign 3.4 ± 1.6 and a main Cobb angle 55°±10° at baseline. The average wait prior to surgery was 1.3 ± 0.4 years. Only the Risser sign, menarchal status and sex were significantly associated with the annual progression rate. We have identified 3 clinically and significantly different groups of patients presenting slow (3 ± 4°/yr if Risser sign 3 to 5), moderate (8 ± 4°/yr if female with Risser sign 0 to 2 and post-menarchal), and fast (15 ± 10°/yr if Risser sign 0 to 2 and premenarchal or male) progression rates.
We present an evidence-based surgical prioritization algorithm for pediatric idiopathic scoliosis that can easily be implemented in clinical practice when long surgical delays are expected.
确定手术等待期间进展速度相关的临床表型，并提出一种分类方案，以便在预计手术延迟较长时，确定需要优先手术的患者亚组。
我们回顾了 2004 年至 2020 年期间接受 IS 手术的前瞻性队列患者的临床和影像学数据，这些患者在手术前至少有 1 年的等待时间。候选预测因子包括年龄、性别、Risser 征、初潮状态、躯干旋转角度、脊柱侧凸曲线类型以及手术时的主 Cobb 角基线。进行单变量和回归树分析，以确定与主 Cobb 角基线与手术之间的年度曲线进展率相关的预测因子。
共有 214 名患者（178 名女性），年龄 15±2 岁，Risser 征 3.4±1.6，基线时主 Cobb 角 55°±10°。平均手术前等待时间为 1.3±0.4 年。只有 Risser 征、初潮状态和性别与年度进展率显著相关。我们已经确定了 3 个在临床上有显著差异的患者群体，表现为缓慢进展（Risser 征 3 至 5 为 3±4°/yr）、中度进展（Risser 征 0 至 2 和初潮后为 8±4°/yr）和快速进展（Risser 征 0 至 2 和初潮前或男性为 15±10°/yr）。
我们提出了一种基于证据的小儿特发性脊柱侧凸手术优先排序算法，当预计手术延迟较长时，该算法可以很容易地在临床实践中实施。
