Ogata Yosuke, Kotani Toshiaki, Asada Tomoyuki, Ohyama Shuhei, Okuwaki Shun, Iijima Yasushi, Sakuma Tsuyoshi, Ohtori Seiji, Yamazaki Masashi
Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan; Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan.
Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
Spine J. 2025 Aug;25(8):1708-1718. doi: 10.1016/j.spinee.2025.01.022. Epub 2025 Jan 31.
Menarche is widely recognized as one of the prognostic factors for curve progression in patients with adolescent idiopathic scoliosis (AIS). However, few studies focus on the relationship between small AIS curves without brace treatment and menarche, presenting a challenge to building further evidence.
This study aims to investigate the chronological changes in curve progression and risk of final brace initiation around menarche in small AIS curves under 25°.
This was a retrospective cohort study.
We longitudinally examined 1,090 AIS patients with a curve of less than 25° at the initial visit.
Patients were followed up until they achieved skeletal maturity or initiated brace treatment.
Curve progression based on time from menarche was analyzed using a t-test. Receiver operating characteristic curve analysis was performed based on the time from menarche, with curve magnitude as the independent variable and the final initiation of brace treatment as the dependent variable.
Overall, 1,090 female patients were included, with a mean initial visit age of 12.9 years (standard deviation [SD]: 1.5) and a mean coronal Cobb angle of 17.5° (SD: 4.3). Curve progression was significantly decreased between 0-1 and 1-2 years postmenarche (0-1 year postmenarche: 2.9°/year vs 1-2 years postmenarche: 1.3°/year; p=.03). After 2 years from menarche, the mean curve progression was less than 0.4°/year. The cut-off value of the curve magnitude for the final initiation of brace treatment at the timing of menarche was 20.5° (area under the curve: 0.89, p<.001, 95% confidence interval: 0.86-0.91).
This study highlights that in small AIS curves under 25°, minimal curve progression was observed after 2 years postmenarche, aiding follow-up strategies for AIS conservative treatment.
月经初潮被广泛认为是青少年特发性脊柱侧凸（AIS）患者曲线进展的预后因素之一。然而，很少有研究关注未经支具治疗的小AIS曲线与月经初潮之间的关系，这给进一步积累证据带来了挑战。
本研究旨在调查25°以下小AIS曲线在月经初潮前后曲线进展的时间变化以及最终开始使用支具的风险。
这是一项回顾性队列研究。
我们纵向检查了1090例初诊时曲线小于25°的AIS患者。
对患者进行随访，直至其达到骨骼成熟或开始使用支具治疗。
使用t检验分析基于月经初潮时间的曲线进展情况。基于月经初潮时间进行受试者工作特征曲线分析，以曲线大小为自变量，最终开始使用支具治疗为因变量。
总体而言，纳入了1090例女性患者，平均初诊年龄为12.9岁（标准差[SD]：1.5），平均冠状面Cobb角为17.5°（SD：4.3）。月经初潮后0至1年与1至2年之间曲线进展显著降低（月经初潮后0至1年：2.9°/年 vs 月经初潮后1至2年：1.3°/年；p = 0.03）。月经初潮2年后，平均曲线进展小于0.4°/年。月经初潮时最终开始使用支具治疗的曲线大小截断值为20.5°（曲线下面积：0.89，p < 0.001，95%置信区间：0.86 - 0.91）。
本研究强调，在25°以下的小AIS曲线中，月经初潮后2年观察到曲线进展极小，这有助于AIS保守治疗的随访策略制定。
