Nam Yunjin, Patel Udit, Chang Dong-Gune, Lee Young Bin, Lim Jungwook, Yang Jae Hyuk, Suh Seung Woo
Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul 08308, Republic of Korea.
Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Seoul 01757, Republic of Korea.
J Clin Med. 2025 Jul 25;14(15):5272. doi: 10.3390/jcm14155272.
: Surgical treatment is generally recommended for adolescent idiopathic scoliosis (AIS) when the Cobb angle exceeds 50 degrees even after skeletal maturity or 40 degrees with remaining growth potential. However, limited evidence exists regarding the natural history of curves between 40 and 50 degrees during the late stage of skeletal growth. This study aimed to evaluate the curve progression in AIS patients with a curve between 40 and 50 degrees at Risser stage IV or V. : The inclusion criteria were as follows: (1) AIS patients at the late stage of skeletal growth (Risser IV or V) and a (2) curve between 40 and 50 degrees, with a minimum follow-up of 5 years. Sex, age, the magnitude of the curve, the location of the apex, Risser stage, height, and weight were measured at the baseline and the final follow-up. Curve progression was defined as an increase in the Cobb angle of ≥5 degrees. Patients were also categorized based on whether their final Cobb angle was <50 or ≥50 degrees to evaluate additional risk factors. : A total of 97 patients were included, with a mean follow-up of 97 months. Their mean age was 14.6 years at the baseline and 22.6 years at the final follow-up. The mean Cobb angle increased from 42.6 to 45.1 degrees, with a mean change of 2.7 degrees and an annual progression rate of 0.35 degrees. Curve progression was observed in 38 patients (39.2%), and 24 patients (24.7%) reached a final Cobb angle ≥ 50 degrees. Younger age ( = 0.004) and Risser stage IV ( = 0.014) were significantly associated with curve progression. In patients with a final Cobb angle ≥ 50 degrees, Risser stage IV ( = 0.050) and a larger baseline curve magnitude ( = 0.045) were also significant risk factors. : In AIS patients at the late stage of skeletal growth, 39.2% experienced significant curve progression. A younger age and Risser stage IV were identified as risk factors for curve progression. A larger baseline curve magnitude and Risser stage IV were also associated with a final Cobb angle ≥ 50 degrees.
对于青少年特发性脊柱侧凸（AIS）患者，当Cobb角超过50度（即使在骨骼成熟后）或40度且仍有生长潜力时，通常建议进行手术治疗。然而，关于骨骼生长后期40至50度曲线自然史的证据有限。本研究旨在评估Risser分期为IV或V期、Cobb角在40至50度之间的AIS患者的曲线进展情况。纳入标准如下：（1）骨骼生长后期（Risser IV或V期）的AIS患者；（2）Cobb角在40至50度之间，且至少随访5年。在基线和最终随访时测量性别、年龄、曲线大小、顶点位置、Risser分期、身高和体重。曲线进展定义为Cobb角增加≥5度。患者还根据最终Cobb角是否<50度或≥50度进行分类，以评估其他风险因素。共纳入97例患者，平均随访97个月。他们在基线时的平均年龄为14.6岁，在最终随访时为22.6岁。平均Cobb角从42.6度增加到45.1度，平均变化为2.7度，年进展率为0.35度。38例患者（39.2%）观察到曲线进展，24例患者（24.7%）最终Cobb角≥50度。年龄较小（P = 0.004）和Risser IV期（P = 0.014）与曲线进展显著相关。在最终Cobb角≥50度的患者中，Risser IV期（P = 0.050）和更大的基线曲线大小（P = 0.045）也是显著的风险因素。在骨骼生长后期的AIS患者中，39.2%经历了显著的曲线进展。年龄较小和Risser IV期被确定为曲线进展的风险因素。更大的基线曲线大小和Risser IV期也与最终Cobb角≥50度相关。
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