The pendulum swings back to scoliosis screening: screening policies for early detection and treatment of idiopathic scoliosis - current concepts and recommendations

This editorial article initiates the school scoliosis screening thematic series of the Scoliosis journal. The various issues on screening policies are discussed; clinical and practical recommendations of setting up school screening programs are also described

Brace Classification Study Group (BCSG): part one - definitions and atlas

The current increase in types of scoliosis braces defined by a surname or a town makes scientific classification essential. Currently, it is a challenge to compare braces and specify the indications of each brace. A precise definition of the characteristics of current braces is needed. As such, the International Society for Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) mandated the Brace Classification Study Group (BCSG) to address the pertinent terminology and brace classification. As such, the following study represents the first part of the SOSORT consensus in addressing the definitions and providing a visual atlas of bracing

The “Risser+” grade: a new grading system to classify skeletal maturity in idiopathic scoliosis

Purpose: This study aims to propose and validate a new unified "Risser+" grade that combines the North American (NA) and European (EU) variants of the classic Risser score. The "Risser+ " grade can effectively combine the North American and European Risser Classifications for skeletal maturity with adequate intra-rater/inter-rater reliability and agreement. Methods: Agreement and reliability were evaluated for 6 raters (3-NA, 3-EU) who assessed 120 pelvic radiographs from the BrAIST trial, all female, average age 13.4 (range 10.1-16.5 years). Blinded raters reviewed x-rays at two time-points. Intra- and inter-rater agreement (RA) were established with Krippendorff's alpha (k-alpha), while intra- and inter-rater reliability (RR) were established with intraclass correlation coefficients (ICC). Acceptable agreement and reliability were set a priori at 0.80. Results: Inter-RA for the second reading met study requirements (k-alpha = 0.86 [0.81-0.90]) compared to the first reading (0.72 [0.63-0.79]) while combined readings was close to target agreement (0.79 [0.74-0.84]). Removal of 20 readings demonstrating outlier tendencies increased agreement for the first, second, and combined reads (k-alpha = 0.85, 0.89, 0.87, respectively). Intra-RA was sufficient for 4 out of 6 raters (k-alpha > 0.80) and one rater from EU and NA presented subpar intra-RA (k-alpha = 0.64 and 0.74, respectively). Inter-RR met study requirements overall reads (ICC = 0.96 [0.95-0.97]) including the first (0.94 [0.92-0.95]) and second (0.97 [0.97-0.98]) reads, independently. Conclusions: The Risser+ system showed excellent reliability across multiple reads and raters and demonstrated 79% agreement overall reads and ratings. Agreement increased to over 85% when raters could distinguish Risser 0 + from Risser 5. These slides can be retrieved from electronic supplementary material

Bracing for juvenile idiopathic scoliosis: retrospective review from bracing to skeletal maturity.

BackgroundJuvenile idiopathic scoliosis (JIS) outcomes with brace treatment are limited with poorly described bracing protocols. Between 49 and 100% of children with JIS will progress to surgery, however, young age, long follow-up, and varying treatment methods make studying this population difficult. The purpose of this study is to report the outcomes of bracing in JIS treated with a Boston brace™ and identify risk factors for progression and surgical intervention.MethodsThis is a single-center retrospective review of 175 patients with JIS who initiated brace treatment between the age of 4 and 9 years. A cohort of 140 children reached skeletal maturity; 91 children had surgery or at least 2 year follow-up after brace completion. Standard in-brace protocol for scoliosis 320° was a Boston brace for 18-20 h/day after MRI (n = 82). Family history, MRI abnormalities, comorbidities, curve type, curve magnitude, bracing duration, number of braces, compliance by report, and surgical interventions were recorded.ResultsChildren were average 7.9 years old (range 4.1-9.8) at the initiation of bracing. The Boston brace™ was prescribed in 82 patients and nine used night bending brace. Mid-thoracic curves (53%) was the most frequent deformity. Maximum curve at presentation was on average 30 ± 9 degrees, in-brace curve angle was 16 ± 8 degrees, and in-brace correction was 58 ± 24 percent. Patients were braced an average of 4.6 ± 1.9 years. 61/91 (67%) went on to posterior spinal fusion at 13.3 ± 2.1 (range 9.3-20.9) years and curve magnitude of 61 ± 12 degrees. Of those that underwent surgery, 49/55 (86%) progressed > 10°, 6/55 (11%) stabilized within 10°, and 0/55 (0%) improved > 10° with brace wear. No children underwent growth-friendly posterior instrumentation. Of the 28 who did not have surgical correction, 3 (11%) progressed > 10°, 13/28 (46%) stabilized within 10°, and 12/28 (43%) improved > 10° with brace wear.ConclusionsThis large series of JIS patients with bracing followed to skeletal maturity with long-term follow-up. Surgery was avoided in 33% of children with minimal to no progression, and no child underwent posterior growth-friendly constructs. Risk factors of needing surgery were noncompliance and larger curves at presentation

Klasifikace skoliotických ortéz vypracovaná SOSORT s SRS, ISPO a POSNA a schválená ESPRM

Účel: Studie prokázaly, že ortéza je účinnou léčbou pacientů s idiopatickou skoliózou. Podle současné klasifikace spadají téměř všechny ortézy do kategorie torakolumbosakrálních ortéz (TLSO). V důsledku toho je zobecnění vědeckých výsledků buď nemožné, nebo zavádějící. Cílem této studie je vytvořit klasifikaci typů ortéz. Metody: Čtyři vědecké společnosti (SOSORT, SRS, ISPO a POSNA) vyzvaly všechny své členy, aby se zúčastnili studie. Šest odborníků 1. úrovně vypracovalo počáteční klasifikace. Na konsenzuálním setkání s dalšími 26 odborníky a představiteli společností umožnila tematická analýza a obecná diskuse definovat klasifikaci (minimálně 80% shoda). Klasifikace byla použita na ortézy publikované v literatuře a oficiálně schválena 4 vědeckými společnostmi a ESPRM. Výsledky: Klasifikace je založena na následujících klasifikačních položkách: anatomie (CTLSO, TLSO, LSO), tuhost (velmi tuhá, tuhá, pružná), primární korekční rovina (frontální, sagitální, transverzální, frontální a sagitální, frontální a transverzální, sagitální a transverzální, třídimenzionální), konstrukce - ventily (jednokotoučové, dvoukotoučové, vícesegmentové), konstrukce - uzávěr (dorzální, laterální, ventrální) a primární působení (ohyb, detorze, prodloužení, pohyb, push-up, tříbodové). Odborníci vypracovali definici pro každou položku a byli schopni klasifikovat 15 publikovaných ortéz do devíti skupin. Závěry: V rámci studie byly vybrány dvě skupiny ortéz, které se zabývají problematikou ortéz: Klasifikace je založena na nejlepších současných odborných znalostech (nejnižší úroveň důkazů). Odborníci uznávají, že se jedná o první vydání a že se bude měnit s budoucími poznatky a výzkumem. Široké uplatnění této klasifikace by mohlo mít význam pro výzkum rovnátek, vzdělávání, klinickou praxi a růst v této oblasti.Purpose: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. Methods: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies’ officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. Results: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction—valves (monocot, bivalve, multisegmented), construction—closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. Conclusion: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field

Klasifikace skoliotických ortéz vypracovaná SOSORT s SRS, ISPO a POSNA a schválená ESPRM

Účel: Studie prokázaly, že ortéza je účinnou léčbou pacientů s idiopatickou skoliózou. Podle současné klasifikace spadají téměř všechny ortézy do kategorie torakolumbosakrálních ortéz (TLSO). V důsledku toho je zobecnění vědeckých výsledků buď nemožné, nebo zavádějící. Cílem této studie je vytvořit klasifikaci typů ortéz. Metody: Čtyři vědecké společnosti (SOSORT, SRS, ISPO a POSNA) vyzvaly všechny své členy, aby se zúčastnili studie. Šest odborníků 1. úrovně vypracovalo počáteční klasifikace. Na konsenzuálním setkání s dalšími 26 odborníky a představiteli společností umožnila tematická analýza a obecná diskuse definovat klasifikaci (minimálně 80% shoda). Klasifikace byla použita na ortézy publikované v literatuře a oficiálně schválena 4 vědeckými společnostmi a ESPRM. Výsledky: Klasifikace je založena na následujících klasifikačních položkách: anatomie (CTLSO, TLSO, LSO), tuhost (velmi tuhá, tuhá, pružná), primární korekční rovina (frontální, sagitální, transverzální, frontální a sagitální, frontální a transverzální, sagitální a transverzální, třídimenzionální), konstrukce - ventily (jednokotoučové, dvoukotoučové, vícesegmentové), konstrukce - uzávěr (dorzální, laterální, ventrální) a primární působení (ohyb, detorze, prodloužení, pohyb, push-up, tříbodové). Odborníci vypracovali definici pro každou položku a byli schopni klasifikovat 15 publikovaných ortéz do devíti skupin. Závěry: V rámci studie byly vybrány dvě skupiny ortéz, které se zabývají problematikou ortéz: Klasifikace je založena na nejlepších současných odborných znalostech (nejnižší úroveň důkazů). Odborníci uznávají, že se jedná o první vydání a že se bude měnit s budoucími poznatky a výzkumem. Široké uplatnění této klasifikace by mohlo mít význam pro výzkum rovnátek, vzdělávání, klinickou praxi a růst v této oblasti.Purpose: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. Methods: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies’ officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. Results: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction—valves (monocot, bivalve, multisegmented), construction—closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. Conclusion: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field