E metacarpals and phalanges, correlate highly with the curve acceleration phase in girls with idiopathic scoliosis. However, these systems require an atlas and access to the scoring system, making their use impractical in a busy clinical setting. We sought to develop a simplified system that would correlate highly with scoliosis behavior but that would also be rapid and reliable for clinical practice....

Humans are one of the few species undergoing an adolescent growth spurt. Because children enter the spurt at different ages making age a poor maturity measure, longitudinal studies are necessary to identify the growth patterns and identify commonalities in adolescent growth. The standard maturity determinant, peak height velocity (PHV) timing, is difficult to estimate in individuals due to diurnal, postural, and measurement variation. Using prospective longitudinal populations of healthy children from two North American populations, we compared the timing of the adolescent growth spurt’s peak height velocity to normalized heights and hand skeletal maturity radiographs. We found that in healthy children, the adolescent growth spurt is standardized at 90% of final height with similar patterns for children of both sexes beginning at the initiation of the growth spurt. Once children enter the growth spurt, their growth pattern is consistent between children with peak growth at 90% of final height and skeletal maturity closely reflecting growth remaining. This ability to use 90% of final height as easily identified important maturity standard with its close relationship to skeletal maturity represents a significant advance allowing accurate prediction of future growth for individual children and accurate maturity comparisons for future studies of children’s growth.

Serial cast correction by using the Cotrel derotation technique is one of several potential treatments for progressive infantile scoliosis. This study reviews our early experience to identify which, if any, patients are likely to benefit from or fail this technique. We followed all patients treated at our institutions for progressive infantile scoliosis since 2003 prospectively at 1 institution and retrospectively at the other 2. Data, including etiology, Cobb angles, rib vertebral angle difference, Moe-Nash rotation, and space available for the lung, were recorded over time. Fifty-five patients with progressive infantile scoliosis had more than 1 year of follow-up from the initiation of casting. The diagnosis of progressive scoliosis was made based upon either a progressive Cobb angle or a rib vertebral angle difference of more than 20 degrees at presentation. All but 6 patients responded to cast correction. Nine patients have undergone surgery to date, 6 because of worsening and 3 by parent choice. As shown in the table, initiation of cast correction at a younger age, moderate curve size (60 degrees, and a nonidiopathic diagnosis. The space available for the lung improved from 0.89 to 0.93. No patient experienced worsening of rib deformities. Serial cast correction for infantile scoliosis often results in full correction in infants with idiopathic curves less than 60 degrees if started before 20 months of age. Cast correction for older patients with larger curves or nonidiopathic diagnosis still frequently results in curve improvement along with improvement in chest and body shape. Derotational cast correction seems to play a role in the treatment of progressive infantile scoliosis with cures in young patients and reductions in curve size with a delay in surgery in older and syndromic patients. Level 4, therapeutic study.

Quality of care is a multidimensional concept encompassing safety, efficiency, outcomes, and the patient experience. Traditional quality metrics, such as mortality rates, complication rates, and patient-reported outcomes, are time-consuming and cost-consuming to obtain and risk-stratify. The implications of reimbursement related to patient satisfaction and the ease of data collection have contributed to the perception that satisfaction is a global indicator of health-care quality; however, high satisfaction scores are not consistently correlated with traditional outcome and safety indicators. Higher patient satisfaction may be associated with increased costs of care. Costs may be further increased by the implementation of the satisfaction surveys themselves, which can increase imaging studies and prescriptions. Therefore, satisfaction surveys are not appropriate measures of overall quality of care. Accurate assessment of quality requires a multidimensional approach that includes specific measures for each domain.

Background: Although the efficacy of bracing for adolescent idiopathic scoliosis has been debated, recent evidence indicates a strong dose-response effect with respect to preventing curve progression of ≥6°. The purpose of this study was to investigate whether bracing, prescribed with use of current criteria, prevents surgery and how many patients must be treated with bracing to prevent one surgery. Methods: Of 126 patients with adolescent idiopathic scoliosis measuring between 25° and 45° and with a Risser sign of ≤2, 100 completed a prospective study in which they were managed with a Boston brace fitted with a heat sensor that measured brace wear. Noncompliant patients were compared both with highly compliant patients and with the entire cohort, with the end point of progression to surgery. The absolute risk reduction (ARR) was calculated and used to calculate the number needed to treat (NNT) to prevent one surgery. Results: Bracing was not effective in preventing surgery unless the patient was highly compliant with brace wear. For patients who were considered to be highly compliant, based on the hours per day that they wore the brace, the NNT was 3 (95% confidence interval [CI], 2 to 7). Conclusions: Within the limitations of a nonrandomized prospective study design, bracing for adolescent idiopathic scoliosis was found to substantially decrease the risk of curve progression to a range requiring surgery when patients were highly compliant with brace wear. Since many patients avoid surgery without wearing a brace, current indications appear to lead to marked overtreatment. Bracing appears to decrease the risk of curve progression to a magnitude requiring surgery, but current bracing indications include many curves that would not have progressed to a magnitude requiring surgery even if the patient had not worn the brace, and overall compliance with brace wear is low. Identifying these lower-risk patients and improving the compliance of those likely to have curve progression could substantially improve bracing results. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Study Design. Longitudinal radiographic study of patients with progressive idiopathic scoliosis. Objective. To determine the relative contributions of vertebral and disc wedging to the increase in Cobb angle during 3 phases of adolescent skeletal growth and maturation. Summary of Background Data. Both disc wedging and vertebral body wedging are found in progressive scoliosis, but their relative contribution to curve progression over time is unknown. Which occurs first is important for understanding how scoliosis progresses and for developing methods to halt progression. Previous studies have not properly identified maturity, and provide conflicting results. Methods. Eighteen girls were followed through their adolescent growth spurt with serial spine and hand skeletal age radiographs. Each Cobb angle was divided into disc wedge angles and vertebral wedge angles. The corresponding hand radiographs provided a measure of maturity level, the Digital Skeletal Age (DSA). The disc versus bone contributions to the Cobb angle were then compared during 3 growth phases: before the growth spurt, during the growth spurt and after the growth spurt. Significance of relative changes was assessed with the Wilcoxon 2-sided mean rank test. Results. Before the growth spurt, there was no difference in relative contributions of the disc and the bone (3° vs. 0°, P = 0.38) to curve progression. During the growth spurt, the mean disc component progressed significantly more than that of the vertebrae (15° vs. 0°, P = 0.0002). This reversed following the growth spurt with the vertebral component progressing more than the disc (10° vs. 0°, P = 0.01). Conclusion. Adolescent idiopathic scoliosis initially increases through disc wedging during the rapid growth spurt with progressive vertebral wedging occurring later.