Adolescent Idiopathic Scoliosis
Conditions
Keywords
AIS
Brief summary
The purpose of this study is to identify the flexibility radiograph(s) that can most accurately predict the curve behaviour after surgical correction of AIS. With these findings, the investigators hope to give further guidance for the selection of fusion levels and to incorporate different dynamic radiographs into the Lenke Classification, leading to a more universal application that can consistently lead to good surgical and clinical outcome.
Detailed description
The Lenke Classification is the most widely-accepted classification for Adolescent Idiopathic Scoliosis (AIS) in the world. Its recommendations for fusion of the minor curves depend on its structurality. It defines a minor curve as structural if there is inflexibility on side-bending more than 25 . However, a recent Delphi survey from a panel of experts in AIS management showed that there was no consensus as to which type of dynamic radiograph was optimal. Up to two thirds of the surgeons did not use side-bending as a routine, and hence they cannot apply the Lenke Classification accurately in clinical practice nor follow its recommendations for fusion. Furthermore, the current classification does not give specific recommendations regarding the selection of fusion levels and does not take into account the clinical appearance of the patients which impact on treatment. Consequently, there are still controversies regarding the Upper Instrumented Vertebra (UIV) and Lowest Instrumented Vertebra (LIV) selections, and following the recommendations may not allow fusion of the least number of segments nor give best clinical results eg shoulder balance.
Interventions
RADIATIONFlexibility Radiographs (supine, supine side-bend, FB)
Supine, supine side-bend, fulcrum bend
RADIATIONFlexibility Radiographs (awake traction)
awake traction
RADIATIONFlexibility Radiographs (STUGA)
supine traction under GA
Sponsors
AO Foundation, AO Spine
The University of Hong Kong
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
10 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Patients diagnosed with AIS who reach the threshold for surgical correction. * Patients aged 10 to 18 years
Exclusion criteria
* Neuromuscular deformity * Prior fusion or spine surgery * Spinal tumor diagnosis * Congenital anomalies
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Investigate the flexibility equivalence of different bending methods, and their predictability of the final outcome | 6 months to 9 months | To investigate the flexibility equivalence of different bending methods: supine side-bending, fulcrum bending (FB) and supine Halter traction without GA (awake), and their predictability of the final outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incorporate these findings into the Lenke Classification of AIS | 6 months to 9 months | To incorporate these findings into the Lenke Classification of AIS |
| Give new recommendations for fusion levels according to the flexibility assessment | 6 months to 9 months | To give new recommendations for fusion levels according to the flexibility assessment |
Countries
Hong Kong
Outcome results
None listed