Abstract：
Treatment selection for idiopathic scoliosis is informed by the risk of curve progression. Previous models predicting curve progression lacked validation, did not include the full growth/severity spectrum or included treated patients. The objective was to develop and validate models to predict future curve angles using clinical data collected only at, or both at and prior to, an initial specialist consultation in idiopathic scoliosis.
This is an analysis of 2317 patients with idiopathic scoliosis between 6 and 25 years old. Patients were previously untreated and provided at least one prior radiograph prospectively collected at first consult. Radiographs were re-measured blinded to the predicted outcome: the maximum Cobb angle on the last radiograph while untreated. Linear mixed-effect models were used to examine the effect of data from the first available visit (age, sex, maximum Cobb angle, Risser, and curve type) and from other visits while untreated (maximum Cobb angle) and time (from the first available radiograph to prediction) on the Cobb angle outcome. Interactions of the first available angle with time, of time with sex, and time with Risser were also tested.
We included 2317 patients (83% of females) with 3255 prior X-rays where 71% had 1, 21.1% had 2, and 7.5% had 3 or more. Mean age was 13.9 ± 2.2yrs and 81% had AIS. Curve types were: 50% double, 26% lumbar/thoracolumbar-lumbar, 16% thoracic, and 8% other. Cobb angle at the first available X-ray was 20 ± 10° (0-80) vs 29 ± 13° (6-122) at the outcome visit separated by 28 ± 22mths. In the model using data at and prior to the specialist consult, larger values of the following variables predicted larger future curves: first available Cobb angle, Cobb angle on other previous X-ray, and time (with Time2 and Time3) to the target prediction. Larger values on the following variables predicted a smaller future Cobb angle: Risser and age at the first available X-ray, time*Risser and time*female sex interactions. Cross-validation found a median error of 4.5o with 84% predicted within 10°. Similarly, the model using only data from the first specialist consult had a median error of 5.5o with 80% of cases within 10° and included: maximum Cobb angle at first specialist consult, Time, Time2, age, curve type, and both interactions.
The models can help clinicians predict how much curves would progress without treatment at future timepoints of their choice using simple variables. Predictions can inform treatment prescription or show families why no treatment is recommended. The nonlinear effects of time account for the rapid increase in curve angle at the beginning of growth and the slowed progression after maturity. These validated models predicted future Cobb angle with good accuracy in untreated idiopathic scoliosis over the full growth spectrum.
This is an analysis of 2317 patients with idiopathic scoliosis between 6 and 25 years old. Patients were previously untreated and provided at least one prior radiograph prospectively collected at first consult. Radiographs were re-measured blinded to the predicted outcome: the maximum Cobb angle on the last radiograph while untreated. Linear mixed-effect models were used to examine the effect of data from the first available visit (age, sex, maximum Cobb angle, Risser, and curve type) and from other visits while untreated (maximum Cobb angle) and time (from the first available radiograph to prediction) on the Cobb angle outcome. Interactions of the first available angle with time, of time with sex, and time with Risser were also tested.
We included 2317 patients (83% of females) with 3255 prior X-rays where 71% had 1, 21.1% had 2, and 7.5% had 3 or more. Mean age was 13.9 ± 2.2yrs and 81% had AIS. Curve types were: 50% double, 26% lumbar/thoracolumbar-lumbar, 16% thoracic, and 8% other. Cobb angle at the first available X-ray was 20 ± 10° (0-80) vs 29 ± 13° (6-122) at the outcome visit separated by 28 ± 22mths. In the model using data at and prior to the specialist consult, larger values of the following variables predicted larger future curves: first available Cobb angle, Cobb angle on other previous X-ray, and time (with Time2 and Time3) to the target prediction. Larger values on the following variables predicted a smaller future Cobb angle: Risser and age at the first available X-ray, time*Risser and time*female sex interactions. Cross-validation found a median error of 4.5o with 84% predicted within 10°. Similarly, the model using only data from the first specialist consult had a median error of 5.5o with 80% of cases within 10° and included: maximum Cobb angle at first specialist consult, Time, Time2, age, curve type, and both interactions.
The models can help clinicians predict how much curves would progress without treatment at future timepoints of their choice using simple variables. Predictions can inform treatment prescription or show families why no treatment is recommended. The nonlinear effects of time account for the rapid increase in curve angle at the beginning of growth and the slowed progression after maturity. These validated models predicted future Cobb angle with good accuracy in untreated idiopathic scoliosis over the full growth spectrum.
摘要：
目的：特发性脊柱侧凸的治疗选择取决于曲线进展的风险。以前预测曲线进展的模型缺乏验证，不包括完全生长/严重程度谱或包括治疗患者。目的是开发和验证模型，以使用仅在，或者在之前和之前，特发性脊柱侧弯的初步专家咨询。
方法：这是对2317例6至25岁的特发性脊柱侧凸患者的分析。患者先前未经治疗，并在首次咨询时提供了至少一张前瞻性收集的X射线照片。重新测量射线照片，不知道预测的结果：未处理时，最后一张射线照片上的最大Cobb角。线性混合效应模型用于检查来自首次可用访问的数据的影响(年龄，性别,最大Cobb角,Risser,和曲线类型）以及未经治疗的其他访问（最大Cobb角）和时间（从第一张可用的X射线照片到预测）对Cobb角结果的影响。第一个可用角度与时间的相互作用，与性有关的时间，和Risser的时间也进行了测试。
结果：我们纳入了2317例患者（83％的女性）和3255例先前的X射线检查，其中71％的患者有1例，21.1％的患者有2例，7.5％的患者有3例或更多。平均年龄为13.9±2.2岁，81%患有AIS。曲线类型为:50%双,26%的腰椎/胸腰椎,16%胸廓，其他8%。结果就诊时，第一次可用X射线的Cobb角为20±10°（0-80），而29±13°（6-122），相差28±22个月。在使用专家咨询时和之前的数据的模型中，以下变量的较大值预测较大的未来曲线：第一个可用Cobb角，以前其他X光片的Cobb角,和时间（与Time2和Time3）到目标预测。以下变量的较大值预测未来Cobb角较小：Risser和第一次可用X射线的年龄，时间*Risser和时间*女性性互动。交叉验证发现中值误差为4.5o,其中84%预测在10°内。同样，仅使用来自第一次专家咨询的数据的模型的中位误差为5.5o，其中80％的病例在10°内，包括：第一次专家咨询时的最大Cobb角，时间,时间2，年龄，曲线类型,和两种互动。
结论：这些模型可以帮助临床医生使用简单变量预测在未来选择的时间点不进行治疗的情况下曲线会有多少进展。预测可以告知治疗处方或显示家庭为什么不推荐治疗。时间的非线性效应解释了生长开始时曲线角度的快速增加和成熟后的缓慢进展。这些经过验证的模型在未治疗的特发性脊柱侧凸的整个生长谱中以良好的准确性预测了未来的Cobb角。
方法：这是对2317例6至25岁的特发性脊柱侧凸患者的分析。患者先前未经治疗，并在首次咨询时提供了至少一张前瞻性收集的X射线照片。重新测量射线照片，不知道预测的结果：未处理时，最后一张射线照片上的最大Cobb角。线性混合效应模型用于检查来自首次可用访问的数据的影响(年龄，性别,最大Cobb角,Risser,和曲线类型）以及未经治疗的其他访问（最大Cobb角）和时间（从第一张可用的X射线照片到预测）对Cobb角结果的影响。第一个可用角度与时间的相互作用，与性有关的时间，和Risser的时间也进行了测试。
结果：我们纳入了2317例患者（83％的女性）和3255例先前的X射线检查，其中71％的患者有1例，21.1％的患者有2例，7.5％的患者有3例或更多。平均年龄为13.9±2.2岁，81%患有AIS。曲线类型为:50%双,26%的腰椎/胸腰椎,16%胸廓，其他8%。结果就诊时，第一次可用X射线的Cobb角为20±10°（0-80），而29±13°（6-122），相差28±22个月。在使用专家咨询时和之前的数据的模型中，以下变量的较大值预测较大的未来曲线：第一个可用Cobb角，以前其他X光片的Cobb角,和时间（与Time2和Time3）到目标预测。以下变量的较大值预测未来Cobb角较小：Risser和第一次可用X射线的年龄，时间*Risser和时间*女性性互动。交叉验证发现中值误差为4.5o,其中84%预测在10°内。同样，仅使用来自第一次专家咨询的数据的模型的中位误差为5.5o，其中80％的病例在10°内，包括：第一次专家咨询时的最大Cobb角，时间,时间2，年龄，曲线类型,和两种互动。
结论：这些模型可以帮助临床医生使用简单变量预测在未来选择的时间点不进行治疗的情况下曲线会有多少进展。预测可以告知治疗处方或显示家庭为什么不推荐治疗。时间的非线性效应解释了生长开始时曲线角度的快速增加和成熟后的缓慢进展。这些经过验证的模型在未治疗的特发性脊柱侧凸的整个生长谱中以良好的准确性预测了未来的Cobb角。
